Association of Sarcopenia with Physical Disability in

Elderly Individuals of Lahore

Erica Alexander DPT 02163310
University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
ericaalex36@gmail.com

Highlights: activities were included to find whether sarcopenia

 Current study is a cross sectional survey to
find the association of sarcopenia with
physical disability in community dwelling
elderly individuals of Lahore.
 SarQOL questionnaire was used to find
physical disability prevalence in elders with
sarcopenia.
 The results showed a significant association
between men and women having
sarcopenia and physical disability
Abstract:
Sarcopenia is an age associated wasting of skeletal
muscles. It is a normal physiological change that
occurs as an individual grows older. To some
extent, physical strength, balance and endurance
are dependent on integrated function of skeletal
muscle tissues. So it is certain that the decline in
muscle mass may have an impact on the quality of
life, change the level of activity which were
participated in before and can even require the need
for supportive devices.
was associated with physical disability.
Results
Frequencies of physical disability and functional
impairment were calculated. 31(40.8%) men and
45(59.2%) had difficulty or disability in carrying
heavy objects e.g., large bags full of shopping,
saucepan filled with water etc. 35(29.2%) of the
elderly people reported difficulty in household
work out of these 29(47.5%) were women and
6(10.2%) were men. 36(39.3%) of the total
population under study had difficulty doing
shopping out of which 24(30.3%) women and
12(20.3%) men. 29(69.0%) men and 13(31.0%)
women had difficulty in undertaking intense
physical activities like running, lifting heavy
objects, moving furniture etc.
Conclusions
Association was found between sarcopenia and
physical disability.

Objective Key words

Sarcopenia; association; physical disability
The objective of the study is to find the association
of sarcopenia with physical disability in
community dwelling elderly individuals of Lahore. Introduction
Sarcopenia is an age associated wasting of skeletal
muscles (1). It is a normal physiological change
Methodology
that occurs as an individual grows older and
Community dwelling individuals of Lahore were
therefore, it is a natural part of aging. Muscles tend
screened for sarcopenia and 120 of them were
to build up and grow stronger from birth until
selected, aged >60, who were further interviewed
around 30 years of age but gradually start declining
regarding their quality of life from a modified
after they reach a particular high value in early
standard SarQOL questionnaire consisting of 17
adult years, mostly beginning to decline at about 45
items. All the adults were healthy and had no
years of age (2). 3% to 5% of muscle mass is lost
chronic disease or terminal illness. The questions
every decade after the age of 30. Even if the
were related to functional and physical abilities,
individual is physically active, muscle loss is still
also, questions regarding ease in performing daily
likely to occur. To some extent, physical strength,
balance and endurance are dependent on integrated
function of skeletal muscle tissues. So it is certain
that the decline in muscle mass may have an impact
on the quality of life, change the level of activity
which were participated in before and can even
require the need for supportive devices. Moreover,
a person may have difficulty leaving the home,
rising from the chair and climbing stairs. This
eventually leads to the need for long term care of
elderly people. Muscle loss can further worsen with
factors such as poor nutrition and disease (1, 3). On
an average, the prevalence of sarcopenia is 5-13%
in individuals aged 65 years and the prevalence
increases as high as 50% in those over 80 years of
age (4). In majority of the elderly population,
etiology is difficult to figure out because the cause
of sarcopenia is generally dependent on a number
of factors such as; physiological and morphological
changes in skeletal muscles, reduced number of
satellite cells, poor blood flow to muscles, loss of
motor neuron end plates, reduction in
mitochondrial protein and DNA content, and
hormonal changes. As the age progresses, there is
an overall reduction in the amount and bulk of
skeletal muscle fibers. Muscle fibers that are fast
twitch or the type 2, are responsible for generating
muscle power, are mainly reduced (5). The satellite
cells, which are the precursors of skeletal muscles,
are also diminished with aging (6). Their role is to
become activated from their quiescent state in
response to strenuous muscle work such as lifting
heavy weights, and also in response to injury.
Consequently, these changes result in decrease in
muscle strength and power. Therefore, such a
change is reflected in the function of muscle.
Another important underlying cause of sarcopenia
is poor blood flow to the skeletal muscles which is
usually coupled with disuse. Neuromuscular age-
related changes may also play a role in causing
sarcopenia. It is due to the fact that nerve cells have
a predetermined life span and the studies show that
after 60 years of age, there is a marked loss of
motor units because the number of functioning
motor units and neurons of spinal cord start to
diminish with age. Motor unit is made up of muscle
fibers and motor neuron. The neuron innervates the
fibers and its main function is to generate or initiate
movement of muscle by sending signals from
brain. As the number of motor neurons decline with
age, muscle fibers are denervated within the motor
unit and finally it results in muscle wasting or
muscle loss (7, 8). With increasing age,
mitochondrial dysfunction takes place. Muscle
mitochondria is basically responsible for muscle
contraction. But with age, the mitochondrial
proteins and DNA contents are reduced. As a result
of this, production of adenosine triphosphate
(ATP) is also reduced and eventually this leads to
the dysfunctioning of muscle fibers and finally
muscle mass loss results (9). With all the
morphological and physiological changes related
to age, as mentioned earlier, it might appear that
sarcopenia is inevitable. The consequences of
reduced muscle mass may contribute to balance
impairment, subsequently increasing the risk of
fall, and also, reducing the development of muscle
force and power. Such a condition is likely to give
rise to other comorbidities. Type 2 diabetes is one
such comorbidity to be named. However, although
muscle loss is bound to happen with advancing age,
it is modifiable with exercise and good nutrition; in
the same way as the condition can be worsened by
inactivity, poor nutrition and disease, older adults
who are engaged in physical activities and exercise
seem to have sufficient muscle mass and strength
to enable them to live independently. In other
words, it can be said that sarcopenia is responsive
to strength training and physical therapy.
Longevity of age is only appreciated if the quality
of life is good. In other words, function is counted
of more importance than mortality. With growing
aging population along with the countermeasures
against loss of skeletal muscle, thus it is very
essential to find out whether sarcopenia is related
or associated with physical disability. This study
would therefore be helpful to consider the
consequences of age-related muscle loss and take
positive steps in order to promote public health.
Methodology
Community dwelling individuals of Lahore were
screened for sarcopenia and 120 of them were
selected, aged >60, who were further interviewed
regarding their quality of life from a modified
standard SarQOL questionnaire consisting of 17
items. It was a cross sectional survey. All the adults
were healthy and individuals with chronic or
terminal disease or illness were excluded e.g., those
with cancer, kidney disease, stroke, congestive
heart failure, etc. The questions were related to
functional and physical abilities, also, questions
regarding ease in performing daily activities were
included to find whether sarcopenia was associated
with physical disability. Data was analyzed by
using SPSS version 23.

