Quote: “In movement, there is life” – Aristotle
“Genius starts with the abs Max” – The Grinch
Muscle is your bodies bank account. It is the currency of life. It is biological gold.
Why Do People Need Nursing Homes?
As a hospitalist I frequently have to place people in nursing homes
. I estimate that the reason why >90% cannot live at home anymore…….NOT ENOUGH STRENGTH. Think: needs help standing, needs help walking, unable to go up steps, unable to lift a dinner plate, etc. Additionally, I have noticed that as soon as muscle goes, cognition follows. Want to maintain your independence as you age? Start by maintaining your physic (aka – muscle)
Most people are concerned about having enough money for retirement. But, what people should be concerned about is having enough muscle. No-one can give this to you. It must be earned over years and decades.
You cant just talk about it, you have to do it. – Arnold Schwarzenegger
Strength peaks in our late 20s and early 30s. After this it declines by about 1-2% per year in most people. This decline is accelerated in the last 1 or 2 decades of life as we literally wither away.
Functions of Skeletal Muscle
- Movement
- Posture, Stability, and Joint Health
- Metabolic Health
- Neurological and Brain Health
- Store of Nutrients and Protein
- Heat Production
- Circulation (particularly venous)
- Protection and Padding
- Communication (facial expressions, posture, gesturing, etc.)
- Attraction and Reproduction
Did you know:
The best way to prevent dementia is physical exercise.
Movement is a form of intelligence an IQ test does not measure. Think about the athlete that cannot speak well and struggles in school, but they are brilliant on the field. Does this athlete lack intelligence. Not at all, athleticism is intelligence. In fact, almost 50% of the brains tissue is in some way utilized for movement. Half our brain is for movement!
What Goes into Movement (simplified)
1. The frontal cortex of the brain decides to move part of the body
2. The motor cortex and other parts of the brain initiate this movement
3. The cerebellum, deep cortical structures, and brainstem fine tune coordination and recruitment of the right muscles.
4. Signals travel down the spinal cord from upper to lower, and then peripheral nerves
5. Specific muscle fibers get a signal to contract from these peripheral nerves
6. The eyes, sensory nerves, vestibular, and other sensory systems interpret the movement and help the brain plan for the next sequence of events.
Notice how much of the movement process is brain and nerves. But
Its not a tumor. – Arnold Schwarzenegger
What to Focus On As You Start Moving More
- Start increasing movement slowly. Assure form is good, Avoid injury. GET HELP (Trainers, PT, OTs, etc.)
- Seek out of variety of movements and activities. Participating in multiple movement activities is better than focusing on just 1. Think more muscle groups, more parts of the brain, more plasticity. 3 sports is better than 1.
- Focus on moving muscles through their full range. Focus on time under contraction. Focus on eccentric and concentric motion.
Eccentric: Contraction of muscle while the muscle is lengthening. Think lowering into a squat or walking down a hill.
Concentric: Contraction of the muscle while it is shortening. Think pushing up from a squat or walking up a hill.
Its Simple, the more you train, the better you get. – Arnold Schwarzenneger
Great New, The More You Use Muscles, The Stronger and More Efficient they Get
The body is awesome. The more we use it, the better it gets. Go to school, you get smarter. Go to the gym, you get stronger. Sadly the opposite is also true. Use it, or loose it. People that keep moving, keep moving. As I tell my hospitalized elderly patients struggling to get out of bed, people who stop moving eventually stop moving forever. But as we discussed above, moving will not only help your muscles, it will also help your brain and nervous system. FORCE YOURSELF TO DO NEW THINGS, CONSTANTLY CHALLENGE YOURSELF, SEEK OUT A VARIETY OF DIFFERENT MOVEMENTS and POSTURES, and you will thrive.
Think about that old person. They are rigid of both mind and body. Think about the young flexible person (e.g. new intern on the job). Being flexible (or plastic, able to change), like movement, are characteristics of youthfulness. So do new movements, new things, and be willing to change your mind throughout life.
The pain you feel today will be the strength you feel tomorrow – Arnold Schwarzenegger
Public Enemy #1 and 2
Chairs – we are casted in the shape of chairs as we age. Eventually all we can do is sit in a chair. Try and spend a lot of your day in postures other than chair pose.
Cars – walking is a game changer. Good parking is killing you. We need to engineer cities for more walking. I cant stop thinking about people circling the Walmart parking lot just to get 50 feet closer……
Societies can engineer better solutions. In Okinawa Japan, sitting on the floor is normal.
In Singapore, cities have been engineered to encourage walking. In both of these places, people live a lot longer than in the United States.
Cliff of Old Age
If I show you a middle age person versus and elderly person, it is easy to see the difference. Frailty, muscle wasting, loose skin, bruising, and rigidity are the marks of the elderly. But when does this transition occur. For most people it happens in their mid-70s. During middle age, putting on muscle is relatively easy and the body can recover from injury. During the elderly years, increasing muscle mass is almost impossible. At best, with diligent training, elderly people can just maintain what they have. So, take advantage of early and middle life by packing on strong muscles that have a variety of experiences (think multiple sports, postures, and capabilities). This muscle and movement ability is your biological bank account. It is the real gold you are seeking. The more muscle and movement reserve you have when you hit elderly years, the higher you will be on the cliff, and the further you will have to fall before your life sucks. And I mean SUCKS. Think, I need help to stand, I cant travel, I am being placed in a nursing home, My brain is in decline. NOT GOOD.
