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129: Sarcopenia Redefined: Loss of Strength and Power Matter More Than Muscle Mass
1.3k Plays6 days ago
A lot of people think sarcopenia means age-related loss of muscle mass. But this is not what it means!
This week on the Movement Logic podcast, Laurel and Sarah unpack sarcopenia: what it actually is, why the definition has changed over time, and why losing strength and power matters more than losing muscle mass. They walk through the evolution from a tissue-focused understanding of sarcopenia to a function-focused one. Learn how the nervous system plays a major role in aging-related decline, and how this explains a far more rapid loss of strength and an even more rapid loss of power. They discuss why resistance training is essential if you want to maintain independence, reduce fall risk, and preserve the ability to do the things you love as you age. They also discuss why yoga, Pilates, walking, and cardio alone are not enough to prevent sarcopenia, and why training strength and power is non-negotiable for long-term physical function.
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RESOURCES
GUARDIAN ARTICLE - We were asked to weigh in about Stacy Sims advice
EPISODE - Barbell Medicine on Sarcopenia
127: ASCM says K.I.S.S.
94: Capacities for Longevity - Power
CLARK, 2008 - PMID: 18772470
CLARK, 2012 - PMID: 22469110
MITCHELL, 2012 - PMID: 22934016
REID, 2012 - PMID: 22016147
European Working Group position stand 2018 - PMID: 30312372
European Working Group position stand 2010 - PMID: 20392703
BHASIN, 2020 (SDOC Paper) - PMID: 32150289
TØIEN, 2023 - PMID: 37881849
WIEGMANN, 2021 - PMID: 33657752
TØIEN, 2023 - PMID: 36442699
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Transcript
Introduction to Hosts and Podcast Mission
00:00:00
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts.
00:00:15
Speaker
or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt? Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices. Let's dive in.
Season Recap and New Topic Introduction
00:00:47
Speaker
Welcome to the Movement Logic Podcast. I'm your host, Laurel Beaversdorf, and I'm with my co-host, Sarah Court. We are back in your ear, season eight. So far, we've discussed the ACSM position stand, then we discussed falls, and now today we have a new topic, which is sarcopenia. I know what we should mention.
Interview Highlights and Media Excitement
00:01:08
Speaker
What's that? today I mean, chronologically, this is not going to make any sense, but ah we did an interview for The Guardian months ago. Oh, yes. And then yeah it'll be out in March. And then March went and we checked in and she was like, I think it'll be out soon. And then April went. And honestly, i hadn't like forgotten, forgotten about it, but I had sort of completely dropped any expectation that it was going to get published. I was like, if it's been this long, it's I don't think it it's I'd seen it seemed wasn't.
00:01:35
Speaker
I was feeling equally pessimistic. Yes, I woke up this morning. to leave messages from people being like great article in the
Discussion on Exercise for Women in Perimenopause
00:01:43
Speaker
Guardian. Yeah. So a while ago we did an interview talking about the messaging that Stacey Sims has around exercise for women over 40, you know, when they start to enter perimenopause roughly and how The interview was about like, she's taking this big stance that's essentially in opposition to what most everyone else who are experts are saying about the ways that women need to exercise as they get older, which is a topic we've obviously talked about a lot, if you are familiar with us. And so, so yeah, we got interviewed.
00:02:15
Speaker
This woman, Lifts, also got interviewed. Her name is Elizabeth Davies, and she's also interviewed in the article. And um It's just very exciting. For us, this is a big deal. It's a big publication for us to be in. Yeah, it's it's big time. It's big time. We finally hit it big with some quotes in The Guardian. Where's that all that cash that's going to be rolling in, Laurel? I don't see it.
00:02:34
Speaker
We
Humorous Product Mentions and Sponsorships
00:02:35
Speaker
hit big this morning. The the cash. Where's the cash? I know. I feel like our last episode was almost an ad for Uncrustables. Like what sounded like we had been sponsored by Uncrustables. And I was like, if only someone from Uncrustables would just listen to that episode, it'd be like, oh, yeah, let me send them some Uncrustables. Do you think it's the sort of thing where like, you know, if you mentioned something and then your phone hears it and then suddenly you're seeing ads for things, do you think if we just keep saying Uncrustables eventually someone who has some relationship to Uncrustables will listen to this episode?
00:03:08
Speaker
Here's the thing. i don't think our audience is a target Uncrustable consumer. I suspect or not. That's a good point. I think it might just be me. I mean, maybe.
00:03:19
Speaker
It sounds like the kind of thing that I would love to eat if I had consumed an edible maybe an hour before. Sounds like it would be a really fun snack. edibles and marathons.
Introduction to Power Play Course
00:03:29
Speaker
So now we have to talk about power play. i Don't make it sound like you don't want to.
00:03:33
Speaker
Well, listen, I want to. I am bursting at the seams with enthusiasm for this course because it is incredibly comprehensive, accessible.
00:03:44
Speaker
It's low on the equipment that you need. It DIY, but we have a ton of informational videos that you can watch that are quick, that will orient you around exercise for developing the capacity of power.
Importance of Power Exercises for Aging
00:04:02
Speaker
And I think the best part of all, well, there's two really good parts. One is that we have nine exercise progressions that are extremely thorough, that will act as an entry point for anyone, no matter their experience level, to be able to engage in power exercise, from the least experienced to people who have maybe, you know, already
00:04:23
Speaker
gotten really good at box jumps and now are ready to kind of mix it up with some new stuff right but the thing that i think is the biggest bonus is that the workouts are between three and seven minutes long so what you're signing up for is some background knowledge some thorough progressions to be able to find an entry point into workouts that are not going to take you very long, but that are going to go a long way toward building up your ability to move explosively, use force quickly.
00:04:54
Speaker
Power is, you know, strongly supported as a form of exercise that is most important for fall risk a reduction. It will contribute to your ability to live independently for longer. It is connected to so many of our daily life activities that we don't even realize are reliant on power.
Understanding Sarcopenia Beyond Muscle Mass Loss
00:05:14
Speaker
right? Like standing up from a chair, opening a heavy door, lifting something heavy from the ground up to your chest or overhead. And it's a, we're going to learn today in this episode, which is about sarcopenia, but guess what? Sarcopenia includes power and the loss of it. um It is something that you definitely lose,
00:05:37
Speaker
and i don't want to be all doom and gloom but like you literally lose it forever you lose the circuitry yeah to being able to move powerfully and explosively forever unless you use it because you got to send your body the signal that hey we still do this therefore we still need to be able to do this counterpoint to the doom and gloom yes the short workout length of three to five minutes is actually ideal, right? We're not shortchanging you on it and saying you don't have to do that much. You actually shouldn't do more than that because if you just keep doing reps as you're getting fatigued, you're no longer training power, right?
00:06:13
Speaker
And part two, it's so joyful and fun. And it's these like big expressions of movement, whether it's slamming a ball and getting out frustration or jumping for joy or skipping and hopping. It's all these things that we used to do a lot as kids. And then, you know, we became adults and we put away childish things and we said, that's not for me. And then you wake up one day and discover, as I have going into like a dance class where I've been like, huh, this feels harder for my feet to move this fast than it used to. And I and i was like, that is really telling and
Launch Details for Power Play Course
00:06:47
Speaker
interesting.
00:06:47
Speaker
yeah So the course will be available on May 22nd. And if you want to read more about it, we'll put a link in the show notes. i will In my head, I went in the bio story show notes. We'll put a link in the show notes ah to our website where there's a whole page you could read more about it.
00:07:06
Speaker
ya Okay, well, let's get into our topic for today, which is sarcopenia. And we're going to talk about this word, what it means, what it describes, and what I think was for me, as well as I think a lot of folks, a pretty persistent misunderstanding about what sarcopenia actually all entails and also what we can do about it. But Before we define sarcopenia, Sarah, before this episode, if someone had asked you what sarcopenia meant, what definition would you have given them I would give them the definition that I learned in PT school, which is the exact ah translation of the meaning of the words, which is loss of muscle, loss of muscle tissue.
00:07:52
Speaker
Cool. Yeah. Yeah, and I would have probably said something along the lines of loss of muscle. Yeah. Okay, so well before we get into it, let's define some terms. We're going to start with our topic of the day. Sarcopenia. Okay, so sarco comes from the Greek sarx, meaning flesh, and by extension, muscle tissue and penia means poverty, deficiency or loss. This is similar to osteopenia, right? Bone poverty, bone loss.
00:08:19
Speaker
um osteopenia being the stage before osteoporosis. So sarcopenia started as a term describing loss of muscle mass, okay, but it is now understood and it's been redefined actually since 2008.
00:08:35
Speaker
Researchers have been working on adding to this definition, so this is not new, but It is now understood as a condition defined primarily by loss of strength, power, and physical function, as well as a loss of muscle.
00:08:50
Speaker
um So it's not just flesh poverty, all right? It's strength poverty, which has also a Greek-derived term to go with it, which we're going to talk about soon, but also ah a loss of power. We're naming problems based on tissue loss, but we're also naming them based on a loss of capacity. Flesh poverty to me sounds like an experimental rock garage jam band from the 80s.
00:09:15
Speaker
Yeah. Flesh poverty. It's very macaw. But this newer definition of sarcopenia where we're thinking about not just what does it mean literally, which is like loss of muscle tissue, but what does that loss of muscle tissue result in?
00:09:29
Speaker
Yep. Which is a loss of strength, a loss of physical function, a loss of the ability to produce power. Well, it's actually not the loss of muscle that results in that though. And that's what we're going to talk about in this episode. It in part influences a loss of strength and it influences loss in power, but a loss of muscle tissue is a loss of flesh, right? And with that, you're probably going to lose some strength and power, but the bigger losses actually come with changes to the neuromuscular system, which is kind of where the term then started to be redefined. gotcha So another new term that we're going to be learning is dinapenia. And I will say before we started talking about this and Laurel started talking about this, I had never heard the phrase dinapenia before.
00:10:12
Speaker
Yeah. And I, can I also just quickly add that this got put on my radar from a barbell medicine episode, which we will also link in the show notes. This term dinapenia got, got put on my radar. So that episode. Dinah,
00:10:24
Speaker
the first part of it derives from the Greek dynamis, meaning power slash force slash strength. So dynopenia is power or force or strength poverty. And it's interesting, sorry, I'm just kind of like thinking about this.
