Sarcopenia

The ageing process is associated with a generalised and progressive loss of muscle mass and strength. From the age of 50, muscle mass decreases by around 1-2 % and muscle strength by 1.5-5% per year. This is associated with a decrease in functional capacity, which manifests itself, for example in, loss of balance, difficulties walking, standing up or carrying and increased risk of falls. Mobility and independence are increasingly impaired.

A variety of complex age-related processes are responsible for muscle atrophy, including:

• Changes in hormonal balance
• Changes in muscle protein synthesis and degradation
• Neurodegeneration
• Increase in inflammatory factors
• Insulin resistance
• Decrease in the number and activation of satellite cells
• Oxidative stress

Factors that promote muscle anabolism, such as insulin-like growth factor or testosterone, decrease. Factors that contribute to skeletal muscle breakdown, such as inflammatory cytokines, increase. In addition, with age, connective tissue and fat are increasingly deposited in and around the muscles.

Sarcopenia is generally referred to as excessive, progressive, generalized loss of muscle mass, strength and function. Sarcopenia is now considered a skeletal muscle disease based on adverse muscle changes that occur throughout life. It is associated with an increased likelihood of adverse outcomes, such as falls, fractures, physical disability, and mortality. According to the commonly used 2018 European Working Group on Sarcopenia in Older People definition of sarcopenia, reduced muscle strength is the primary diagnostic criterion because it better predicts adverse outcomes than muscle mass. Muscle strength is currently considered the most reliable measure of muscle function.

1. Low Muscle Strength - Sarcopenia is likely to be present if muscle strength is low.
2. Low Muscle Quantity/Quality - The additional documentation of low muscle quantity or quality confirms the diagnosis.
3. Low Physical Fitness - If the physical capacity is also low, sarcopenia is considered severe.

Sarcopenia is associated with a number of negative, often serious, consequences. For those affected, coping with everyday life becomes increasingly problematic. Sarcopenia leads to an increased risk of falls, impaired mobility, and progressive loss of independence and quality of life. Sarcopenia is a major cause of the geriatric syndrome frailty and is associated with osteoporosis, type 2 diabetes, heart disease, respiratory disease, and cognitive impairment, among others. Sarcopenia is ultimately associated with disability, hospitalization, need for long-term care, and a 3.6 fold increase in mortality.

The most effective intervention for prevention and treatment of normal and excessive (sarcopenia) age-related muscle wasting is considered to be physical activity, specifically strength training at least 2 to 3 times per week - as also recommended in guidelines. It improves muscle strength, muscle mass, and physical performance. To best prevent or delay sarcopenia, muscle mass should be maximized in youth and young adulthood, maintained in middle age, and muscle loss minimized in older age. Regular strength training in middle to old age can slow muscle loss, prevent sarcopenia, and maintain physical functioning, mobility, independence, and quality of life for longer. It is also suitable for the treatment of existing sarcopenia.

Not all older people are able to achieve the comparatively high stimulus intensity required in strength training for good muscle development and maintenance, or to perform conventional high-intensity strength training. Possible reasons for this are already advanced muscle atrophy, severe functional limitations and concomitant diseases. Many patients with sarcopenia and/or frailty, osteoporosis, osteoarthritis or heart problems also shy away from strength training with weights. They feel too weak, unstable and are afraid of falls and injuries. Furthermore, many people refuse to do strength training several times a week. In addition to a lack of motivation and convenience, a lack of time often plays a major role.

For this group of people with little affinity for sports or already weakened, frail, multimorbid middle-aged and older people, technologically supported training in the form of Electro Muscle Stimulation (EMS) is an attractive and equally effective option. The application takes place under individual supervision in a 1:2 or 1:1 setting and, at 1 time per week for approximately 20 minutes, is a time-saving procedure in which the effect of light, subliminal physical exercises is amplified to an effective level, and a high stimulus intensity is achieved. EMS also ensures immediate, continuous recruitment of muscle fibres. Since no weights are required, medical EMS is particularly easy on the joints and subjectively less demanding.

The efficacy and safety of EMS for the prevention and therapy of age-related muscle atrophy and sarcopenia have been demonstrated in various studies. Among other things, it has been shown to have a positive effect on muscle mass, strength, function, functional performance, and abdominal fat. At the molecular level, EMS provides modulation of factors, particularly IGF-1, that promote muscle protein biosynthesis, inhibit breakdown, and activate satellite cells. EMS thus provides an innovative, effective, safe, joint-friendly and time-efficient treatment concept for the long-term prevention and therapy of age-related muscle atrophy and sarcopenia.