Are You Strong Enough?
Why Muscle Mass & Strength Are Essential To A Long & Healthy Life
Muscle mass and strength are major determinants of how long you will live and the quality of your life as you age.
If you want to be able to do the things you wish to do when you are older, you will need the strength to do so.
If living longer but with a poor quality of life concerns you, strength and muscle mass need to be a priority.
Not in several decades’ time.
But today.
Up to age 50, muscle mass and strength typically do not limit your quality of life.
Sure, being stronger or having more muscle mass would make some things easier, but most people at age 50 can get by just fine.
After age 50, that changes. And changes fast.
If you are of average strength and muscle mass now, you will likely be of average strength and muscle mass in your 80s or 90s. I’m not sure if you have seen many 80 or 90-year-olds recently, but that’s not the average I aim for.
Sure there are outliers, but they are the exception rather than the rule.
With less than 20% of those over 80 being able to stand on one leg unassisted for 10 seconds, that doesn’t sound like a good indicator of being able to do all the other things in life that you had hoped to do1. Even more alarming is that 50% of 71-year-olds are unable to complete this task. So don't think that this is an issue only for the octogenarians among us.
If you want to do more than most 80 and 90-year-olds in the future, you will need to aim for more than ‘average’ today.
“If you want to be a kick-ass 90-year-old, you can’t settle for being an average 50-year-old.”
The issue is that you are already losing ground and probably don’t even know it.
Strength & Muscle Mass.
Between 60 and 90, males will lose approximately 33% of their muscle mass, and females will lose about 26%2. Between 20 and 80, most people will lose 35 to 40% of their muscle mass3. Initial muscle mass changes are subtle but become dramatic in later decades.
We see a similar pattern in terms of muscle strength, with males and females losing approximately 42% and 31%, respectively, after age 404. Again, the changes in strength in your 40s are unlikely to be an issue, but by the time you hit your 70s and 80s, the loss of strength can be a major limiting factor in doing simple things like getting up from a chair or off the floor if you fall.
Why is the loss of muscle mass and strength important?
Because a decline in these metrics is life-threatening.
Simple as that.
Individuals with low muscle mass are 86% more likely to die compared to those with higher muscle mass5.
For those with low muscle strength, the impact on mortality is even greater, with those in the low muscle strength group over twice as likely to die6.
Interestingly, this was regardless of whether they had high muscle mass, suggesting that muscle strength may play an even more important role. However, as a general rule, it is very hard to have high muscle strength without a significant amount of muscle mass.
One of the easiest ways to assess an individual’s strength is to measure grip strength.
The relationship between grip strength and mortality is clear.
For every 5kg loss of grip strength, the chances of an earlier death increase by 16-20%7.
Similar relationships exist with the number of push-ups a person can do or, as mentioned above, whether one can stand on one leg unassisted for 10 seconds. It’s not that grip strength or one-leg stands are the key to living longer; it’s that they are simple measures that reflect a loss of muscle strength overall.
Individuals with low grip strength are significantly more likely to have issues with simple quality-of-life measures such as walking, self-care and carrying out normal activities of daily living8.
Remember what our goals are here?
What do I want to do in my last decade of life?
Get up off the floor unassisted.
Carry my travel bag through an airport unassisted.
Walk without limitation through a city.
Do household activities such as carrying groceries.
Walk up two flights of stairs with ease.
I am not planning on setting a deadlift record in my 80s, but I do plan on being able to lift my carry-on bag into the overhead bin of an aircraft.
That is what I am aiming for.
Now ask what you are aiming for.
If you know what you aim to do in your 80s and 90s, you can work backwards to see where you should be today.
Most people will want to be above average in their final decade, so you must ensure you are above average in your current decade. Even though strength training can slow the loss of muscle mass and strength, it cannot eliminate it entirely.
So how can you assess where you currently stand compared to the average?
Grip strength can be easily measured using a grip strength dynamometer.
Muscle mass can be assessed in various ways but one of the most accurate ways is by DEXA scan.
There are many ways to assess both muscle mass and strength but what is essential is you benchmark the result against your age and sex-matched peers, and if you are currently below where you wish to be you engage in a strength training regime to improve your metrics.
Building muscle mass and strength later in life is possible, but having invested in these metrics throughout your life will ensure that you are more likely to live a longer life of higher quality.
Low muscle mass or strength does not guarantee a poor quality of life in your final decade but appropriate muscle mass and strength can give you the opportunity to do the things you wish you could.
Only you can decide what those are.
Only you can do the work necessary to get you there.
Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals British Journal of Sports Medicine Published Online First: 21 June 2022.
Nutritional influences on age-related skeletal muscle loss. Proc Nutr Soc. 2014 Feb;73(1):16-33.
Age-related sarcopenia in humans is associated with reduced synthetic rates of specific muscle proteins. The Journal of nutrition. 1998;128:351S–355S.
The Changes of Muscle Strength and Functional Activities During Aging in Male and Female Populations. International Journal of Gerontology Volume 8, Issue 4, December 2014, Pages 197-202
Sarcopenia as a predictor of all-cause mortality among older nursing home residents: a systematic review and meta-analysis. BMJ Open 2018;8:e021252.
Associations of Muscle Mass and Strength with All-Cause Mortality among US Older Adults. Med Sci Sports Exerc. 2018 Mar;50(3):458-467.
Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants BMJ 2018; 361 :k1651
Relationship between low handgrip strength and quality of life in Korean men and women. Quality of Life Research. Vol. 27, No. 10 (October 2018), pp. 2571-2580
Very similar in a lot of ways to attia but Paddy's posts are much easier and simpler to understand and therefore more useful. No need to spend 2 hours going through the ATP pathways :) Keep it up Paddy Im a Dr and a big fan of yours. Have forwarded your posts to anyone who will listen.
Seems that you should have quoted Peter Attia when you used his words about being a "kick-ass " 90 year old - just sayin'