00:10:39
Speaker
It's interesting that people are choosing to take the term sarcopenia, which if we're super technical about it, just means loss of muscle tissue, but then apply to it the the capacities that you lose which Dynapenia instead of adopting, instead of just sort of like wholeheartedly adopting Dynapenia and saying like, well, you know, maybe you were worried about sarcopenia, but maybe you should be more worried about Dynapenia. Yeah, and this is the shift that's happening. According to my understanding of the literature I looked at, that there are some researchers who use the term dynopenia, and then there are some researchers who continue to use the term sarcopenia, and that term sarcopenia has been updated to include a loss of these functions and capacities. However, in my opinion, I think it's actually more clear to use a separate term, me too right, like dynopenia, but I don't see that dynopenia has been as widely
00:11:37
Speaker
accepted yeah it doesn't have as good of a prt it doesn't but i feel like it's very helpful to have that separate term to go oh so we're gonna actually name this like separate thing that we're losing that's actually different from the thing we thought was the most important thing that we were losing which was the tissue yeah so yeah so you know the general public still probably largely understands that sarcopenia is a loss of muscle size they may or may not understand that that it includes a loss of strength and power Yeah, they don't. And I didn't. I thought it was literally just the loss of muscle mass. And of course, it would follow logically that that would result in a loss of strength and power. But what we're going to learn in this episode is that um it's probably less important that you lost muscle mass and more important that you lost the neuromuscular muscle. circuitry. Yeah, because the capacities that we care about just for like functional living, you know, getting through your daily life, we should care more about ah loss of strength, loss of power, loss of mobility, more than loss of muscle size.
00:12:39
Speaker
Exactly. Hopefully it's not confusing. It's probably smart to use sarcopenia in a way to like also talk about the downstream effects. But I'm kind of on team Dinapenia at this point. I'm like, I'm like, we need to just like pick this new word and like put it out there and get people understanding it.
00:12:53
Speaker
Absolutely. So as far back as 2008, researchers were noticing and arguing that a loss of strength with aging was simply not well explained by a loss of muscle mass alone.
00:13:05
Speaker
So they're like, you know, people are getting weaker, but it doesn't look like it's coming just from the loss of muscle mass. And they observed that actually muscle mass was also a much poorer predictor of outcomes like falls, fractures, disability, and mortality than the loss of strength and power were as well. So not only were they like, we're not really seeing how the muscle mass loss is leading to the strength loss. As clearly, that they're also going, you know what is a much better predictor of how well people are going to do later in life is like how strong they are, not necessarily how much muscle mass they have. So another way to say this too is that researchers notice that muscle size and muscle function, they don't really track closely, right? We might assume they do, but they don't. Someone can have relatively low muscle mass and still maintain pretty good strength and power. Likewise, and this is where it gets really confusing, someone can also have what appears to be a decent amount of muscle mass, but still experience declines in their strength and power. yeah
00:14:02
Speaker
Yeah. All right. Let's just quickly review a few familiar terms just to make sure everybody listening is on the same page. So strength is the maximum amount of force that you can produce.
00:14:13
Speaker
Power is how quickly you can produce that force. In our most recent episode that we did on falls and on episode 94 that we did on power, We talked about how many real world tasks are time sensitive, right? It's not just about being strong. It's using that strength quickly. If you trip and you can't get your other foot out in front of you fast enough, it doesn't matter if you can deadlift 200 pounds.
00:14:38
Speaker
Yeah. Now, and speaking of the sarcopenia, dinapenia, like different terminology debate of whether or not we should just shift it over to dinapenia or just make it all sarcopenia. I have the same issue with the way that strength and power are often grouped together as being just strength, which I see a lot in research. um Or sometimes like a test that's actually measuring power will be called a mobility test. I'm like, ah, I noticed this, but I think that has to do with the mobility or like the function side of things, right? So I mean, it's fair to call a five-time sit-to-stand test of
00:15:11
Speaker
test of functional mobility ability or mobility. I mean, that's fair, but like really, what are we actually measuring when we take a time piece and measure how quickly someone can stand up and sit down five times? right We're measuring power. I noticed this while doing my lit review on exercise for fall prevention. i I wanted to compare strength exercise with power exercise to see which would be ah more conducive to reducing fall risk. And it was tough because a lot of the research I found didn't actually measure falls as the outcome of interest. It measured people's performance on these mobility tests. And of course, power exercise outperformed strength in a head-to-head comparison because the power exercise better prepared people to perform well on a test of power.
00:15:54
Speaker
But you know there was plenty of other research that I looked at that supported both strength and both powers being conducive to reducing fall risk. But I do think that clarity of terms, well-defined terms, when we use a term, this is what we mean. So we can actually talk about something and all be on the same page. And sometimes hard, i mean, research is hard and science is a very complex process. And of course, it would be ideal if everybody could just use the same term all the time, to describe the same thing, but that's not the way it works. But at any rate, I think it's helpful when there can be agreed upon
00:16:24
Speaker
terms and that we can decide what are we actually testing, you know, and then let's call it that. Yeah. I sort of wonder, this bit of an aside, but I wonder, you know, I think about the kind of language that you have to write on um on a soap note, right? A daily note that you, when you're working with a client as a physical therapist, and yeah especially in particular, you know, you're always trying to prove to insurance that what you're doing is necessary so that they will pay for it. And so you have to talk about the the person's ability to do these functional tests, right?
00:16:55
Speaker
But when you're describing what's improved, I wonder if it's sort of like, well, it's easier to describe what we would think of as like their functional capacity than it is to say their power improved. Because like somebody reading it might be like, well, what does their power mean? How is that going to make them more stable in the home or something like that. I don't know. That's just sort of a... I know. I agree with you. But when we're talking about exercise science and we're trying to decide what intervention will best improve this capacity, let's accurately name the capacity. 100%. And then let's define and discuss the differences between these different exercises and interventions and things like that. So anyway, that's just totally my, ah I guess, gripe, but not really that gripe. No, i but I think it's a good point. And I think that's ah a lot of... yeah
00:17:38
Speaker
problems come up because we do see a lot of words used in one setting, in one way, in another setting, another way. like Perfect example is another term that we need to define that I mentioned earlier, function, right? Function in a clinical setting is not like cars and rails and what are what were all those things called? Pails and rails. cars Controlled articulation. Pails and rails. I can't you remember what that stood i thought for a second were talking about like cars and trains. Cars and trains. No. um You know, all those like sort of like specialized activities that are supposed to make you specially functional or something. But in in a clinical setting, function is like, can you live your life? Can you get out of a chair? Can you get dressed? Can you take a shower safely? Can you go to the store? You know, all of these like real world activities. Yeah, yeah, absolutely. So um we're going to discuss in this episode, this evolution of sarcopenia's definition, or it's it's shift away from from discussion of like a muscle size issue to more of a muscle function issue, and also how this happens and what we can do about it.
00:18:41
Speaker
Yeah, yeah. I also wanted to add to, I found an interesting parallel between this focus away from muscle size, which is something you can see, It's also something you can measure and you probably need to use some pretty good technology to like really accurately measure it. But it's something that you can see. You can see that someone is muscular, you can see someone is not.
00:18:59
Speaker
And then this contrast between like that thing you can see versus this thing that in order to measure it, you have to have someone actually perform or do something, right? And so can you stand up from your chair? Can you lift this weight? Can you run a marathon, right? like So talking about performance and function is very, very different thing to focus on Then talking about how much muscle mass someone has on their body reminds me of the difference between like what we focus on a lot. We talk about exercise for women, which is that for so long, women have been taught to really focus on exercises and means by which to change their appearance, to lose weight, usually, or to tone or sculpt or whatever that means, right? And then shifting that focus in women
00:19:43
Speaker
and their mental model of exercise and why they're doing it toward actually know exercise in order to be able to do shit you weren't able to do before. yeah Exercise so that you can climb five flights of stairs and not be out of breath.
00:19:55
Speaker
Exercise so that you can pick up your seven-year-old. Exercise so that you can garden and not have knee or back pain. Exercise so that you can fucking deadlift your body weight. You know what I mean? and And so like, what can you do versus what do you look like? This shift you know, something we've, we've really hammered home a lot in these podcast episodes is reminiscent of this different focus in science, but I just thought that it was an interesting parallel. Absolutely.
00:20:20
Speaker
Yeah. yeah um So let's talk about how sarcopenia occurs, Sarah. So we have for sarcopenia, we have primary causes and we have secondary causes. So the primary cause of sarcopenia is age related change.
00:20:36
Speaker
Right, Laurel, I think everybody feels like it's just inevitable, right? As I get older, I'm going to get weaker. There's nothing I can do about it. And you you see it happen to your relatives. Like um I saw my dad get physically smaller. Definitely. You know, i saw i saw my grandparents get physically smaller. And, you know, you just kind of assume that like, okay, you grow up and then you grow down, right? Or you you get bigger and stronger and then eventually you just start to get smaller smaller and frailer and weaker. And that's just, that's the cycle of life And that's the belief in our, in society, right? It's not, there's, I mean, I, with my older female patients all the time,
00:21:13
Speaker
I am fielding questions about things like, you know, can I actually get stronger now? You know, or can I, can I grow, can I put more muscle on? I'm like, absolutely. even possible? Yeah. yeah but But people think it's no longer possible. They think they're like past a certain age and you can't do it anymore. When, when the reality is that like,
00:21:29
Speaker
I think we need to just flip the narrative completely ah away from like, as you get older, you move less to actually, as you get older, now you need to start hoofing it.
00:21:40
Speaker
You need to start moving more, not less. Yep. Yeah. Yeah. yeah and So yeah, so age-related loss of muscle is the primary cause of sarcopenia, but I think it's really important to highlight this, which is that primary does not mean the most common cause. Mm-hmm. In fact, age-related change is considered a diagnosis of exclusion. So what that means is that a clinician can't arrive at this determination that your sarcopenia is because you've gotten older until they have ruled out all other possible causes for someone's sarcopenia, even if they are old. So we're going to get into these possible causes when we discuss the secondary causes of sarcopenia, which, spoiler, are much more common than the age-related primary cause. But let's say it's age-related. So what's going on at the biological level when we experience age-related sarcopenia? So first, there are a number of processes that change with age. Things like accumulated DNA damage, mitochondrial dysfunction.
