Do not underestimate the importance of muscle mass in older adults

Guest author: Rob van Berkel, research dietitian and writer on nutrition and health.

Do not underestimate the importance of muscle mass in older adults

As people age, the decline in muscle mass and muscle strength is inevitable. This has consequences for quality of life and increases the risk of health problems, including fractures, chronic diseases, and even mortality. Fortunately, there are ways to slow down or even reverse this process.

What is ageing?

Ageing is a natural process in which cells gradually lose their ability to function and repair themselves effectively. As a result, muscle mass, bone density, and the elasticity of the skin and blood vessels decline, and cells become less responsive to anabolic stimuli (Wilkinson et al., 2018; Gustafsson et al., 2024). The risk of chronic conditions increases and quality of life decreases. The rate at which this occurs varies between individuals and is influenced by factors such as genetic predisposition, physical activity, nutrition, and medication use (Cruz-Jentoft et al., 2019).

Loss of muscle mass in older adults

Muscles are continuously undergoing protein synthesis and breakdown. This process occurs at a rate of approximately 1–2% per day, meaning that muscle tissue is fully renewed within about two months. A disruption in the balance between muscle protein synthesis and breakdown leads to loss of muscle mass and strength.

Muscle mass reaches its peak between the ages of 20 and 30. Thereafter—typically beginning between the ages of 30 and 50—a gradual decline occurs at an average rate of approximately 1% per year until around age 70. Beyond this age, the rate of decline accelerates to approximately 3% per year (Leon AS, 2016). As a result, ageing can lead to a loss of more than 30% of peak muscle mass. This loss may be even greater depending on population characteristics such as age, health status, physical activity level, and nutritional intake.

The decline in muscle strength occurs more rapidly. Between the ages of 50 and 60, muscle strength decreases by approximately 1.5% per year on average, followed by a decline of about 3% per year thereafter (von Haehling et al., 2010). Progressive loss of muscle mass, strength, and function (performance) eventually leads to sarcopenia. The term is derived from the Greek words sárx (flesh/muscle) and penía (loss or deficiency).

What is sarcopenia?

There are several definitions of sarcopenia. According to the European Working Group on Sarcopenia in Older People (EWGSOP, 2019), sarcopenia is a progressive skeletal muscle disorder associated with an increased risk of falls, fractures, and mortality (Cruz-Jentoft et al., 2019). It affects approximately 10–27% of older adults worldwide but can also occur in younger individuals (Petermann-Rocha et al., 2022). The primary characteristic is reduced muscle strength, followed by reduced muscle mass and impaired muscle function.

Muscle strength

Muscle strength is often measured using handgrip dynamometry or the Timed Chair Stand Test (standing up and sitting down five times as quickly as possible). Sarcopenia is defined as handgrip strength below 27 kg in men or 16 kg in women, or a Timed Chair Stand Test taking longer than 15 seconds (Cruz-Jentoft et al., 2019).

Muscle function

Muscle function can be assessed in various ways. A commonly used method is gait speed. A walking speed slower than 0.8 metres per second over a distance of 4 metres indicates impaired muscle function (Cruz-Jentoft et al., 2019).

Muscle mass

Muscle mass is most accurately measured using DEXA, MRI, or CT scans, but these methods are costly and less practical for routine use. Bioelectrical impedance analysis (BIA) provides a practical alternative for detecting muscle mass loss (Lee et al., 2024), and some devices include a sarcopenia index. Sarcopenia is defined as an appendicular muscle mass below 20 kg in men and below 15 kg in women (Cruz-Jentoft et al., 2019).

Consequences of low muscle mass in older adults

Muscle mass serves many essential functions. Its loss in older adults can lead to various consequences, including (Beaudart et al., 2017; Yuan et al., 2023; Beaudart et al., 2025):

  • reduced muscle strength;

  • impaired functional performance;

  • reduced immune function;

  • increased risk of chronic diseases and mortality;

  • reduced bone quality.

These consequences increase the risk of falls (resulting in fractures or injuries), reinforce feelings of loneliness and depression, and reduce self-confidence. They also contribute to a lower quality of life, increased dependence on assistive devices or informal care, loss of independent living, and a higher likelihood of hospitalisation with slower recovery.

How can muscle mass and strength loss be limited or improved?

Although ageing inevitably leads to loss of muscle mass and strength over time, this process can be influenced. Improvements remain possible even after the age of 75 through resistance training and appropriate nutrition (Grgic et al., 2020).

Resistance training

Physical activity—particularly resistance training—is a powerful stimulus to counteract muscle loss (Fragala et al., 2019). This does not necessarily require a gym and can also be performed at home using resistance bands, for example. You are never too old to begin resistance training. The Dutch Physical Activity Guidelines also recommend that adults and older adults perform muscle- and bone-strengthening activities at least twice per week, combined with balance exercises (Health Council of the Netherlands, 2017).

Nutrition

Without sufficient energy and protein intake, the body enters a catabolic state, leading to muscle loss. Guidelines recommend a protein intake of 0.83 grams per kilogram of body weight per day for healthy adults and older adults (EFSA, 2012; Health Council of the Netherlands, 2021). However, experts recommend that older adults (approximately ≥55 years) consume at least 1.2 grams per kilogram of body weight per day, increasing up to 2.0 grams per kilogram of body weight in the presence of chronic illness (Taylor et al., 2018; Chapman et al., 2021).

Studies show that healthy older men (approximately 70 years old) require more protein per meal than younger men (approximately 20 years old) to optimally stimulate postprandial muscle protein synthesis (Moore et al., 2015). Dutch research has also shown that consuming a protein-rich drink (40 grams) before sleep increased overnight muscle protein synthesis by approximately 33% in older adults (mean age 71) compared with a non-protein placebo drink (Kouw et al., 2017). This effect increased by an additional 31% when resistance training was added (Holwerda et al., 2016).

Monitoring

To reduce the risk of sarcopenia and detect it in a timely manner, it is important to monitor muscle mass in at-risk populations. This can be done using DEXA, MRI, or CT scans, or with the more practical BIA method.

Conclusion

Maintaining muscle mass and strength is essential for older adults to preserve independent functioning, reduce the risk of falls, and support overall health. Resistance training and adequate protein intake can effectively counteract muscle loss, regardless of age. Regular BIA measurements provide valuable insight into muscle mass and its progression over time, allowing nutrition and resistance training recommendations to be tailored accordingly.

References

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