Diagnoses Associated with Low Muscle and Strength
Fragility – state of vulnerability, in this case physical
Debility – weakness, frailty, lack of strength (perhaps my most common hospital diagnosis)
Sarcopenia – loss of skeletal muscle mass, strength, and function
Protein Calorie Malnutrition – inadequate intake of protein. Causes cachexia (muscle wasting) and sarcopenia.
The elderly are at the highest risk for these things. All of these are huge risk factors for disease, infection, and death. But the process often begins decades before these problems are formerly diagnosed.
Everybody pitties the weak, jealousy you have to earn. – Arnold Schwarzenegger
Sarcopenia
- Sarx (Greek for flesh or muscle) + penia (Greek for poverty or lack)
- Loss of muscle mass, strength, and function
- Age is the greatest risk factor (loss of hormones like estrogen and testosterone, decreased protein synthesis or muscle building, and reduced nerve function all contribute)
- Physical inactivity, illness, injury, bedrest, malnutrition, and inflammation are other causes
- Low strength, muscle wasting, reduced speed, and eventually inability to perform ADLs (activity’s of daily living) are the hallmarks
- Sarcopenia is when your biological bank account is running out.
- Researchers are seeking to drug this. But movement will remain very important even when efficacious drugs become available. Muscle without training is just meat. Just as:
Talent without training is nothing – Luke Skywalker (The Mandalorian)
When Debility Happens You Will Need:
- Care Givers
- Assisted Living Facilities (ALF)
- Long Term Care (nursing home)
- Help from everyone you know.
In this light you will become less useful and more of a burden on other people and society. I am happy we have these facilities to take care of our debilitated elderly. In my job as a hospitalist, I absolutely depend on these facilities. But if longevity is your goal, take action now to avoid needing these things for as long as possible. Action starts in childhood.
Summary
- Muscle is biological gold. It gives us movement, keeps us metabolically healthy, and feeds the brain.
- Strength peaks in the late 20s and early 30s. After this, it declines 1-2% per year in most people
- Most people fall off a cliff in their mid-70s and start loosing muscle rapidly. During this time, adding on more muscle becomes nearly impossible
- Entering old age with adequate muscle and movement reserve are essential for maximizing longevity and remaining useful.
- Seek out different types of activities that activate diverse muscle groups through full ranges of motion and different amounts of time under tension.
You cant be afraid to fail. It’s the only way you can succeed. – Arnold Schwarzenegger
Next time we are going to talk about DEXA Scans.
Ill be back.Hasta la Vista, Baby – Arnold Schwarzenegger
References
- Cho MR, Lee S, Song SK. A Review of Sarcopenia Pathophysiology, Diagnosis, Treatment and Future Direction. J Korean Med Sci. 2022 May 9;37(18):e146. doi: 10.3346/jkms.2022.37.e146. PMID: 35535373; PMCID: PMC9091430.
- CHATGTP for Deadlift Record Holders
- Wang YC, Bohannon RW, Li X, Sindhu B, Kapellusch J. Hand-Grip Strength: Normative Reference Values and Equations for Individuals 18 to 85 Years of Age Residing in the United States. J Orthop Sports Phys Ther. 2018 Sep;48(9):685-693. doi: 10.2519/jospt.2018.7851. Epub 2018 May 23. PMID: 29792107.
- Wikipedia – Muscle, Sarcopenia
- Tataryn N, Simas V, Catterall T, Furness J, Keogh JWL. Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Med Open. 2021 Mar 8;7(1):17. doi: 10.1186/s40798-021-00306-w. PMID: 33683497; PMCID: PMC7940464.
- Roig M, O'Brien K, Kirk G, Murray R, McKinnon P, Shadgan B, Reid WD. The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis. Br J Sports Med. 2009 Aug;43(8):556-68. doi: 10.1136/bjsm.2008.051417. Epub 2008 Nov 3. PMID: 18981046.
- Tagliafico AS, Bignotti B, Torri L, Rossi F. Sarcopenia: how to measure, when and why. Radiol Med. 2022 Mar;127(3):228-237. doi: 10.1007/s11547-022-01450-3. Epub 2022 Jan 18. PMID: 35041137; PMCID: PMC8960583.
- My experience as a practicing Hospitalist across multiple states.
- Ruschel C, Haupenthal A, Jacomel GF, Fontana Hde B, Santos DP, Scoz RD, Roesler H. Validity and reliability of an instrumented leg-extension machine for measuring isometric muscle strength of the knee extensors. J Sport Rehabil. 2015 May 20;24(2):2013-0122. doi: 10.1123/jsr.2013-0122. PMID: 25310795.
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