Tan Tock Seng Hospital physiotherapist Nicolette Ng, guided by the hospital’s senior physiotherapist Rethinam Ganesan, showing a forward lunge, an exercise that can help prevent the loss of muscle mass. ST PHOTO: NG SOR LUAN
The Straits Times (2 December 2020)
Living Well Use or lose your muscles - Being sedentary, especially during the pandemic, can lead to the loss of muscle mass and function. Experts share ways to prevent it.
At the start of the year, Mr Lim H.L. wrote down one goal – to lose at least 5kg this year.
Then Covid-19 struck and gyms were shut during the circuit breaker from April to June.
The 31-year-old account executive “lost all motivation” to get active. Lacking the discipline to join an online workout class, he “moved around minimally” and spent much of his free time bingewatching Netflix shows.
“Everything was extremely convenient – moving from the bed to my work desk and to the living room – that was how I lived for many months, especially when we were advised not to leave our homes unnecessarily,” said Mr Lim, who now works alternate weeks from home.
Like him, many people have reduced their daily physical activities due to restrictions brought about by the coronavirus pandemic. But doctors warn that underusing one’s muscles may have serious consequences.
Dr Lau Pik Onn, a senior resident physician at private medical clinic Icon Health Screening, said: “The reduction in physical activity and movement during the pandemic, especially in adults and seniors, can lead to the loss of muscle mass and function, a condition called sarcopenia.”
Dr Leong Choon Kit, a family physician at Mission Medical Clinic in Serangoon, said that lately, he has seen more elderly patients suffering from a loss of muscle mass.
He said: “I think the circumstances limiting the movement of the elderly, their families restricting them for fear of them contracting Covid-19 and their own fear of catching the virus, all have a part to play in causing inactivity and the loss of muscle mass.”
While losing muscle is part of ageing, it also affects people who have a sedentary lifestyle or are physically inactive for an extended period of time.
If a muscle is not used, the body will eventually break it down to conserve energy, explained Dr Lau.
Signs of muscle mass loss include fatigue and a drop in energy levels, a slower walking speed, decreased strength, general weakness and frequent falls.
A weaker hand grip, such as difficulty opening a jar, can also be a sign of progressive loss of muscle mass.
The condition can affect a person’s balance, gait and daily tasks, such as walking, climbing the stairs and lifting objects.
Dr Lau said studies have shown that people start to lose muscle mass from as early as 40 years old, with a drop of about 8 per cent of muscle mass every decade. The rate almost doubles to 15 per cent every decade after age 70.
Mr Rethinam Ganesan, a senior physiotherapist at Tan Tock Seng Hospital, said that while people above age 40 have a higher rate of muscle mass loss, those below 40 should also be concerned.
"Prevention should commence before the onset of muscle mass loss. Early prevention reduces the risk of falls and fractures. It also increases the lifespan and improves the quality of life of an individual,” he said.
Muscle mass loss could also be the result of a poor diet and lowered sex hormones, such as low oestrogen during menopause and low testosterone during andropause.
Dr Lau said it is important to eat a balanced diet with adequate protein and vitamin D, and to avoid sugary and processed food.
“Protein provides the building blocks for muscle and stimulates its growth, while low vitamin D has been associated with a higher risk of sarcopenia,” she said.
Foods rich in protein include eggs, meat, cheese, yogurt, nuts, beans and legumes.
“One should aim for 1.2g of protein for every 1kg of body weight, especially the elderly,” added Dr Lau.
Besides the loss of muscle mass, a lack of exercise and physical movement can also lead to other health problems.
Associate Professor Reshma Merchant of the Yong Loo Lin School of Medicine at the National University of Singapore said a sedentary lifestyle can impair glucose tolerance and reduce insulin sensitivity, which may lead to chronic diseases such as diabetes, obesity, and metabolic syndrome.
Five tips to prevent loss of muscle mass
KEEP MOVING
Physical activity is important. Stand up, stretch and walk about in the office and at home frequently.
STRENGTH TRAINING
Do this at least twice a week for 15 minutes each time. You can lift weights or do pull-ups, push-ups and sit-ups. You can also use resistance bands.
AEROBIC EXERCISE
Do at least 150 minutes of aerobic activity a week, such as brisk walking, cycling and using the stairs.
BALANCED DIET
Eat a diet with sufficient vegetables and fresh fruit. Have enough protein, such as yogurt, eggs, lean meat and beans. Avoid eating processed and sugary foods.
VITAMIN D
Low vitamin D levels are associated with a higher risk of sarcopenia, or the loss of muscle mass and function. Spend time outdoors because the sun is one of the best sources of this nutrient. Fatty fish, eggs and fortified cereals are also good sources of vitamin D.
Source: Dr Lau Pik Onn, senior resident physician at private medical clinic Icon Health Screening
Combat muscle loss
Dr Chan Kin Ming, a geriatric specialist at Chan KM Geriatric & Medical Clinic, said people who are not eating well or meeting their nutritional requirements through food can consider taking a supplement that contains beta-hydroxy-betamethylbutyrate, also known as HMB.
HMB is a leucine metabolite that helps to counteract muscle loss. It is naturally produced in small amounts when the body breaks down leucine, an essential amino acid that can be obtained from foods such as milk, Greek yogurt, soya beans, beef and chicken.
“It slows muscle breakdown and supports the building, repairing and protection of muscle tissue. While HMB is found in our body, the level declines with age,” said Dr Chan.
Foods such as avocado and cauliflower contain small amounts of HMB, but getting enough HMB through food alone can be challenging, he added.
Physical exercise, both strength training and cardiovascular, is also important to maintain muscle health and strength.
Strength and resistance training exercise, at least twice a week, is the most effective way to prevent muscle loss, said Dr Lau.
This includes weightlifting, pulling against resistance bands or moving part of the body against gravity, such as climbing the stairs and doing leg presses, or extending the knees against resistance on a weight machine.
EASY WORK: Tan Tock Seng Hospital physiotherapist Nicolette Ng demonstrating simple moves to prevent the loss of muscle mass, such as wall push-ups (above) and heel raises (below). ST PHOTOS: NG SOR LUAN
"Going for a stroll after a meal is much better than watching TV on a couch. Everyone should be concerned about muscle wasting. What we don’t use will be taken away from us." DR LEONG CHOON KIT, a family physician at Mission Medical Clinic in Serangoon
Said Mr Ganesan: “When a person engages in a routine strengthening exercise regimen, it helps to provide a constant challenge to achieve muscle growth or maintenance, preventing the occurrence of muscle loss.”
Daily physical activities like doing household chores can help maintain muscle mass as well, he noted.
Aerobic exercises such as walking, cycling and jogging also work. Dr Leong said the loss of muscle mass is typically associated with the underuse of muscles.
“Going for a stroll after a meal is much better than watching TV on a couch. Everyone should be concerned about muscle wasting. What we don’t use will be taken away from us,” he said.
