Sarcopenia, frailty and exercise

Many thanks to Offord and Witham for their article on sarcopenia.¹ They rightly identify low levels of physical exercise as a major cause of sarcopenia and subsequent frailty, dependency and premature death. As they say, exercise has some effect in reversing sarcopenia but by the time that sarcopenia has become a clinical problem it is probably too late to treat. A trial that investigated weight-training in nursing home residents, aged 90 years or older, showed weight training to be clearly beneficial in terms of strength and self-care scores - but, the scores soon fell back to their pre-trial levels after the study ended.² Prevention is what is needed and this means regular exercise for the population as a whole, starting as early in life as possible and continuing throughout life.

Regular moderate to vigorous exercise is not only a protection against sarcopenia but is also the key to prevention of a large number of non-communicable diseases which themselves lead to a further reduction of physical performance – obesity, diabetes, heart disease, osteoporosis, some cancers and many others. Regular exercise lengthens lifespan but, perhaps more importantly, healthspan. The compression of morbidity at the end of life is what we all seek for our patients as well as ourselves. It is regular exercise which lengthens healthspan and reduces the financial, social and health costs which result from an increasingly dependent elderly population. The desirability of decreasing the period of dependency at the end of life cannot be overstated.

Sadly it seems that end-of-life dependency is actually increasing. The Office of National Statistics report in 2012 showed that a 65 year old man could expect to be free from disability and long term illness for a further 10.6 years but by 2014 this had decreased to 10.3 years. For women the figures were 11.2 years falling to 10.9 years.³

Inactivity should be managed as seriously as cigarette smoking. Public education, the provision of better exercise facilities and the promotion of active travel (ie walking or cycling to work) should become political imperatives. And the medical profession should spend a great deal more time and effort in encouraging an idle population to get off its collective backside and start exercising.