00:22:43
Speaker
Mitochondria are the energy-producing parts of your cells. They don't work as efficiently. We get changes in signaling, um There's these little things called myokines, which are signaling molecules released by muscle. And then there's adipokines or adipokines, not sure which one, which come from fat tissue. And these things signal to your body to change and grow and these change, right? These these changes in signaling um due to age. And these are real and it's not avoidable, right? Underlying biological changes that come with age are not avoidable. But, and this is really important, sarcopenia is not just about aging.
00:23:24
Speaker
There are other much more common causes that accelerate it much more common, okay, because here's the deal. If it were just aging, there wouldn't be as much variability as we see in the older populations. We wouldn't see people in their 70s, 80s, 90s, who not only don't have sarcopenia, but are outperforming much younger folks in strength and power, right? Folks that are young enough to be their grandchildren,
00:23:54
Speaker
Like, Sarah, I don't know about you, but my algorithm loves to show me lots of reels of like older folks winning sprint competitions or deadlifting more than I have ever deadlifted in my life and maybe ever will. and ah men and women, and they're just kicking ass. Absolutely. And and they're and they're in their eighty s yes Some of them, what well I saw ah a guy win a sprint ah event in his 90s. Amazing. um I mean, probably for the 90 year olds, but man, that guy was like fast. Right. I mean, that's the thing is, and and to to my point as well, like I see them a lot. The thing that always frustrates me a little bit is it's always framed in a like, check out this granny.
00:24:37
Speaker
who is incredibly strong, like it's and like, but and it is at the moment, like she's an outlier. And I'm like, we need to flip the narrative and make it like yeah all grannies should be getting stronger kind of thing, right? Right, right, um yes. But yeah, to go back to the point about ah age-related sarcopenia, you know, we wouldn't see people be able to maintain muscle function or or or grow it in their older age and outperform people who are young enough to be their grandchildren. if sarcopenia was only an age-related thing and it happened to everybody and it was inevitable, right?
00:25:13
Speaker
you know aging Aging alone can, and to some extent does, create the conditions for sarcopenia to be present, but it doesn't even come close to fully determining the outcome. And it is not even the most common cause of sarcopenia. So now we have to get into this secondary cause of sarcopenia, and these are the way more common reasons.
00:25:33
Speaker
These include factors like disuse, and sedentarism not using your muscles enough not loading them enough not asking them to produce force over a long enough period of time there's also disease chronic conditions that affect metabolism inflammation overall activity levels can be affected that can cause sarcopenia then there's always you know events that happen illness injury hospitalization that lead to disuse and that disuse leads to sarcopenia, um sometimes referred to as a catabolic crisis where muscle is broken down more rapidly during periods of bed rest or reduced activity. I keep mentioning this ah statistic and and I keep not actually pulling it up and and speaking about it accurately, but the the stats on like, if you, let's say you got hospitalized and you were in a hospital bed for three days and you weren't able to get out of it, the the downward slope
00:26:27
Speaker
of that sarcopenia, right? is is It's kind of mind-blowing how much being stuck in bed just creates these conditions for frailty so quickly.
00:26:40
Speaker
Like it does not take a lot of time. um yeah There's also things like poor nutrition, inadequate protein intake, or overall low energy intake. Anorexia, of course, can result in severe sarcopenia at any age. I feel like sometimes with the older population as well, we're seeing things where You know, people say that they feel less hungry as they get older and they might forget to eat or maybe they're living alone at home and like sort of what they can manage is not gonna be, you know, enough to keep tissue on their body. And then also medications can play a role. Corticosteroids like prednisone can accelerate muscle loss.
00:27:15
Speaker
And these are also not individual ah silos that don't relate. Like a lot of these things overlap and and co-occur, right? So you might be aging, Right. But then also less active, also dealing with the chronic condition and recovering from an injury and maybe not eating enough all at the same time.
00:27:33
Speaker
But most people just identify the age as the issue. and they're like, oh, I guess this is what 50 feels like. Oh, I guess this is what 60 feels like. Oh, this is what 70 feels right.
00:27:46
Speaker
Not so fast because yes, as we've said, the primary cause of sarcopenia, age-related change is not the most common, right? Don't confuse the fact that it's primary with common, but age-related causes of sarcopenia certainly describe something very real that happens, right? We're not gaslighting you. Aging is real, but it's the secondary causes that really explain why the rate and severity can vary so much between individuals, as well as the prevalence of severe sarcopenia in older folks generally.
00:28:17
Speaker
The good news and and the key takeaway that we want you to leave with is that many of these secondary factors are modifiable if you resistance train and consume enough food in general, specifically protein, but more importantly, if you resistance training. And it's also important to remember that even in the context of aging, the trajectory is not fixed. You can still impact the rate of loss enormously through changes to your lifestyle, right? Exercise, resistance training, and diet, right? yeah it's It's modifiable. I, um my mom is turning 80 this year and why i have another client that I work with who is 82. And if you put these two people side by side, you'd be blown away by the difference.
00:29:01
Speaker
yeah know yeah ah in their physical capacity. and And largely for my mom, she never stopped playing tennis. I remember a while ago, maybe when she was in her 60s, where she was saying like, well, you know, i'm I'm the oldest one out there and I'm not seeing people my age. And should I stop? And I was like, hell no, do not stop. And she didn't. and great It's a great sport for sarcopenia prevention. Totally, right? Which some of you might be going, well, it's not a way to put muscle on your body. And it it definitely isn't.
00:29:28
Speaker
But just wait, because remember, sarcopenia includes a loss of power. Yeah. And tennis is a power sport. It sure is. Yeah. Yeah. So we now know that loss of muscle mass, strength, and power are all included in the definition of sarcopenia. And they have been for many years.
00:29:47
Speaker
Maybe the public hasn't caught up. And I think a lot of clinicians haven't quite caught up as well. we're starting to understand that it's the capacities of strength and power that actually might matter most for function, for fall prevention, for mortality, more so than muscle mass. So let's talk about rates of decline or how quickly these capacities decline strength and power in comparison with muscle size, because this might really shine a light on why we think that these capacities might matter more. Okay. Because if it were really just a muscle size story, shouldn't all three fall together at roughly the same pace, right? Shouldn't strength and power decrease at the same rate as muscle mass?
00:30:28
Speaker
And it's not the way it turns out. So let's start with muscle and strength. There's a paper by Mitchell and colleagues from 2012 that followed people over time and looked at how their muscle mass versus their muscle strength changed with aging. And what they found is that their muscle mass declined relatively slowly on the order of about 0.6 to 1% per cent per year depending on their age and sex. And I believe this is starting around middle age. But their strength declined much faster, roughly 2.5 to 4% per year. So for perspective, that's roughly two to more than five times faster of a decline than muscle size.
00:31:07
Speaker
And importantly, this paper also found that any changes that were observed in muscle size only explained a small portion of the changes seen in strength.
00:31:18
Speaker
So it's not the case that the muscle size was the sole, the loss of muscle size was the sole reason for the loss of strength. In fact, it probably wasn't even the biggest reason. So right away, you have this mismatch, right? Muscle is going down, but strength is going down faster. Okay, this idea isn't new. It was actually pointed out earlier by researchers Clark and Menini in 2008, who noticed that a loss of strength with aging was not well explained by a loss of muscle mass alone.
00:31:48
Speaker
These researchers, from what I can tell, these are the folks that introduced the term dynopenia to identify age-related loss of strength as a distinct phenomenon from a loss of muscle mass, highlighting that declines in force production have different mechanisms and more direct consequences for function and health outcomes than a loss of muscle mass.
00:32:12
Speaker
Okay, so now if we talk about power as well, because here's what's interesting, strength isn't even the fastest thing that declines. So there's a paper by Reed and Fielding from 2012, that specifically looks at muscle power. And they make the point that power declines earlier and more precipitously than strength with advancing age.
00:32:31
Speaker
And we also have longitudinal data supporting that pattern in a more recent study by Wigman, Wigman, Wegman? don't know. wait man Weigman. Weigman and colleagues. I'm just going to try to say it casually. Weigman and colleagues from 2023, they looked at changes across a wide age range, and they found that lower body power was already declining in people in their 20s and 30s while yeah while measurable measurable strength declines tended to show up later. They also showed that power exhibits a larger and more consistent decline across age groups compared to both strength and muscle mass.
00:33:06
Speaker
So the pattern is muscle size declines. strength declines faster, power declines earlier and more extensively than strength. And none of these are tightly coupled with each other, which means something really important for how we think about aging, the thing that we've historically focused on, right, muscle size, is not the main driver of the thing that actually limits people. It's not even the closest.
00:33:30
Speaker
Strength matters more. Power might matter most of all, right? Because now our definition of sarcopenia includes a loss of strength and power. h Yeah, let's talk about the evolution of this definition of sarcopenia in research. All right. So where did the term come from? It's a term coined by a man named Erwin Rosenberg in 1989. And he was a nutrition scientist and researcher focused on aging. He was interested in how changes in muscle affect health and function as we get older. He said, quote, no decline with age is more dramatic or potentially more functionally significant than the decline in lean body mass.
00:34:09
Speaker
Perhaps it needs a name, sarcopenia, unquote. So right from the beginning, there's this idea that the loss of muscle results in these functional consequences. But importantly, the term itself was built around a loss of muscle mass. Okay, that was the thing being named. It wasn't originally defined in terms of strength.
00:34:29
Speaker
It wasn't defined in terms of power. And it definitely wasn't defined in terms of functional performance tests. Those things were implied, though. um They just weren't operationalized, meaning they weren't tested, measured, or used as formal criteria to define or diagnose the condition.
00:34:44
Speaker
And it's the case, I think, still today that most people still, I think, think of sarcopenia as a loss of muscle lung. Now, researchers and clinicians focus mostly on measuring muscle mass, of course, in order to diagnose the condition because they thought that that was the the cause of you know, the decline in, um you know, functional ability, right, was the loss of muscle mass. So before the late 2000s, they would measure muscle mass using tools like CT scans, um MRI, DEXA scans, bioelectrical impedance, and anthropometric measures, things like calf circumference. um Muscle mass imaging, while not perfect, gives us a physical quantity and
00:35:26
Speaker
We can measure it in relatively consistent ways. And so that's good for science, especially. And it also just feels intuitive to think that smaller muscles would be weaker muscles. And they usually are, right? And that bigger muscles have more contractile proteins and therefore are stronger. And that is usually the case, right? That they can then produce more force. So the early model is pretty straightforward. As we age, we lose muscle size. And that loss of size explains the loss of strength. And it seems like, you know, it's a pretty clean, logical story.
