Opinion: resistance exercise and dietary protein are key components in lessening the amount of frailty in older adults 

By Mary Ní Lochlainn, St Thomas’ Hospital London

Populations worldwide are ageing and Ireland is no exception. It has been predicted that the number of over 85 year olds in this country will multiply by five by the year 2041. While increased life expectancies are generally a cause for celebration, many are concerned about the fact the time spent living with disability or "frail" is also increasing. Data from the Irish Longitudinal Study on Ageing (TILDA) shows 45 percent of people over 65 are either frail or pre-frail  Societies need to consider how we can deal with the increased number of frail people and we also need to consider what steps we can take to reduce frailty in the population. 

A key component of frailty is muscle health, which affects physical functioning. We lose muscle as we grow older for a variety of reasons and some lose more than others. Older people lose more muscle than younger people with a period of bedrest for example, and can also take longer to retrain after being immobilised.

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From RTÉ Radio One's Ray D'Arcy Show, Sarah Harper, Prof of Gerontology at Oxford University, says we have to reform our thinking around old age

The loss of significant amounts of muscle in older age results in a condition called sarcopenia. Older people with sarcopenia have a higher risk of osteoporosis, fractures, disability and death, so finding ways to prevent this is a crucial area of interest for researchers in this field. Not everyone develops sarcopenia, but gradual muscle loss occurs even in so-called healthy ageing. Frailty and sarcopenia overlap but are not exactly the same thing. Sarcopenia is specific to muscles, whereas frailty is more of an overall picture of the person.

In order to prevent sarcopenia, the best form of exercise to do is resistance exercise such as squats, weight lifting, push ups etc. The weights can be as small as necessary and all exercises can be adapted to an individual’s level. This is opposed to aerobic exercise, such as running, swimming, walking etc (what many people refer to as cardio exercises). While most people are aware of the many health benefits of exercise, fewer are aware of the importance of protein in order to preserve healthy muscle function - and not just for bodybuilders!

In order to overcome anabolic resistance, older people need to eat more protein than younger people

Large studies have shown that those who eat less protein are more likely to lose more muscle and to become frail. Those who eat more protein tend to have a better health in a variety of ways. Interestingly, older people have been shown to require more protein than younger people just to get the same reaction in their muscles.

This is called anabolic resistance and we do not fully understand why this happens, but is likely to be a combination of a number of different factors. We are currently developing a study within our cohort of older twins to try and assess whether the gut microbiome may play a role in anabolic resistance. We know the gut microbiome is important in physical health and in our immune function, among many other bodily processes, so perhaps it is a factor here too.

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From RTÉ Archives, Alasdair Jackson reports for RTÉ News in 1983 on a 100th birthday party for Cavan woman Mary Ann Henthorn who attributes her longevity and good health to eating porridge for breakfast every morning (oats do contain more protein than other grains)

In order to overcome anabolic resistance, older people need to eat more protein than younger people. The Recommended Daily Allowance (RDA) for adults in Ireland and around the world is 0.75g/kg/day. An international group of experts have advised a higher RDA of 1-1.2g/kg/day for older adults (age 65+).

This is another reason why the food pyramid is wrong. For example, a person over 65 years old weighing nine stone (57kg) requires about 60g of protein/day. A typical skinless cooked chicken breast (weighing approx. 180g) contains 54g of protein and then a large egg contains 6g which would make up 60g for the day.

Seitan is one of the best protein sources for vegans/vegetarians with 200g containing 50g of protein. Other options are lentils, green peas, quinoa and spirulina. The unfortunate truth is that despite needing more, people tend to eat less protein as they get older. This is for a variety of reasons, as shown in this visual.

Factors leading to lower protein consumption in older adults

While more research is needed to fully understand anabolic resistance, consider the amount of protein in your diet and in the diet of your older loved ones in the meantime. Consider adding a few eggs here and there - followed by some squats!

Dr Mary Ní Lochlainn is an Academic Clinical Fellow in Geriatric Medicine at St Thomas’ Hospital, London


The views expressed here are those of the author and do not represent or reflect the views of RTÉ