Staying Strong After 65: Sarcopenia, Falls and Load Tolerance

What Sarcopenia Is

Sarcopenia is now described as a muscle disease, or muscle failure, rooted in adverse muscle changes that accumulate across a lifetime. It is common in older age but can occur earlier. The revised European consensus places low muscle strength at the centre of the definition, uses low muscle quantity or quality to confirm the condition, and treats poor physical performance as a marker of severe sarcopenia (Cruz-Jentoft et al., 2019). The Australian and New Zealand consensus guidelines recommend adopting this definition locally (Zanker et al., 2022).

Strength, rather than size alone, is the key concept. Formal measurement is needed to identify it, and that sits with a doctor or other relevant health professional, not with how a person looks.

Why Falls Matter and What Reduces Them

At least one-third of community-dwelling people over 65 fall each year. A Cochrane review of 108 randomised trials found high-certainty evidence that exercise reduces the rate of falls by 23%. Programmes centred on balance and functional exercises reduced falls, and programmes combining several types of exercise, typically balance and functional work plus resistance training, probably reduced them as well (Sherrington et al., 2019).

The review was uncertain about the effect of resistance training on its own, so strength work is best seen as one part of a broader programme that includes balance challenge. Where adverse events were reported, they were mostly minor and musculoskeletal in nature.

Load Tolerance Can Be Rebuilt Gradually

Muscles and tendons keep adapting to load throughout life, but tolerance is easily lost with inactivity or a layoff from injury or illness. The Australian and New Zealand expert panel gave its strongest support to a healthy lifestyle and to offering tailored resistance training to people with sarcopenia (Zanker et al., 2022). Tailored is the important word: starting level, progression and exercise choice depend on current strength, joint pain, medical conditions and medications, which is why an individual assessment is advisable before beginning or restarting a programme.

When to Seek Medical Review

A GP should review a fall that causes injury, a fall with a head knock, repeated falls, blackouts or dizziness, or new unexplained weakness. Unintentional weight loss, sudden severe back pain or bone pain after minimal trauma, new numbness, or loss of bladder or bowel control also need medical assessment rather than an exercise plan alone.