00:35:53
Speaker
Okay, so so to add to this, medicine already had a template for thinking this way, right? It often defines disease based on how much of a tissue is there, right? Bone density for osteoporosis, plaque for cardiovascular disease, fat mass for obesity. And there was also a broader tendency to use technology to quantify tissue rather than to measure what the tissue could do, right? How much of it do you have, not what can it do? And at the time, imaging technology was rapidly advancing in the 80s and ninety s the early 2000s. Tools like CT and DEXA scans became much more widely available in research settings. So then we found this huge surge in studies looking at body composition, bone density, lean mass, fat mass, right? These are all these structure-based models where you measure the quantity of a tissue and then use that to define disease. So In a lot of ways, the field went where the tools were, which happens in every industry, right? In tech, we we optimize for whatever we can measure, clicks, views, engagement. In medicine, we track biomarkers because they're quantifiable, even when they don't perfectly capture outcomes.
00:36:57
Speaker
So sarcopenia had become defined largely in terms of how much muscle someone had, right? A marker we measured and quantified, and then later learned didn't actually really perfectly capture outcomes because our concern is about what that loss means for function, right? And this sets up this, interesting contrast between structure and function. Structure is about how much muscle do you have.
00:37:19
Speaker
Function is about what can you use that muscle to actually do, right? This distinction that Laura was talking about before about the difference between how it looks versus what it can do. So for a while, sarcopenia was treated primarily as a structure problem, right? Function matters, but it was harder to measure and probably much less standardized at the time.
00:37:39
Speaker
But then what started to shift was this realization that, you maybe muscle size wasn't actually tracking very well with the outcomes that people cared about. People with similar muscle mass could have very different levels of strength, physical performance, and then different risks for falls, fractures, disability, loss of independence, mortality, things like that. So then the field started to prioritize measuring funkin.
00:38:01
Speaker
Funkin? Funkin. Measuring funkin. Next up, flesh poverty with their hit, measuring funkin. so All right, so the field started to prioritize, measuring, sorry, now and just making myself laugh.
00:38:15
Speaker
How big is your funk? What's your function? The field started to prioritize measuring function because it turned out to be way more relevant and important. Sarcopenia's definition has thus not been static. It's moved pretty steadily from a structure-based concept towards a function-based one. Although I will say, I think people still think of it more as a structure-based than function. Absolutely. yeah i mean, again, as I did. Yeah. So this started around, as I said, 2008, Clark and Menini, they published a paper called Sarcopenia Does Not Equal, and they have the sign, like the cross out of the equal sign, Sarcopenia Does Not Equal Dinopenia.
00:38:53
Speaker
And this is one of the big turning points conceptually because they argued that age-related strength loss is not well explained by loss of muscle mass alone. And they wanted to separate the loss of muscle tissue, Sarcopenia, from the loss of strength, which includes power, right, in in this case, in this conversation, Dinopenia. because those two things, again, do not always move well together. So then in 2010, the European Working Group on Sarcopenia and Older People, or EWGSOP, published a paper called Sarcopenia, colon, European Consensus on Definition and Diagnosis, colon, Report of the European Working Group on Sarcopenia and Older People. They did not have anyone with any marketing training come in and help them with that title.
00:39:37
Speaker
They put two colons in the title. And they said sarcopenia and European twice. They just needed a copy editor. yeah So this was a major step because they did not define sarcopenia.
00:39:50
Speaker
as muscle mass alone. They defined it as a syndrome involving progressive and generalized loss of skeletal muscle mass and strength with risk outcomes like physical disability, poor quality of life, and death.
00:40:04
Speaker
But importantly, in 2010, low muscle mass was still required for diagnosis. You needed low muscle mass plus either low strength or low physical performance to be diagnosed with sarcopenia. So function was added, but mass was still kind of the gatekeeper.
00:40:21
Speaker
Then in 2012, Mitchell and colleagues published a quantitative review that helps make the mismatch harder to ignore. They summarized evidence showing that strength declines much faster than muscle mass, that strength and mass follow different trajectories, and that loss of strength is a more consistent risk factor for disability and death than loss of muscle mass. So this is where the field has more support or starts to gain more support for the idea that sarcopenia cannot just be a size problem. So then we get to the updated European position stand
00:40:57
Speaker
In 2018, published in 2019, Cruz and Gentoff and colleagues ah published Sarcopenia, revised European consensus on definition and diagnosis, often called EWGSOP2.
00:41:10
Speaker
We've talked about position stands a lot this season. Updated position stands. I'm just laughing at EWGSOP2 because it's like, again, get a better name. It's a robot in Star Wars. ah the Welcome, new egg wasopto.
00:41:25
Speaker
d do This is where the shift becomes much more explicit. Okay. So we have this updated position stand between 20, what was it? 2010 to 2018. So eight years later.
00:41:39
Speaker
Okay. So in this updated position stand, they say that the original 2010 definition was a major change because it added muscle function to older definitions.
00:41:49
Speaker
which were based only on low muscle mass, but in their new revised guidelines, muscle strength must come to the forefront because strength is better than mass at predicting adverse outcomes. So in EWGSOP2, low muscle strength becomes the primary parameter. And again, strength includes power, okay?
00:42:11
Speaker
So when you hear strength, include power. low strength means probable sarcopenia so now it's used as a diagnostic right now it's used to measure whether someone has sarcopenia low muscle quantity or quality and we're going to talk about what quality means confirms the diagnosis so our our first thing we want to find out is if this person is weaker, right in some way, and then we look at their muscle mass, yeah and poor physical performance is used to identify severe sarcopenia, yeah right. So we'll talk about the tests they use to identify severe sarcopenia in a second. Yeah, but it's interesting.
00:42:45
Speaker
So that the the the difference in that approach between the 2010 and 2018, EWG SOP paper, right? So the model in 2010 was first show that there's low muscle mass, and then make that point towards low strength or poor performance. And then 2018, the model flips first look for low strength, then use muscle quantity or quality to confirm yeah and then use physical performance to determine the severity.
00:43:11
Speaker
Right. So it it moves the capacity of strength out of this kind of a secondary supporting place to like the main area of focus. And then the sarcopenia definitions and outcomes consortium or S-DOC pushes this even further.
00:43:28
Speaker
In the S-doc work, I don't know if it is S-doc, I'm just saying that. Yeah, S-doc. It's fun to say. like It's good. Led by Basin and colleagues, low grip strength and slow gait speed predicted outcomes like falls, mobility limitations, hip fractures, and mortality, while DEXA-measured lean mass did not predict those adverse outcomes i just want to jump in real quick for anyone who doesn't know this dexa scans are famous for measuring bone density but dexa scans can actually measure all kinds of tissue in your body including lean muscle mass so that's what they're talking about here they're talking about like yeah the amount of tissue right and that did not predict those adverse outcomes so
00:44:08
Speaker
sdoc includes weakness and slowness in the definition of sarcopenia and the big deviation from prior definitions is that lean body mass is absent so holy cow like now sarcopenia doesn't even include in in sdoc's definition doesn't include muscle mass so if we zoom out the timeline is first sarcopenia names muscle loss and then the researchers point out that strength loss and muscle loss are not the same thing then the 2010 European consensus says, okay, function matters, but mass still has to be there. And then the 2018 European revision says, well, actually strength should come first.
00:44:45
Speaker
And then the S doc goes even further and says, when we look at outcomes, weakness and slowness matter and lean mass may not need to be part of the definition at all. So the direction of travel is really clear, right? The field has been moving away from defining sarcopenia as how much muscle someone has and towards what that muscle can actually do
00:45:09
Speaker
Let's talk about power play. This course, I'm super proud of it. Me too. We tend to think of power exercise. The first thing in my head is plyometrics. And then the next thing is box jumps.
00:45:22
Speaker
like right Right. Olympic barbell lifts. Right, exactly. If that's what I think power is, then I have to figure that's what a lot of people think power is. Really hard movements they can no longer do.
00:45:32
Speaker
Power plays a much bigger role in our lives. We need to move against resistance quickly. Even just something super basic like getting out of a chair has a power component to it. I don't think we realize how often we use it and then how quickly we lose it. Yeah, absolutely. i think a lot of people don't realize that it's a capacity that they need to work on Let's say you're in your 40s or fifty s and you've been working on your strength training, but all of a sudden you're supposed to do faster movement and you're suddenly discovering that, oh, wow, that's actually weirdly hard. That doesn't feel as automatically accessible as it used to when I was younger. We stop doing that type of stuff as we age. We lose this athletic way of moving as we get older, which is really about producing force quickly. And that's what our course is all about. It's about but moving your body weight, moving objects through space quickly and explosively. The other thing that I really like about this course is that we have these exercise demonstration videos that show each of the movements that we're teaching and how to take it from a pretty basic to much more challenging. But then we also have these three to five minute workouts. And by the way, adding power is literally three to five minutes. It's actually these very short yeah little bites of exercise. And it lands best when it's short like that. Yeah. We've actually made workouts for people so that you can mix and match how hard you need it to be, how much time you have, what you're working on, and select a workout that works for you. And then also progress that workout once it gets easy.
00:46:59
Speaker
I think we do a really good job of showing them how to progress safely. Definitely. In addition to... plyometric exercises involving impact. We also have medicine ball exercises where you can literally take out all of your aggression on the wall or the floor with a ball. We also have weight-based power exercises like the clean, the push press where we're using a kettlebell or a dumbbell. Also training power for your upper body, right? So it's not just about hopping and skipping and jumping, but actually explosively move through the upper body. Another thing I think that people don't realize about power is that the amount of weight you're going to be lifting should be something that feels actually quite light because now we're going to ask you to shove it, throw it, slam it around, and we need you to be able to move quickly with that load. It definitely is a course that is going to bring you back to some of the more athletic movements that you did when you were younger. I think people are going to dig skipping and bounding and throwing balls against walls and coordinating somewhat sophisticated movement in the air, expressions that are just inherently joyful.
00:48:10
Speaker
And we're going to reclaim our ability to move with jubilance. It goes on sale on May 22nd, $99. That price will go up after this sale period.
00:48:21
Speaker
And then the cart closes May 31st. You just got this little window to grab it. If this sounds interesting to you, if you want to hear more about it, then you're going to head on over to the page on our website. The link for that is in the show notes.
