According to Harvard Health, nearly 70% of adults over the age of 65 will need some type of ongoing assistance with Activities of Daily Living in their lifetime. ADLs encompass activities such as bathing, cooking, shopping and cleaning. Systemically, this represents a massive investment in infrastructure, assisted living facilities, training and hiring of aides, therapists, etc., to supply the rising demand. For families, this represents a large cost, affording the care and assistance their loved ones need. Individually, this can be a difficult and dismaying process for adults used to being independent.
One of the biggest culprits causing this care crisis is sarcopenia, muscle loss. As we age, we naturally lose muscle, and as we lose muscle we lose capacity and independence. However, how much muscle we lose is highly variable, with our own behavior choices representing the largest modifiable factor in this equation!
Muscle is your Superpower! Loss of muscle mass has a twofold effect on our capacity. First, and most recognizable, as we lose muscle, physical tasks become more difficult. Climbing stairs, standing from a seated position, walking long distances, all become more difficult as our body’s maximum capacity diminishes. Second, and less obvious, is that the body’s capacity to heal from injury, disease, or medical/surgical intervention diminishes as we lose muscle mass. Our muscle is both a repository for countless immunological pathways and our physical reserve, a savings account we can rely on in times of crisis.
The universal truth in medicine and surgery is “more muscle, more good”. Strength training and the strong muscles are directly responsible for improved medical outcomes both as a preventative (improved bone health, endocrinological health, organ function) and as a recovery tool post-op and -medical intervention.
I wish I could take credit for this statement, but if there is a magic pill in medicine, it is exercise; the only problem is that it isn’t magic and it isn’t a pill.
Everyone knows exercise is good, so the problem isn’t a lack of knowledge. In my opinion, the biggest obstacle in proper exercise prescription is the perception that people will not engage in an activity that causes acute (temporary) discomfort in exchange for chronic (long term) gain. This results in doctors often giving generic advice like, “try to walk X number of steps per day” or, “increase your physical activity”. While there are many health benefits to general physical activity, and many activities we consider exercise (walking, swimming, zumba, etc.) none of these activities will efficiently build the muscle mass you need.
As an exercise physiologist, dealing with sarcopaenia and age related functional decline, my single biggest focus is how to effectively and efficiently build muscle mass and dynamic capacity. In this context, my primary focus is not only working muscles against resistance, but specifically innervating type II or fast twitch muscles. These are the muscles that provide explosive power (important in changing direction and preventing falls), and significant mass (the physical reserve we discussed previously)
This is why I am such a huge proponent of utilizing Minimum Effective Dose (MED) as the standard for all training. This solves two problems simultaneously. First, many people do not want to or enjoy spending large amounts of time exercising. MED can be effective in as little as 15-20 minutes per session and 30-60 minutes per week; a very small investment of time when put into perspective (FYI: there are 10,080 minutes in a week).
Second, the world of exercise can be overwhelming with the number of exercise variations that exist. Many trainers think that they need to create complex and varied routines to keep their clients interested and to prove their knowledge and effectiveness as a trainer. I think this is a mistake. In his 1939 memoir, Antoine de Saint-Exupéry states “Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away”. In other words, keep it simple! That is my absolute philosophy in exercise prescription. In reality, we only need 3-5 exercises to achieve maximal results.
The only exercises you really need are: some type of squat (a sit-to-stand is fantastic), some kind of row (pulling a weight towards your body), and some kind of press (pushing a weight away from your body). With these three exercises, you utilize ~90% of your muscles. If you want to get exceptionally fancy, add a weighted carry and a hinge. As for repetitions and resistance levels, 3 sets of 10 repetitions, using a weight or resistance that feels difficult but not impossible around repetitions 8, 9 and 10. Rest 1-2 minutes between sets, and perform these exercises on non-consecutive days.
I will add that if you only have time for one exercise in your life, make it some kind of squat. The muscles in our legs easily represent the largest muscle mass in our bodies. Keeping them strong is one of the most effective ways to prevent falls and injuries.
