The Key to Combating Sarcopenia in the Elderly
Resistance exercise isn't just for the young - it's a powerful tool for seniors to regain autonomy and vitality.
From the age of 30, our bodies begin to progressively lose muscle mass and strength. This process, known as sarcopenia, affects the functionality of the locomotor system and is associated with increased morbidity and mortality in older adults 1 .
However, this decline is not inevitable. Recent research demonstrates that a specific type of exercise can not only slow the process but even reverse it. This article explores how resistance training emerges as the most effective therapeutic strategy to restore strength and independence to our elders.
Sarcopenia is a disease characterized by the combined loss of muscle mass and strength that appears with aging 1 . From age 50, muscle mass decreases at a rate of 1%-2% per year, and strength decreases even faster, between 1.5%-3% per year from age 65 1 .
Increases the risk of dependency by 2 to 5 times compared to same-age individuals without sarcopenia 1 .
Associated with increased risk of falls, fractures, disability, and mortality 9 .
Sarcopenia diagnosis is generally based on three criteria: loss of muscle mass, loss of strength, and alterations in physical function, assessed through tests such as handgrip strength, walking speed, or the chair stand test 1 .
Against sarcopenia, physical exercise is the therapeutic strategy that has shown the best results, and among exercise modalities, resistance (or strength) training is the most effective 1 9 .
How exactly does it work? Resistance training, which involves muscles exerting force against opposition, acts at multiple levels:
Effort against resistance activates intracellular signaling pathways, such as the mTOR pathway, that "turn on" muscle building mechanisms 6 .
Especially of type II fibers, which are lost most with age and are crucial for power 6 .
Improves the connection between the nervous system and muscles, optimizing their coordinated functioning 1 .
The scientific evidence is compelling: programs that include high-intensity strength exercises show significant improvements in muscle mass, strength, and performance in functional tests 1 .
A 2025 systematic review and network meta-analysis scientifically compared different exercise modalities in elderly individuals with sarcopenia obesity 7 .
The findings showed how each exercise modality differently impacts various aspects of sarcopenia:
| Exercise Modality | Hand Strength | Fat-Free Mass | Body Fat % | Walking Speed | Chair Test (30s) |
|---|---|---|---|---|---|
| Multicomponent Training (MCT) | Superior | Superior | Superior | Superior | Superior |
| Resistance Training (RT) | Superior | Moderate | Good | Insignificant | Superior |
| Combined Training (CT) | Moderate | Moderate | Good | Good | Good |
| Aerobic Training (AT) | Insignificant | Insignificant | Moderate | Insignificant | Insignificant |
The study revealed that:
| Exercise Modality | Body Composition | Hand Strength | Walking Speed | Chair Test (30s) |
|---|---|---|---|---|
| Multicomponent Training (MCT) |
98%
|
65%
|
95%
|
55%
|
| Resistance Training (RT) |
45%
|
85%
|
35%
|
90%
|
| Combined Training (CT) |
60%
|
40%
|
75%
|
70%
|
| Aerobic Training (AT) |
20%
|
10%
|
25%
|
15%
|
(SUCRA values represent the percentage of relative effectiveness; higher percentage indicates greater efficacy) 7
Although exercise is fundamental, its effectiveness can be enhanced with appropriate nutritional intervention. Research demonstrates that combining resistance training with protein supplementation produces significantly greater improvements than exercise alone 6 .
A randomized controlled trial with 53 sarcopenic men showed that those who supplemented with 15g daily of collagen peptides along with their resistance training obtained better results: +4.2 kg of lean mass (compared to +2.9 kg with placebo) and +16.5 Nm of leg strength (compared to +7.3 Nm) 5 .
| Supplement | Mechanism of Action | Evidence in Sarcopenia |
|---|---|---|
| Proteins (especially whey) | Provides essential amino acids that activate muscle protein synthesis via mTOR 6 . | Significant effect on strength (SMD=0.45) and muscle mass (MD=0.37) vs exercise alone 6 . |
| Collagen Peptides | Source of specific amino acids; improves recovery and muscle function 5 . | Increases lean mass (+4.2 kg) and leg strength (+16.5 Nm) with training 5 . |
| Creatine | Improves phosphocreatine reserve, facilitating recruitment of type II muscle fibers 6 . | Greater improvement in muscle mass (SUCRA=99.9%) vs other supplements 6 . |
| HMB (β-hydroxy-β-methylbutyrate) | Inhibits the ubiquitin-proteasome system, reducing muscle catabolism 6 . | Showed no significant benefits in strength or mass in older adults 6 . |
One of the biggest challenges is getting older adults to stay consistent with training. A feasibility study in Taiwan addressed this problem through an assisted referral program: after 4.5 sessions guided by a physician in the hospital, 54.5% of participants successfully integrated into strength training programs in their communities 8 .
≥2 sessions per week 6 .
Moderate to high (>60% of 1RM - the maximum load that can be lifted once) 1 .
Start with elastic bands or body weight, gradually increasing resistance 3 .
Initially key to ensure correct technique and prevent injuries 8 .
Ideally, combine strength with balance and aerobic exercises to address all dimensions of physical aging 7 .
Sarcopenia is not an inevitable destiny of aging, but a condition that can be effectively prevented and treated. Scientific evidence converges to indicate that resistance exercises, particularly when integrated into multicomponent programs and combined with adequate protein nutrition, constitute the most powerful intervention to preserve strength, muscle mass, and most importantly, autonomy and quality of life in old age.
Replacing the usual prescription of simply "walking" with exercise programs that include strength training adapted to the characteristics of each older person represents an essential paradigm shift in our approach to healthy aging 1 .