00:48:38
Speaker
Yeah. All right. So let's talk about why muscle size can be misleading. We're going to get into this concept of muscle quality. Okay. I think we've mentioned muscle quality, like, just in passing in a couple episodes, but we now have to get into it fully because it explains a lot of what we've already talked about regarding how muscle size can stay relatively similar, but someone's strength can decrease much faster than their size suggests that it should, right? So let's talk about muscle quality. Up until this point, we've been comparing muscle size, which is the amount of muscle tissue you have, strength, which is the maximum amount of force that muscle can produce, and power, which is how quickly that force can be produced.
00:49:15
Speaker
We've highlighted that strength and power decline faster than muscle size. So this raises a pretty obvious question, which is how can muscle force decline if the amount of muscle doesn't change that much?
00:49:27
Speaker
Doesn't that contradict the idea that bigger muscles are stronger or that muscle size determines strength? And the answer is, again, those statements are directionally true, but they are incomplete because bigger muscles, yes, they tend to be stronger, but size alone of the muscle does not determine its strength.
00:49:44
Speaker
Muscle size and muscle function are related, but they are not the same thing. We need to talk about this term muscle quality to understand this. So muscle quality is generally defined as the amount of force or power you can produce per unit of muscle mass. So you can have a bigger muscle that is capable of exerting less force per unit than a smaller muscle, which is capable of exerting more force per unit.
00:50:12
Speaker
In other words, And this is not usually the case, but it is possible that a smaller muscle can be stronger than a bigger muscle. It usually isn't, but sometimes it is. In other words, it's not just how much muscle you have. It's how well that muscle works. Muscle quality helps this mismatch between size and strength make more sense.
00:50:32
Speaker
So a muscle can look relatively normal in size, not particularly enormous, not particularly small, especially on imaging, but it can still function poorly. And one way this is often explained is with the banana analogy, which has been used in exercise science to describe changes in tissue properties with age.
00:50:50
Speaker
So a green banana and a ripe banana, let's say they're roughly the same size. However, their internal structure is very different. You pick up the green banana and it feels firm, maybe a little more elastic, more resistant to deformation. And you pick up the right banana and it's softer. It's a little squishy. It's a little less structured. It's more compliant. Your muscles are not bananas. All analogies are imperfect, but something similar happens with your muscle, right? As we age, muscle tissue doesn't always just shrink.
00:51:19
Speaker
Rather, it changes. And this is not exclusive to older adults. And it is not an an inevitability. Muscle quality can decline in younger people as well. particularly with prolonged inactivity and certain diseases.
00:51:32
Speaker
Now I'm gonna use a term that makes Sarah very angry. And the term is skinny fat.
00:51:40
Speaker
She has a good sense of humor about it today. I've seen her in other days where i'm like, oops, she's getting mad. No, I am mad about it I will say also, speaking of our Guardian piece that came out today, yeah ah part of the piece ah she's- First of all, wait, I just want to pause for saying that sounds so badass. We're like, speaking of our Guardian piece that came out today. Can we go back to that, please? I just want to talk about that for a moment. No, because I was reading it and- ah It talks about how Stacey Sims used this term, skinny fat, on the Mel Robbins podcast. And that's when I heard it. That's when it first made, like, I had that, like, Popeye, like, steam coming out of my ears moment. Is that the first time you'd heard the term? No. oh I hadn't heard it in a while. The first time I heard it was at Equinox when I used to work for Equinox. And they made they had a whole advertising campaign around, are you skinny fat? And it had, like, this outline of a skinny woman. And then the text was like, you know,
00:52:34
Speaker
you're fat maybe but killing you or I don't know. was It was trying I don't know if it was talking about visceral, I don't know what the fuck it was talking about, but it got pulled really quickly because a lot of women were like, what is wrong with you? yeah um And again, I'm going to go out on a limb and say- Of course they're like, they pick a woman. Right. Well, I'm going to go out on a limb and say there were no women in that decision-making ah field when they came up with that advertising campaign. No, but like my point is like, ah you know of course you didn't put a man up there as if men can't get skinny fat. Right, right. Exactly. Right. Well, you know, they're they're used to preying on us.
00:53:04
Speaker
it's Well, yeah, because the word skinny and the word fat are incredibly triggering words for women. Yeah. So, ah yeah. and and And also skinny fat is not a scientific term. It's not a medical term. It doesn't actually mean anything specifically. It's a term that people have sort of come up with. But because it has no clear meaning.
00:53:23
Speaker
you know If you ask someone to to to actually describe it, I don't think they can, especially. But yeah um i think what people are trying to describe is like someone who doesn't appear to have a lot of muscle, but they're also not carrying a lot of visible body fat, right? yeah Or they look, you know, quote unquote, normal size, but they don't feel strong or they don't perform well physically.
00:53:44
Speaker
And the problem is that that that term is often used to do do what grifters and influencers love to do, which is to try to visually diagnose something that you can't actually see very well from the outside, right? What people might be trying to point to, but without having the language for it is something more like muscle quality, but you can't see muscle quality from the outside.
00:54:05
Speaker
You can't look at someone and know how much force they can produce per unit of muscle, right? You can't see how well their nervous system is recruiting motor units. You can't see how much- Unless you're EWSOP too. Beep boop boop bop. That's right. You can't see how much of their muscle is contractile tissue versus non-contractile tissue.
00:54:24
Speaker
um So when when somebody says like, oh, I'm skinny fat or she's skinny fat, right? Again, mostly a term directed at women. What they might actually be describing is something like, I am kind of skinny and I don't feel very strong.
00:54:36
Speaker
But here's the deal. You can be kind of skinny and have good muscle quality. Meaning the muscle you do have might be able to produce quite a bit of force per unit of muscle.
00:54:49
Speaker
yeah Speaking of which, one of my very best friends, ah I texted her about this before the show because I knew I was going to bring her up. And i wanted to i was like, are you okay with me doing this? And P.S. tell me your actual numbers.
00:55:01
Speaker
Because I was like, I want to talk about your... height and weight and also your lifting numbers just to give people an example of an insanely strong skinny person let's just clarify your friend is not a competitive powerlifter not even and she's only started weightlifting like barbells and stuff like this she's been doing it maybe a year maybe a little over a year okay not especially super long all right let's hear the numbers so she is five foot three okay she weighs about 115 pounds okay Her deadlift PR is 160. Nice.
00:55:31
Speaker
And she can, but this is, this, here's, this is the part that blows my mind. Yeah. On the leg press machine, 280. two hundred and eighty yeah that's awesome She's like, I'm at the bottom of the stack on the leg press machine. I'm like, girl, that's great I am like in the top third. What are you talking about?
00:55:46
Speaker
um But yeah yeah, she's someone where you would look at her and you can see she has muscle definition, right? She might even be what people would love to call toned, right? You can see that she has muscles, but she's little, she's not a big person.
00:55:59
Speaker
And so you wouldn't look at that person and be like, I bet she gets on the leg press machine and takes the pin and puts it all the way at the bottom, right? Right, right. But she does. actually yeah Yeah. Yeah. Yeah. Okay, cool.
00:56:10
Speaker
All right. Setting aside the term skinny fat, let's go back to muscle quality, okay, so which is the scientifically derived term. It is one of the ways muscle changes due to age, but much more frequently due to disuse, secondary causes. And what happens is that it accumulates more non-contractile material. So yes, things like fat, but also fluid within the muscle itself.
00:56:33
Speaker
And this is sometimes referred to as myosteatosis. So fat and fluid are not contractile, but they do contribute to the muscle's overall mass. So the muscle may appear similar in size, but its ability to produce force is reduced.
00:56:47
Speaker
At the same time, there are changes happening at the level of the muscle fibers, right? And we will get more into this, but frankly, this part blew my freaking mind in researching for this episode, okay?
00:57:00
Speaker
But as a teaser, you see a reduction in the size and number of type 2 fibers, which are the fibers responsible for producing high levels of force or high levels of force quickly. And this is closely tied to changes in the nervous system, okay? Because motor neurons help determine the characteristics of muscle fibers, whether they're type one or type two, and it's the fibers they innervate, right? These motor neurons. So you also get additional changes in the nervous system itself, including fewer motor units, less efficient signaling, and reduced ability to recruit high threshold motor units, right? More on this soon.
00:57:40
Speaker
So now when we say that strength declines faster than muscle size and power declines faster than strength, this is part of the explanation. It's not just that you have less muscle, it's that the muscle you have is doing less.
00:57:53
Speaker
The quality of the muscle is reduced. And this idea of muscle quality is really what bridges that gap between structure and function because it explains how you can have similar looking structures, muscles, right, on a scan, but very different outcomes in terms of the function of what someone can actually do. So we need to talk about the other reasons that this happens, aside from changes to muscle quality that Laurel just talked about. What are other reasons that strength declines faster than muscle size? And also, why does power decline even earlier and more dramatically?
00:58:26
Speaker
And the shorter answer is because this is not just a muscle tissue problem. It is a neuromuscular problem, meaning it involves both the muscle tissue and the nervous system that controls the muscle tissue. So to understand this, let's start with the basic unit of movement, which is the motor unit. A motor unit is one motor neuron and then all the muscle fibers that the neuron controls.
00:58:50
Speaker
So you could picture like one electrical wire coming out from the spinal cord and then that wire branches out to connect to possibly a group of muscle fibers maybe be many maybe only a few right there's a variety when that neuron fires the fibers that it controls contract and the motor unit is basically one of the smallest functional units your nervous system uses to produce force not all motor units as i was saying are the same some motor units are lower threshold um these ones are easier for your nervous system to access
00:59:21
Speaker
These tend to control the type one muscle fibers, which are the sort of slower, more fatigue resistant fibers. They're ones you use all day long for. so Posture while you're standing, walking around, sitting, low level movement, easy, basic life. They don't go away because we're kind of always using them in some amount all day long.
00:59:40
Speaker
Then you have higher threshold. Let me just go back and and define threshold. Threshold means the ease with which it is accessible. So some motor units are lower threshold, right? It's much easier for the nervous system to access them.
00:59:53
Speaker
And that's these type one motor units. Higher threshold motor units are harder to access and they're recruited when you need more force, more speed, more power.
01:00:05
Speaker
We don't use them as much and some people rarely use them at all, which is never, never, you never use them, which is part of the problem. These motor units typically control type two fibers, which are often called your fast twitch fibers. And those ones are better at producing force quickly.
