Sarcopenia: how to spot muscle loss and what to do about it

The jar lid is harder than it used to be. Getting out of a low armchair needs a rock forward and both hands on the arms. Two flights of stairs now come with a pause that was never there before. It rarely arrives overnight and it almost never hurts, which is exactly why it gets filed under age and left alone.

What it actually looks like

Muscle mass starts drifting down from your thirties, and the rate picks up after sixty. Mass, though, is not the main problem. Strength falls faster than mass, and the speed at which a muscle produces force falls faster still. You can keep roughly the same thigh measurement and lose a large slice of what that leg can actually do.

So the early signs are functional rather than visual. Standing up from a chair with a shove. Walking slower than everyone else on the pavement. Carrying the shopping in two hands instead of one. Turning on the spot and feeling it wobble. When that starts, measure something instead of guessing.

Three checks you can do at home

Five chair stands. An ordinary kitchen chair, arms folded across the chest, five full stands as fast as you safely can without bouncing off the backrest. Under 12 seconds is fine; over 15 seconds is widely treated as a sign the legs are falling behind. If you cannot do one without your hands, that is a result in itself.

Walking speed. Mark out 4 metres in a hallway, start walking a couple of steps before the line at your normal pace, and time that stretch. Slower than 5 seconds is the threshold commonly used as a warning.

Calf circumference. Sit with the knee at a right angle and measure the widest part of the calf. Around 31 cm or below is a rough flag, not a diagnosis; swelling or extra weight makes the number misleading.

Grip strength needs a dynamometer and is best done by a GP or physiotherapist. The reference points usually quoted sit around 27 kg for men and 16 kg for women, but improvising it at home tends to flatter you.

Why the muscle goes

There is no single cause, just several that overlap. Older muscle responds less to the same signal: the same amount of protein and the same set of squats produce a smaller response than they did at thirty, so you need more of both. On top of that, motor units are lost with age, the fast ones first, which is why power disappears before ordinary strength does.

The second part is more mundane. There is simply less demand. Less carrying, fewer stairs, less lifting. Muscle does not distinguish between retirement and neglect — it only registers that nobody is asking anything of it.

The sharpest losses happen in short episodes that look harmless: a few days in bed with a chest infection, a plaster cast, an operation, a fortnight pottering around the house after a virus. One or two weeks of inactivity can take a noticeable bite out of leg strength, and it does not come back on its own. Our week-by-week plan for returning to training after illness covers how to claw it back.

Strength training is the part nothing replaces

Walking will not do this job. Neither will cycling, stretching, or protein on its own. Muscle is built and kept only when it is given a reason, and the reason is resistance that feels heavy.

A framework that holds up: two to three sessions a week, 25 to 40 minutes each, with at least a day between them. Five to seven exercises covering the legs (chair stands, box squats, split squats), a hinge from the floor or a raised bar, a push (wall press-ups or a chest press), a pull (band rows), and carrying something heavy in your hands.

Two to three sets of 6 to 12 reps. The load is right when the last two reps are genuinely hard and you stop one or two short of your form breaking down. Progress is boring by design: next time, one more rep or 1 to 2.5 kg more. Doing the same weight for the same reps week after week is a habit, not training.

For the first six to eight weeks strength climbs faster than size, because what improves first is how well the nervous system recruits the fibres you already have. That is normal, and it is the reason not to quit when the mirror shows nothing. The full schedule is in our piece on building strength and independence after 60, and if standing is currently the obstacle, start with the seated exercise programme. Strong legs are only half of staying upright and avoiding falls, so keep some balance work in the week too.

Protein: how much, when and from where

For older adults the working target is 1.2 to 1.6 g of protein per kilogram of body weight per day. For someone of 70 kg that is roughly 85 to 110 g. If you have kidney disease, this is a conversation with your doctor rather than a number to adopt on your own.

Distribution matters as much as the total. Older muscle responds better to a decent-sized serving than to the same total dripped through the day, so aim for 25 to 35 g per meal, three or four times. Breakfast is where most people lose: tea and toast is about 5 g, and that part of the day is effectively wasted.

In real food, 150 g of chicken breast gives around 30 g, three eggs about 18 g, a 200 g pot of Greek yoghurt about 18 g, 150 g of cottage cheese around 20 g, and a cup of cooked beans about 15 g. There is more detail on sources and timing in our guide to protein after 60.

The mistakes that speed it up

• Walking and nothing else. Excellent for the heart and the head, and worth keeping, but it does not load the legs enough. How to fit it around the rest is covered in walking as the foundation.
• Losing weight without lifting. Cut calories with no resistance work and a meaningful share of what comes off is muscle — much harder to rebuild after seventy than it was to lose.
• Recovering for too long. After an illness people wait to feel like their old selves, and the waiting stretches into months. Starting gently and early beats starting perfectly and late.
• All or nothing. Two brutal sessions, five days of soreness, three weeks off. Two moderate sessions a week for a year wins that contest without trying.

When to see a doctor

Sarcopenia develops slowly, so anything fast deserves a look. Book an appointment if you have lost more than 5 per cent of your body weight without trying over six months, if strength drops sharply over a few weeks, if you have had a fall or started fearing one, if there is weakness or numbness on one side, swelling in one leg only, or new difficulty swallowing.

It is also worth asking for a review of your current medicines, since some contribute to weakness and dizziness, and for basic bloods. Low vitamin D and thinning bone often travel with weak muscle, which we go into in the article on bones and vitamin D after 60.

The short version

• The first sign is function, not appearance: harder chair stands, slower walking, unsteady turns.
• Measure it — five chair stands over 15 seconds, or 4 metres of walking slower than 5 seconds, means act now.
• Strength training two to three times a week, 2–3 sets of 6–12 reps with steady progression, is the one component nothing substitutes for.
• 1.2–1.6 g of protein per kilogram daily, split into 25–35 g servings, and do not skip breakfast protein.
• The biggest losses happen during illness and bed rest; the sooner you start moving again, the less becomes permanent.