Addressing Sarcopenia: Strength, Prevention, and the Path to Better Longevity and Health

The ageing process begins much earlier than many realise - from around the age of 30, we start losing muscle mass and strength, a process that accelerates as we age. By 50, muscle mass decreases by 1-2% and strength by 1.5-5% each year, with fast-twitch type 2 muscle fibres deteriorating most rapidly. Studies are inconsistent, and many people don't receive a diagnosis or treatment for sarcopenia. But rates of the condition range from 5% to 13% in people ages 60 and older. The estimates increase to 11% to 50% in people ages 80 and older. Rates vary, but you may lose as much as 8% of your muscle mass each decade.

Everyone loses muscle mass over time, but people with sarcopenia lose it more quickly. This loss affects our ability to perform basic functions like walking, standing, or carrying objects, leading to impaired mobility and independence. It's crucial to act now, no matter your age, to maximise strength in early adulthood and prevent future decline. For those already experiencing frailty or conditions like sarcopenia, osteoporosis, or heart problems, medically-supported electromyostimulation (EMS) offers an effective and joint-friendly alternative to traditional strength training. 

Sarcopenia is generally referred to as excessive, progressive, generalized loss of muscle mass, strength and function. Sarcopenia is now considered a skeletal muscle disease based on adverse muscle changes that occur throughout life. It is associated with an increased likelihood of adverse outcomes, such as falls, fractures, physical disability, and mortality. Muscle strength is currently considered the most reliable measure of muscle function.

Sarcopenia is common among seniors, with prevalence/frequency increasing with age. However, it can also affect younger people. Sarcopenia is considered “primary” (or age-related) when no other specific cause of muscle wasting beyond aging is apparent. If other causative factors are present (or even in addition to aging), it is considered “secondary.” These include systemic diseases such as cancer, endocrine, neurological, and especially inflammatory diseases. In addition, physical inactivity, such as due to a sedentary lifestyle or immobility due to illness, as well as a poor diet with insufficient energy and/or protein intake, promote the development of sarcopenia.

Sarcopenia is associated with a number of negative, often serious, consequences. For those affected, coping with everyday life becomes increasingly problematic. Sarcopenia leads to an increased risk of fall impaired mobility, and progressive loss of independence and quality of life. Sarcopenia is a major cause of the geriatric syndrome frailty and is associated with osteoporosis, type 2 diabetes, heart disease, respiratory disease, and cognitive impairment, among others. Sarcopenia is ultimately associated with disability, hospitalization, need for long-term care, and a 3.6- fold increase in mortality.
 

To best prevent or delay sarcopenia, muscle mass should be maximized in youth and young adulthood, maintained in middle age, and muscle loss minimized in older age. Many people with sarcopenia, frailty, osteoporosis, osteoarthritis, or heart issues avoid strength training due to weakness, instability, or fear of injury. For these individuals, medically-supported electromyostimulation (EMS) offers a safe and effective alternative. EMS, done under supervision once a week for 20 minutes, enhances light exercises to target muscles, stimulate type 2 fibres, and is gentle on the joints. Studies show EMS is effective for preventing and treating age-related muscle loss and sarcopenia.

Many patients with sarcopenia and/or frailty, osteoporosis, osteoarthritis or heart problems also shy away from strength training with weights. They feel too weak, unstable and are afraid of falls and injuries. Furthermore, many people refuse to do strength training several times a week. For this group of people with little affinity for sports or already weakened, frail, multimorbid middle-aged and older people, technologically supported training in the form of medical electromyostimulation (EMS) is an attractive and equally effective option. The application takes place under individual supervision in a 1:2 or 1:1 setting and, at 1 time per week for approximately 20 minutes, is a time-saving procedure in which the effect of light, subliminal physical exercises is amplified to an effective level and a high stimulus intensity is achieved. EMS also ensures immediate, continuous recruitment of type 2 muscle fibres. Since no weights are used, medical EMS is particularly easy on the joints and subjectively less demanding. The efficacy and safety of medical EMS for the prevention and therapy of age-related muscle atrophy and sarcopenia have been demonstrated in various studies.

Case study:

John Barnard, 65 from Norwich, Norfolk, has always had a busy, active lifestyle, involving ski holidays, cycling events and golf days. He first discovered EMS training as a way to build physical strength to complement his active lifestyle as he got older. Four years on, EMS has become an integral part of John's routine and the reason his “spirit feels energised”.

John began his journey with EMS training in 2016, after a free trial at EMS Fitness Norwich. “I've always been active and love going skiing and competing in cycling events,” says John. “As I got older, I needed to find something that would help me stay agile and less prone to injury while skiing.”

“The first time I tried EMS it was like nothing I had experienced before. It felt weird but strangely effective,” recalls John. Four years on, John is still training once a week with PT Beatrice van den Heuvel at EMS Fitness Norwich.

“I still see weekly progress and that feels so encouraging,” says John. “You don't notice it happening day to day, but as you get older your balance and coordination aren't as good as they once were. EMS helped me regain these. Not just that but my overall strength has really improved, particularly my core strength, which helps me with everyday life.

“What I didn't expect to gain from EMS was a new-found mental strength,” adds John. “I truly mean it when I say my spirit now feels more energised. I so look forward to my weekly sessions, they give me a real focus and are a staple part of my routine.”

Following the announcement of a national lockdown in March, John was forced to take a six-month break from EMS. “When I had to pause my EMS sessions, I found myself feeling more lethargic and less motivated to be active,” recalls John. “It shocked me how, without regular EMS training, I didn't feel as strong, physically or mentally. Thankfully in just five sessions after lockdown I felt my strength returning to the level it was before.

“I'm always trying to better myself and what I love about EMS is how the sessions can be tailored to whatever challenge I'm facing. If I have a ski holiday coming up, Beatrice will adapt the workout to focus on building lower body and core strength. If it's cycling, we'll work on more endurance-based training. It's amazing just how versatile EMS can be.
“Another real benefit is not having to use any gym equipment. For me, this makes it much less daunting than having to handle huge weights. I think a lot of older people would agree. EMS takes the intimidation of exercise away. It's just you and your trainer who makes sure you are doing everything correctly."

“EMS brings it all together, like icing on a cake. The sessions are quick, but they take me to a different level of fitness and I really feel I achieve a lot in a short space of time. My physical strength has improved tenfold because of EMS training but most importantly my spirit feels alive!”

Physio and rehab clinics are key in spreading this message. Not only can they advise and guide patients, but they also have the opportunity to offer EMS training as a service for those who have recovered or wish to maintain MSK health. This creates a new revenue stream and attracts a broader client base, providing ongoing support for patients without the need for further treatment.

Physio and rehab clinics have a unique opportunity to make a lasting impact on their patients. While many seek help when they're at their lowest, it's important to emphasize the benefits of ongoing care, such as EMS training, even after recovery. By incorporating EMS into your services, you can offer patients a valuable tool to maintain their MSK health. This not only helps your patients continue their progress but also provides the potential to attract new clients and create an additional service offering. Even converting just a handful of clients to EMS could add a significant boost to your clinic's success.