01:00:21
Speaker
So these high threshold motor units and type two fibers Amy the especially concerned about here, because with aging we start to lose motor units and the loss seems to especially affect the motor neurons that are connected to those higher threshold fast powerful motor units. Dr. Amy Quinton, yeah so this a nervous system change right, which is. Related to but actually different than the muscle itself. And here's the thing too, and again, I hate to be the bearer of doom and gloom news, but when you lose these type 2 fibers, they don't come back.
01:00:56
Speaker
right So when you don't use them, you lose them, yeah they go away. You can't reinstate a type 2 fiber that has gone away and or converted to type 1. Okay, so let's discuss. Clark and Menini in their 2008 paper, by the way, we're going to linkak all these papers in the in the show notes and you can pull them up. A lot of them are open access. Clark and Menini in their 2008 paper described this as part of the nervous system and its contribution to dynopenia. Noting that aging, we're also going to add disuse, affects multiple parts of the neuromuscular system, including motor unit recruitment, rate coding, neuromuscular transmission, and the ability to voluntarily activate muscles. So what do all those words mean? Okay, motor unit recruitment refers to how many motor units your nervous system brings online to produce force. So one muscle is made up of multiple motor units, which are made up of multiple fibers. The type 2 govern a larger percentage of the muscle fibers. Type 1 govern a smaller percentage motor unit. So motor unit recruitment is how many of these motor units in total your nervous system brings online. It could be a very small percentage of the motor units slash muscle fibers. It could be the entire, like all of the motor units of a muscle, full recruitment, right? Rate coding refers to how quickly those motor neurons fire, which is coming from your brain, that signal comes from your brain, which influences how quickly your muscle can contract. And the neuromuscular transmission is the process by which the nerve signal gets passed to the muscle so that it can contract.
01:02:23
Speaker
Voluntary activation is your ability to fully turn on your muscles when you're trying to produce force consciously, right? um They also, Clark and Menini, describe a process where type 2 fibers, this is where my mind got blown, can become de-innervated, meaning they lose their nerve connection. And then what happens is that a nearby type 1 motor neuron is like, no,
01:02:47
Speaker
I will rescue you. We cannot lose this fiber. So it sprouts a branch to the fiber and re-innervates it. It rescues it.
01:02:57
Speaker
It rescues some of those abandoned fibers. I think that's crazy. That's pretty cool. Yeah. So the fiber doesn't necessarily disappear, but it is now under different management.
01:03:08
Speaker
Okay. Meaning that fast, powerful fiber that used to be connected to a fast motor neuron gets picked up by a slower motor neuron. Your type twos become type ones.
01:03:20
Speaker
And this means you shift your force producing capacity permanently away from strength and power and more toward endurance. They don't go back to being type twos. Do you happen to know, cause this is what I was thinking about while you were talking.
01:03:32
Speaker
If let's say you are an older person, you've lost some power, you've lost some of these type two fibers. If you start training power, I understand that the ones that have gone to type one, don't go back to being type two, but is there any conversion of type ones to type twos?
01:03:49
Speaker
You mean do type ones become type twos? For people who, let's say, start training power again. No. So what happens is that if you, with whatever type twos you have, if you start training power, you don't grow more type twos, but you do get better at rate coding neuromuscular transmission. With neural changes.
01:04:07
Speaker
And so you have, again, these neuroadaptations that make you able to produce more force. Cool. Right? And a lot of it is based on coordination as well, right? Yeah. You do you do improve your capacity, but you don't you don't actually raise your ceiling. yeah You can't. Right. Because you lost those type twos. Right. And and so it's it sounds kind of hopeless, but it's not because you can still make massive improvements to the stuff you currently have. Yeah. And therefore, it now is the best time to start.
01:04:39
Speaker
Right. Hopefully that's the takeaway, not like, oh, it's too late for me. I might as well just go start digging my own grave. I've lost the fibers. Yeah. you know um actually what we want you to take away from this is that like go go start now yeah still put this podcast down put it down stop listening or keep listening to this podcast and go do some power training yeah all right so we see this pattern of of type twos converting to type one play out in people who have been training in either aerobic endurance sports or strength sports for decades. There's a great 2023 paper by Toyin and colleagues looking at masters athletes in endurance versus strength sports.
01:05:18
Speaker
And even among highly active people like this, the muscles of these athletes look very different depending on how they trained for large portions of their lives. For those of you who don't know what a masters athlete means, typically it's defined as an athlete over the age of 40. Which makes me feel ancient. But anyway, I'm a master's athlete. Yeah. Strength trained athletes tended to preserve more of those fast twitch type two fibers.
01:05:41
Speaker
Endurance trained athletes showed fewer type two fibers and more signs of fiber grouping. which is exactly what you'd expect to see after this kind of de-innervation and then re-innervation. So these are not inactive people. They're training a lot, but endurance training alone did not preserve the fibers most responsible for producing force quickly or power and for producing high levels of force or strength.
01:06:06
Speaker
So we're going to come back to this later, but this starts to hint at you know a really important point, which is yes, all exercise is good, but not all exercise preserves the same capacities.
01:06:17
Speaker
And if the goal is to maintain strength and power as we age, strength training ends up being a non-negotiable because the specific type of exercise you do determines what specifically gets preserved.
01:06:30
Speaker
That fast, powerful fiber that used to be connected to a fast motor neuron may get picked up by a slower motor neuron. And over time, the fiber will start behaving more like the motor neuron that controls it, unless you keep it around by signaling to your body that you still need it, also known as strength and power training. So hopefully this helps to explain one of the reasons why we see this shift away from fast, powerful output with age. It's not just that the muscle is smaller, it's that the wiring has changed.
01:07:00
Speaker
yeah And the change in wiring is not inevitable with the passage of time and the accumulation of age. It is preventable, but once you lose it, you can't get it back. So the time to start using it is now.
01:07:14
Speaker
yeah There's another 2023 study by Toyin and colleagues, ah same author, same year, that compared these masters athletes who had trained for years. And it found that strength-trained athletes showed higher descending motor drive, meaning a greater ability to send a strong signal from the brain to the muscle.
01:07:33
Speaker
Whereas endurance trained athletes showed more spinal reflex activity, but not the same level of drive for a high force output. That's so interesting. And it's so interesting in particular that the source of the drive for type two is appears to be coming from your brain, whereas the source of the drive for type one appears to be coming more from your spine, which makes a lot of sense to me because the spinal to motor to muscle loop is a much faster one.
01:08:04
Speaker
um And it's the kind of thing that you use when you have a, like a reflex, like you touch something hot and you pull your hand away. Like that's a spinal cord activity because it's just a really quick turnaround kind of thing. And posture is, is, is very reflexive. Right. Right. And also just kind of any sort of endurance activity is, is also the same way. So, so I think that's just kind of fascinating.
01:08:25
Speaker
Okay. Yeah. Yeah. Super fascinating. So Laurel, are we, but does this now mean that we have to eat our words and we are now anti zone two cardio? Is that what we're saying? yeah God, no, no. I think what it means is that we need to be doing both forms of exercise, but you cannot um endurance train yourself to ah a strong and powerful body in old age. Like you are not immune from sarcopenia. You actually need to resistance train. yeah So this is said with love to all my endurance athletes who are listening and anyone who just thinks walking is enough. It's like, no, yeah it's really not.
01:08:59
Speaker
Yeah, do both. Also because people who only lift weights aren't immune from the kinds of conditions that cardiorespiratory training uniquely helps protect against as well, like cardiovascular disease, hypertension, stroke, type 2 diabetes. and lower cardiorespiratory fitness, which is strongly associated with mortality risk. So yeah, not an either or, not anti-zone 2, not anti-cardio.
01:09:20
Speaker
But if you want to prevent a decline in muscle quality and you want to prevent sarcopenia, a loss of strength and power, you absolutely need to resistance train. Yeah. It's a yes and, not an either or. Yeah. It's a yes and. Yeah.
01:09:33
Speaker
So to recap, type two fibers, the fibers that govern strength and power, these are, you can think of them as being energetically expensive tissue, right? And also like neuromuscularly expensive in the sense that they require more signaling. They require more loading. I like to think of the threshold as being the load, right? Like if it's high threshold, that means high speed, high speed.
01:09:58
Speaker
intensity, okay, maybe more accurately than to say load. Like you need, it needs to be a hard set. It needs to be a fast movement. And they require you to ask your body to produce force, right? More force, force quickly, high levels of force. But if your life never requires that, and let's be honest, if we just let technology do the work for us, like our life probably never will require it, right? Our environment is set up so that our body has just very few reasons to maintain these systems unless we actively look for opportunities, AKA exercise, AKA resistance training, to maintain them.
01:10:33
Speaker
This is not a moral statement. we're not We're not trying to sell you our programming with this, or are we? We are actually kind of. Okay, listen, it's just, it's really, it's, think of it this way. It's biology being ruthlessly practical.
01:10:46
Speaker
It's being very practical. Like, see, if you never use your high threshold motor units, if you never ask your body to produce force or produce it quickly, those pathways are expensive and they're not getting used.
01:10:57
Speaker
So over time, that system gets used less and it becomes less available and they fucking go away forever. Mitchell and colleagues in their 2012 review get into the muscle fiber side of this. One study they discuss found type 2 fiber size reduced by about 57%, while type 1 fiber shrank by up about 25% between the third and ninth decade in life, so between 30 to 90-year-olds. So the simplified version is that type 2 fibers take a bigger hit. Type 2 fibers are especially vulnerable
01:11:32
Speaker
while type 1 fibers are relatively better preserved and so vulnerable in the sense that like we got to take care of them, right? We got to give them reason to stick around. and And so, you know, what we're telling you, it kind of explains the order of losses, right? Power goes first because power depends heavily on type 2 fibers, high contraction velocity, rapid nervous system signaling, then strength declines, then muscle size may decline more visibly,
01:11:56
Speaker
but By the time someone looks frail, a lot of that functional loss has already has already happened. Like that ship has kind of sailed. And this matters because we don't want to wait until muscle loss is the obvious reason that we're intervening because by that time, it's actually pretty late in the game. That's why you shouldn't go by how someone looks. And that includes you, right?
01:12:19
Speaker
You should go by what you can do yeah and then just try to get stronger. Start with where you are in terms of your strength, which is a measurable capacity and try to improve. Yeah.
01:12:31
Speaker
So the question is, you know, can we reverse this? And the answer is, No, not on a not on a cellular level. We're seeing that once these connections to the type two muscle fibers are lost,
01:12:47
Speaker
the type 2 fiber stops being a type 2 fiber, it does not then reverse itself and go backwards, right? These are yeah biological changes. Training does not erase that, but yeah it doesn't mean abandon all hope, right?
