Unless you own the Time Stone, your last name is Strange and you’re from the Marvel Comic Universe, it’s quite fair to say that you don’t know what the future has in store for your health. For instance, will you have to rely on a wheelchair to get around, or will you still be able to ride an e-scooter 10 years down the road?
The Ministry of Health Singapore estimates that one in two healthy Singaporeans aged 65 could become severely disabled in their lifetime and require long-term care. And no, this isn’t the result of accidents or disease but a sobering peek into your future if you don't take care of your muscles now.
For starters, not many welcome growing older. Your skin develops wrinkles and dark spots. You now have to mind your cholesterol levels, and the clincher: Weight gain. While all that is happening, you’re also losing muscle mass, no thanks to the ageing process.
“Studies show that starting at the age of 40, we lose about 8 per cent of muscle every decade, with the rate almost doubling to 15 per cent every decade after the age of 70,” said Dr Christopher Lien, senior consultant at Changi General Hospital’s (CGH) Geriatric Medicine department.
WHY IS MUSCLE LOSS A CONCERN?
You’d think that weight loss is great. After all, it’s a goal you’ve pursued your entire adult life, isn’t it? Contrary to the present you (that is, if you’re in your 30s or 40s), “weight can be protective in health and function” in seniors, who are described as 65 years old and above, said Adjunct Assistant Professor Samuel Chew, senior consultant with CGH’s department of geriatric medicine. “Having a low BMI (Body Mass Index) of less than 18.5 is often a marker of malnutrition, chronic illness or muscle loss.”
In fact, when you’re in your 60s or 70s, you could become frail when you’re dropping 5 per cent of your weight in six months or 10 per cent in a year, said Dr Lien. You may increase your risks of infections, pressure ulcers, and failure to respond to medical treatments should you fall sick.
Other than being susceptible to illnesses, having a lower muscle mass, and in turn, less strength, is bad news for seniors’ mobility, too, said Dr Chew. “Low muscle strength in the lower limbs have been associated with a three- to 10-time increase in falls risk.”
Besides a low muscle mass, frailty can also be defined in other ways, said Dr Lien, who cited the FRAIL scale:
- Fatigue: Are you more easily tired than usual?
- Resistance: Do you have difficulty walking up a flight of stairs?
- Aerobic: Are you able to walk a distance of one block?
- Illnesses: Do you have more than five illnesses?
- Loss of weight: Have you lost more than 5 per cent of your total weight in the past six months?
“If you answer positively to one or two of the above questions, you may have early signs of frailty – a state we refer to as pre-frailty,” said Dr Lien. “If you answer three or more ‘yes’, it is likely that you are frail, and should see your doctor for ways to improve your state.”
STRENGTHEN UP AGAINST FRAILTY
Some, like 40-year-old homemaker Alicia Yang, aren’t waiting till they hit their 60s to do something about age-related muscle loss. “I’m pretty concerned,” said Yang, who has three daughters whose ages range from four to eight.
“As an older mother with young children, I want to be there for my girls until they’re at least 18. By then, I would be in my 50s. How am I going to last 10 years to see them through to that age?”
Yang realised that taking care of herself now is key. “I want to be a fit older woman. I see a lot of old people in wheelchairs these days and I don’t want to be one of them. I know that keeping fit and lifting weights are ways to maintain my strength. So, even if I fall, I won’t break something owing to osteoporosis.”
Yang’s toned arms and enviable six-pack are the results of attending HIIT (high intensity interval training) classes five times a week for almost three years. “It has changed my life because they do the exercises that I like, the kind that kills me!” she said with a laugh.
PUMP SOME IRON
There is actually a way of predicting how you might cope in your senior years right now – no inextricable amount of time travelling needed. It is a simple test that requires you to get up from a chair on one leg while keeping your arms crossed in front of your chest and holding the pose for three seconds.
If you can’t do it, you run a high risk of not being to walk in your 70s and beyond, according to the Society of Geriatric Medicine Singapore (SGMS), which created the Stand4Strength challenge with Abbott.
If your grandparents or parents can’t do the above test and also seem to exhibit certain degrees of frailty, there is help for them yet. And, like Yang has found out, it involves exercise. Yes, for you and even your parents.
You needn't work out at Yang's intensity to reap the benefits. But neither should you rely just on brisk walking, jogging, cycling or other cardiovascular exercises – though they’re still highly important for preventing chronic diseases such as diabetes and hypertension. The key is in resistance exercises that work the major muscle groups.
“Studies have shown that weights or resistance exercise is required to maintain or build up muscle mass,” said Dr Chew. “The easiest exercise for seniors to start off with is the sit-to-stand exercise, and can be done at home without any additional special equipment.”
To take it further, Dr Tay San San, chief and senior consultant at CGH’s Rehabilitation Medicine department, recommends resistance training for each major muscle group for two or more days a week.
It is recommended that seniors and the general population should aim for at least 150 minutes of moderate intensity aerobic activity per week.
“Include at least 48 hours of rest between each training for the same muscle group. These exercises can be carried out using elastic bands or weights,” she said. “It is recommended that seniors and the general population should aim for at least 150 minutes of moderate intensity aerobic activity per week.”
For those who are already familiar with resistance training, Dr Chew suggested “weights exercises involving the flexors and extensors of the hip and knees, starting with about 20 per cent to 30 per cent of the maximum weight that you can lift repetitively”.
“Do three sets of eight repetitions two to three times per week,” he said. “Studies show that, in general, up to 12 weeks of such a programme are required before meaningful, measurable improvements in lower limb strength and function can be recorded.”
GET MUM AND DAD TO EAT MORE PROTEIN
You don’t have to be a bodybuilder to know that protein is the building block of muscles. Just how much protein do you need? About 0.8g per kilogram of body weight, according to the Healthline website, which, for the average sedentary man, is about 56g a day and 46g for his female counterpart.
But for seniors, their protein requirements are higher. “Research has shown that seniors need to consume more protein than younger adults because their bodies are less efficient at digesting and using protein to make muscle,” said Dr Low Yen Ling, director of research and development with Abbott Nutrition Asia Pacific Centre.
Dr Low said that seniors should eat 1g to 1.2g of protein per kilogram of body weight a day. Active older adults or those who have an acute or chronic illness may need even more protein: Upwards of 1.2g to 1.5g of protein for each kilogram of body weight per day.
However, it’s unfortunate that many older individuals aren’t getting enough protein, said Magdalin Cheong, deputy director of CGH’s Dietetic Consultation. “Many of our seniors may not realise that consuming sufficient protein and calories is important not only for their muscle health, but also essential for good nutritional status.”
Cheong added that some seniors may be well aware of protein’s role but aren’t able to eat more, owing to hurdles such as dental issues.
If you have elders at home who find it difficult to eat meat, a ready source of protein, Dr Low suggested making the chewing easier for them by serving them shredded chicken breast, minced pork or beef cooked in a pressure cooker.
Softer forms of protein, including eggs and fish such as salmon, cod, or tuna are great options, too. “In addition, tofu, soy products and milk can also be consumed to provide extra protein,” she said.
But if protein is still lacking after these interventions, Dr Chew suggested supplementing seniors' diets with high-protein oral nutritional supplements and protein powder. "They can also help enhance the intake of protein in the diet and are often prescribed after consultation and assessment by the dietitian."
See your doctor before starting any fitness programme.