I Wish I Had Less Muscle Mass…

I Wish I Had Less Muscle Mass…

…said no 80 year old EVER! This is a topic I’ve discussed often in these pages, and I suspect I will return to it often in the future. The more I research the topic of longevity, the more I appreciate the importance of muscle mass. We all understand, at least at an intuitive level, that ‘frailty’ is a big source of disability and unfortunately death in the Elderly. But that understanding becomes much more concrete when it’s backed by facts.

Let me share an astounding statistic that captures what I am talking about (and that I frankly could not believe at first): If someone over the age of 65 (NOT that old, btw!) falls and fractures their hip, that person has about a 1 in 3 chance of being dead within a year! Let that sink in for a minute…if you are older than 65 and break your hip, there is a 30% chance you will be dead within one year!¹

By the way, it’s not the acute injury that leads to fatality. Most people survive the surgery and initial hospitalization after breaking a hip—it’s what comes afterward that is the true danger.

The reason people don’t survive the subsequent rehab and recovery after breaking a hip is because they were too frail going into the injury.

Very specifically (and formally), “frailty” is defined by a lack of lean tissue (muscle mass).Unless you look like Arnold Schwarzenegger in his peak as Mr. Universe, then the math is simple: you need more muscle mass.

Unfortunately, many of my patients think of muscle mass as an appearance issue. So often, I hear female patients say, “I don’t want to be too muscular.” What they mean is that they don’t want to appear too muscular. The truth is that, especially in older people, building healthy muscle mass doesn’t mean bulking up: I call this “the myth of accidental muscle.” Why? There are many reasons, but here’s the Cliffs notes version: it just doesn’t happen.

So, now that we know how important it is to build and maintain muscle mass (and that it won’t make us look like the Hulk), how do we do it? There are two crucial elements to maintaining muscle mass: you need to give your body building blocks (protein), and you need to send a signal to your muscles to grow (through resistance training).

My understanding and outspoken support of resistance training has developed over the last several years. In the past, I used to tell my patients to focus on aerobic training. This is still a great way to stay fit, but for my money, resistance training is where the real strength comes from. My recommendation is that whatever time you devote to exercise every week (whether that’s 4 hours or 12), spend at least half of that time on resistance training. And if you feel like doing even more resistance training, all the better.

¹ Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, Eriksson S, Wilsgaard T, Jørgensen L, Ahmed LA, Schöttker B, Brenner H, Bellavia A, Wolk A, Kubinova R, Stegeman B, Bobak M, Boffetta P, Trichopoulou A. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017 Mar;281(3):300-310. doi: 10.1111/joim.12586. Epub 2017 Jan 17. PMID: 28093824. Available: https://pubmed.ncbi.nlm.nih.gov/28093824/. Accessed January 22, 2024.