01:13:01
Speaker
What we can and should be doing, all of us, frail or no, is strengthen the system that remains, right? Preserve more of those type 2 fibers so that we don't lose as many more.
01:13:12
Speaker
keep these high threshold motor units more accessible, improve recruitment, coordination, rate of force development, muscle size, muscle quality. We can work on all these things and and the timeline matters because if motor unit loss becomes more pronounced later in life, especially around 60, but power has actually started declining much earlier, waiting till your 70s to do something about it is not not the move. If you're 70 now, do something about it now.
01:13:40
Speaker
But if you're 60 now and you're like, i got 10 years, don't, no, you don't. yeah So not this is not to say that it's that it's ever too late, right? I see this all the time, people in their 70s, 80s, 90s getting stronger, but it gets harder.
01:13:57
Speaker
It's gonna take more effort to maintain what you have or grow what you have the older you are. So use it or lose it, but try to use it sooner so that you preserve more of what you have. so Use it so that the system stays available. So use it so that when you are in that moment, you need to catch yourself.
01:14:15
Speaker
climb stairs, get up off the floor, move quickly, generate force for unexpected reasons, your body still has access to that capacity. Yeah. Okay. So just to briefly orient us, because, you know, we've been walking through this, this evolution, right? We've gone from defining sarcopenia based on muscle mass to incorporating function to now prioritizing strength, power, performance. Okay. That's all well-established. We're going to kind of shift into like the medical world here only briefly because sarcopenia is a disease progression, right? So how is it diagnosed, right? Um,
01:14:50
Speaker
When it comes to diagnosing sarcopenia, the question is no longer just like, how much muscle do they have? Sarcopenia, yes. Sarcopenia, no. It's how does this person use their body? Can they use their body effectively?
01:15:02
Speaker
And this gets measured in a few key ways. And most ways are centered around strength and function. So first is strength. Getting a picture of how strong someone is most commonly measured with grip strength, which is very um confusing. Yeah.
01:15:18
Speaker
This is this because but so first of all, the reason is that it's simple and quick. It's surprisingly informative too, right? Low grip strength is used as a screening tool. it's ah like on a first signal that overall total body strength capacity may be reduced. But this is just this is where it's confusing. This is just a proxy measurement. It's a stand-in because it's really easy to measure grip strength. And it turns out to be a pretty accurate stand-in for getting a picture of like how strong someone's whole body is. What it does not mean is that you need to go and strengthen your fucking grip. And the number of people who have been misled to believe that is a lot.
01:15:55
Speaker
It's, oh, yes. Yes. Oh, so so so we also look at whole body function, um or doctors also look at whole body function, but tends to be more reflective, you know, I think probably more reflective of real world ability. yeah So one of the most common tests that's administered is called the chair rise tests, usually five repetitions.
01:16:15
Speaker
with no hands as fast as possible. There's also gait speed, typically measured over a short distance. um This might seem basic, but walking speed turns out to also be a pretty powerful predictor of outcomes like disability, hospitalization, mortality, and whether or not someone has severe sarcopenia.
01:16:31
Speaker
Now, beyond those, some frameworks use composite tests like the short physical performance battery, which combine these tests of balance, gait speed, chair rise, timed up and go, which is standing up, walking a distance, coming back and sitting down. um So then we add like turning, transitional movements.
01:16:49
Speaker
And some people use a screening tool called the SARC-F questionnaire, which asks about, you know, people record their difficulty with strength, with walking, with rising from a chair, with climbing stairs, their history of
Real-World Outcomes and Medical Tests
01:17:02
Speaker
falls. It's a quick test, but it does tend to be pretty good at identifying people who have already gone kind of a ways down the road of functional decline.
01:17:10
Speaker
And Across all of these, a pattern is consistent. We're not measuring tissue, we're measuring capacity. And importantly, these capacity measures are actually tied to real world outcomes. They tell us something about whether someone is at a risk of falling or fracturing or losing their independence or needing care. right If someone takes longer than roughly 15 seconds to do five sit to stands or their gait is below a certain speed, that is a reflection of how well these systems are working together in real life.
01:17:41
Speaker
And it's what actually ah determines whether someone falls, whether they fracture, whether they lose independence. why they require care, and ultimately how long they live. ah But diagnosis is messy because there isn't one universally agreed upon standard, but rather there are multiple frameworks, multiple cutoffs, combinations of tests. You might see in practice a mix of strength measures, walking ability, chair rise, stair climbing, fall history.
01:18:06
Speaker
um So not they're not perfect, but they do tend to catch people once the problem is already ah pretty fairly advanced, um which yeah I think is is is an important point to make, which is that ah diagnosis is less important than starting to do something about it. Right.
Primary Treatments for Sarcopenia
01:18:27
Speaker
that The treatment, the quote unquote treatment for sarcopenia is not risky. It's not rare. It's not specialized. It's not a drug. It's the same foundational things we already know we need to improve health, strength training, regular physical activity, adequate nutrition. They're low risk, broadly beneficial, the boring basics.
01:18:46
Speaker
So waiting for
Importance of Early Preventive Measures
01:18:48
Speaker
a formal diagnosis of sarcopenia doesn't make sense. And if you're at a level where you're going to receive that diagnosis, you're already pretty late in the game, right? You've probably already lost a meaningful amount of capacity and how that is then impacting your ability to live independently.
01:19:03
Speaker
Yeah, don't wait to be diagnosed with sarcopenia to start doing something about it. yeah start Start now if you haven't already. um 40s, 50s, sooner, right? if you're if your Our demo is forty s and up, but like listen, if you are the rare 20-year-old listening, like you you start now.
01:19:19
Speaker
Start now. Okay. It's a slow process, but it's happening in the background and what you do over a long period of time consistently, right? Determines how much capacity you keep. We just talked to ah Dr. Phillips, Stu Phillips today. This is our second podcast recording session in one day. And and we kind of landed on the the fact that like everything that gets talked about and discussed and debated in exercise science is like, okay, fine, great, awesome. But the thing that actually is the real kicker is the real thing that's going to move the needle that's going to make the biggest difference for 95% of people is just consistently... doing
Role of Resistance Training in Prevention
01:19:59
Speaker
the exercise, like doing it consistently. Consistency is the key. um
01:20:05
Speaker
And so start now and be consistent with it. yeah For sarcopedia, prevention strength training is the primary tool. Yes, nutrition matters, but you can't protein yourself out of muscle weakness. You must resistance train. Yep. We talked in our ACSM episode two episodes back from this one, and we we speak frequently in that episode about different ways to train, right? Higher velocity training where you're trying to move quickly tends to be especially helpful for improving power and reducing fall risk. Lower velocity training is still very effective for building strength and muscle. You know, it's not an either or, but the key idea here is that you you need to be consistently asking your body to produce force.
01:20:43
Speaker
and sometimes maybe produce force us quickly because that's the system that declines when you don't.
Progressive Stimulus in Training
01:20:50
Speaker
And the consistency piece is so huge because once is never, right? A couple of times is never.
01:20:56
Speaker
you know, every week is something. Yeah. Ideally twice a week, right? And so this brings us full circle. we start We started by talking about sarcopenia as a loss of muscle, what we're really concerned about is this loss of ability, this loss of capacity. and And the extremely good news is that at any age, this capacity is highly trainable, but you actually have to freaking train it. Less talking, more doing.
01:21:24
Speaker
Maybe you are doing it while you listen to us talk about it. We hope you are, like do it. yeah That's the key. You got to do it. do it All right, so if we're gonna look at what kind of exercise we should be doing to combat sarcopenia, we've already answered this question, but it does bear repeating. If all exercise is good, is all exercise enough to preserve the specific things we actually care about?
01:21:46
Speaker
No, we must resistance train to combat sarcopenia. There's no ifs, ands, or buts about it. And that includes training the capacity of strength and training the capacity of power.
01:21:59
Speaker
but how do I go about this? right Well, you don't need to train like an athlete or go from zero to maximal effort overnight. And in fact, if you try to do that, that's a really good way to fail completely and give up. And not be able to train for like maybe a couple of weeks. Forever, or just be like, oh, that was horrible. I hated it. It was too hard. I couldn't do it. Exercise is not for me. like That's the worst outcome of all. yeah yeah We want to avoid that. Yeah.
01:22:22
Speaker
So you got to give your body some amount of stimulus. right You need to give your body a reason to maintain the capacities or improve the capacities that are most vulnerable to decline. right So the best place to start is with what we call a minimally effective dose, right something that's challenging enough to create a signal to your body, but still manageable.
01:22:46
Speaker
And then from there, you progressively increase that dose over time. It might be more load. It might be more effort. It might be more workouts per week. Progressive stimulus. Progressive stimulus. so remember the Remember the cool term we learned from Dr. Phillips? do remember. And if you'd shut up, I was about to get there. What is it called? um ah Not a spoiler. It was kind of a spoiler. What did I do? it ah yeah stole your thunder. I stole your thunder. Give me my thunder back.
01:23:13
Speaker
So ah when we were talking with Dr. Stu Phillips, he, he, and we were talking about progressive overload, he started talking about like, instead of thinking of it overload, meaning load, that actually what we want to progress is just the stimulus. And so the stimulus could be the load, right? The actual weight, but it could also be the number of sets you are doing, the number of repetitions you're doing, the number of times you work out per week, the, you know, range of motion you're doing in each left. Like there's a lot of different ah elements that go into progressing something, right? But we want to maintain this progression in whatever capacity, because that's how we get the most response from our body.
01:23:53
Speaker
how does How do we do that and live for longevity, Laurel? I'm just going to casually crowbar our product into this conversation. We do that. Don't we talk about that now? Yeah. Well, so we, we start our students slash lifters with a volume that we are now quite confident because we've done this course like five or six times that they will adapt positively to yeah every once in a while. An individual will say like this or this or this is cropping up. It's a lot of times it's around hands and elbows, right? Like, Because if they haven't lifted it at all, they start picking up weights for the first time twice a week. We do two sets of every exercise, six exercises per workout. So it's fairly low volume, but it's like an appropriate amount for a beginner. There might be for some folks that might be a little too much for just their hands, their grips. So then we adjust for just those folks. Some folks um are like, is this all? Should I be doing more? And to those folks who were are like, well, have you strength trained before? What's your history? And if they're like, no, I'm new to it, we're like, yes, it's enough. yeah And then my my second question is often like, you know, if they ask this in like month after month one is over, month two is, you know, halfway through, I'm like, are the numbers going up? Like, are you actually lifting heavier weights for, you know, similar rep ranges that are like, yes. I'm like, I'm like, okay, so you're making progress with two sets per exercise. And they're like, yes. I'm like, well, then why would we change anything? Right. Because that
Balancing Exercise Volume and Intensity
01:25:17
Speaker
is a sign that whatever it is you are doing is making the change that you're seeking. So, and is appropriate for you. it ain't broke, if it ain't broke, don't fix it. yes I think too, like some people just are used to feeling destroyed after every single workout and they're like, I don't feel destroyed, but I'm getting stronger.
01:25:31
Speaker
How does this work? How is this possible? Yeah. I just remember someone asking one time, like, you know, cause we talk about the importance of rest between sets. And i remember somebody being like, should I be doing like jogging in place? I'm like, no.
01:25:43
Speaker
Yeah, exactly. Cause we're not trying to like maximally exhaust you all the time. That's not how strength training works. Yeah, exhaustion is not the capacity we're seeking. Exactly. Don't don't confuse fatigue for the stimulus. Right, right. And for the adaptation we're seeking, right? You can actually get the adaptations you want. You can reach the goals you have without feeling like the workout almost killed you. Right. Believe it or not. You can even have energy after the workout for like a nice brisk long walk. Right. Believe it or not. um and And the strength training that you did do that didn't destroy you is actually strength training.
01:26:18
Speaker
It's not cardio with weights, which tends to be less effective at actually making you stronger. Okay. It's not bad. It's not, I'm not anti-orange theory, but if you actually want to like really make a dent in your strength, really send a strong signal, a strong message to those type two fibers, like we need you. Strength training where it's at. yeah um Additionally, we do all occasionally have students who sign up who actually do have a fairly long history of strength training and they maybe just want to learn barbells right and so for those folks we actually tell them to do three sets instead of two right because we don't want we don't want them coming in and doing like much much less volume right than what they had been doing because that could result in them actually backsliding a little bit Again, I still don't really think that that's likely with regards to like those people coming in and learning barbells for the first time because they're they're making completely new connections in their body yeah coordination-wise to these very different exercises that now involve a barbell. So
Dispelling Exercise Misconceptions
01:27:16
Speaker
honestly, for the most part, we just tell people to trust the process. yeah And that is some of the best advice we give, which is just trust the process. Once is never. This is not a week-long program. This is not something you're going to do once.
01:27:27
Speaker
and see if This is something you would stay with us for six months and do twice a week. yeah That's actually what makes the change. yeah Yep. It's consistency. So Sarah, oh yes how does this progression happen in PowerPlay, our other course? I'm so glad you asked. Well, ah the way that it happens in PowerPlay is we, for, what are there, nine exercises, 10 exercises, something Nine exercises. We have a progression through all of them from basically easier to more challenging. And then they're all represented in these workouts, right? So some of the workouts are shorter, some of the workouts are a bit longer, some variations are easier, some variations are harder. It's a little more self guided in the sense that like you're going to pick the variation that works for you to then do as your workout, but you're going to see things change where you notice that like, it's not as hard to produce the effort involved, or you're able to change to a slightly harder variation now, right? So That's sort of that um progressive stimulus idea, even more so than like just adding load, right? Because we're saying like, well, you're noticing the quality of what you're doing and you're noticing how fatigued you are afterwards, how much time you need to recover, all of that. And then you can progressively make it challenging for you. But you always have to start where you are yeah and not try to start where someone else is, right? Yeah, or where you think you should be, which I think is very common. like People are like, I used to be able to do this when I was 20 and I haven't done it for 35 years, but let me just ah try to get to where I think I should be. It's like, no, no, What do you mean it's not going to be the same as 35 years ago Yeah. um So you want to have end avoid both ends of the spectrum, right? You don't want to underdose where the effort of the load isn't high enough and you don't get adaptation. We see this happen a lot to older women.
01:29:15
Speaker
It's very irritating. I had a woman come into the clinic one time when I was still working there who was on a program that was actually making her weaker. And, and she was supposedly a fall risk and all this kind of stuff.
01:29:27
Speaker
I watched her move a little bit. I watched her doing some of these exercises with the stupid yellow two pound dumbbell. And I was like, does this feel like anything to you? And she looked at me and she's like, not really. So that's deeply irritating to me that people just make these assumptions.
01:29:40
Speaker
about, you know, you're this age, therefore you can only lift this much. But the flip of it is if you overdose, right? If you think that working out looks like this, feels like this, right? You do too much intensity, too much volume too soon, you potentially accumulate fatigue faster than you can recover from. And that can set you back either by an injury possibly, or you then for like four days following are so sore that you can't work out. And you're like, well, what is the point of this? i can't be consistent. It's too hard, right? Yeah. So especially if you're deconditioned or you haven't engaged in these types of exercise of strength training or power training, the goal is to find the balance where it's enough challenge that over a little bit of time you're seeing change happen, but not so much challenge that you can't keep doing it.
01:30:26
Speaker
Exactly. Yeah. That Goldilocks, right? Right. That really sweet spot. Yeah. And now this is also where we need to be really clear about what kind of exercise simply will not be enough of a stimulus by the nature of the way the exercise is done for the goal, right, of of preventing sarcopenia, which is a loss of type two fibers and a reduction in neuromuscular circuitry and ability and also loss of muscle mass. We get some hate for this, but listen, this is this is research supported, right? Yoga is not enough.
01:31:00
Speaker
Pilates is not enough. Walking is not enough. And cardio is not enough. And the reason is that these activities likely rely more on type one fibers.
01:31:13
Speaker
None of them, except for maybe cardio and maybe some walking is done quickly. So we're not getting the type two fibers that way either. It's the velocity is not fast enough in yoga and Pilates. The loads are not ah high enough. The sets, there are no sets, right? take Taken to a challenging enough level.
01:31:31
Speaker
We're not saying that these forms of exercise aren't incredibly beneficial. We're also not saying they're a terrible place to start. Okay. But if you want to continue to send the signal to those type two fibers and to have more of them stick around for longer, these are not the ways to do it. Yeah.
01:31:45
Speaker
okay these are great ways to work on other things but not the prevention of sarcopenia and the maintenance of strength and power yeah i like to think of it as being like not loud enough right your type 2 fibers need to be shouted at it's not loud enough and no even if you wear a weighted vest it's not fucking loud enough ah So this isn't good v bad movement. um it's It's also not a message that like women should never do yoga or their bones will turn to chalk or whatever. Like screw that too, because that's also, I think, just like creating more dogma. it's It's about understanding what each type of exercise, what each type of movement actually does well, and then what it doesn't do, and then making sure that somewhere in your week,
01:32:26
Speaker
regardless of all the different types of exercise you like to do or even predominantly like to spend your time doing awesome but can you make space twice a week to work on strength and power yes that's going to make the difference yeah so there is a reason the cdc suggests muscle strengthening twice a week there's a reason that the acsm um guidelines updated now say strength train twice a week you need to send the signals those type 2 fibers stick around yeah and it's It's better if you send it twice a week than it is if you can send it once a week. Great.
01:32:53
Speaker
Better than zero times a week. The best is twice a week. So now that you have a little bit more background about why we say these things, right? It's not just that we're like haters.
01:33:04
Speaker
I'm saying it because I'm a hater. I don't know why you're saying it. No, I'm kidding. saying it We're saying it because it's it's based in science. yeah It's based in research and it's been known about for a long time. And I've said this before as well, but also, you know, we both come from the world of yoga. And as we're seeing our colleagues and our peers and our, you know, fellow yoga practitioners, grow, grow, get older, I guess, is i they're not really growing, they're getting older as we are. They're growing older. they' grow Exactly. they're I knew grow was going somewhere. We're we're all growing older. and Yoga is great. Pilates is great.
01:33:38
Speaker
Walking is great. But very often when I see people, that's what they're doing, women in particular. And and i'll so I'll ask them, you know what it what kind of exercise do you regularly do? And they'll tell me. And it it'll be just like you know walking, Pilates, yoga, hiking, you know all these kind of low load you know ah activities. And and the the missing thing.
01:33:59
Speaker
puzzle piece is always some kind of resistance training. I point that out to them as as part of the reason why I want them to start resistance training. I'm like, you've got a whole, you're doing lots of other exercise, which is great, but not every exercise covers everything, right? And so we've got to get this resistance training in. There's also a dose of certain types of exercise modes at which you stop actually improving. So maybe like instead of walking 15,000 steps, right walk, sure, 10 if you like that number, or eight or seven, and spend the rest of the time you would have been walking the additional 8,000 steps strike training. Exactly. Right? Because you're going to probably move the needle more in terms of your health and
01:34:39
Speaker
and longevity and ability to live independently and also prevent injury. Yeah. If you actually take
Course Promotion and Trained Programs
01:34:45
Speaker
some of the time that you're like, maybe just kind of topping off at a maximum amount you reached like 8,000 steps ago and really put your time and energy toward like making big, big improvements in this other area. Yeah. ah Well, and with that, we hope this episode inspires you to continue to use those systems that determine whether you can catch yourself when you trip, whether you can get up off the floor, whether you can lift heavy things and put them up on high places where you can stay independent. Ultimately, whether you maintain the capacity to live your life the way you want to in your older years.
01:35:24
Speaker
Right. Yeah. Maybe after listening to this, you'll also decide that you should sign up for our course power play, which cart opens in a few days. It's $99. Can't beat it. $99. $99 in a lack of power. Ain't one. And maybe you also consider possibly getting on the wait list for lift for longevity, which we are starting. We haven't decided on the day yet, but sometime in September. Sometime in September. That's what decided. Sometime September. um Yeah. So there you go. There you go if you If this conversation made you think, well, I should probably do some resistance training or some of this power business, what an incredible coincidence we have offerings under both of those headings for you.
01:36:03
Speaker
Who'd have thought? Well, thank you all for joining us. We will see you in two weeks. Rate, review, subscribe. Oh yeah, do that. Help help help some sisters out. yeah We've got some enemies in the in the reviews. They don't like us because we're mean. We're mean to venture back capitalist companies preying on women's vulnerabilities and menopause. We're such meanies. We're mean to billionaires. bad man So much hate. man Okay, rate, review, subscribe. you in two weeks. See two weeks.