Results
Mean age of the subject was 68.02. Frequencies of
physical disability and functional impairment were
calculated. 31(40.8%) men and 45(59.2%) had
difficulty or disability in carrying heavy objects
e.g., large bags full of shopping, saucepan filled
with water etc. 35(29.2%) of the elderly people
reported difficulty in household work out of these
29(47.5%) were women and 6(10.2%) were men.
36(39.3%) of the total had difficulty doing
shopping, 24(30.3%) women and 12(20.3%) men.
29(69.0%) men and 13(31.0%) women had Figure 2: Association between sarcopenia and
difficulty in undertaking intense physical activities disability or difficulty in doing shopping.
like running, lifting heavy objects, moving
furniture etc. P value was calculated using Value df P value
Pearson’s Chi Square test and it was found to be
<0.05 for all these daily activities, hence showing Pearson Chi-Square 5.159a 1 .023
an association between sarcopenia and disability. P Table 2: P value < 0.05
value was > 0.05 for light and moderate physical
activities, so no association existed between mild
physical activities (doing ironing, walking slowly
or watering the garden) and sarcopenia.

Figure 3: Association between sarcopenia and

disability or difficulty in undertaking intense
physical activities.

Value df P value
Figure 1: Association between sarcopenia and a
disability or difficulty in doing housework. Pearson Chi-Square 10.219 1 .001
Table 3: p value < 0.05 showing a significant
association
Value df P value
a
Pearson Chi-Square 20.275 1 .000
Table 1: p value <0.05 showing a significant
Discussions
Sarcopenia is an age-related condition that is bound
association
to happen with advancing age. Loss of skeletal
muscle mass eventually affects quality of life
because of reduced muscle strength and function.
This ultimately leads toward physical disability or
difficulty in carrying out activities of daily living.
Janssen et al. (10) in a cross sectional designed
research, studied the association of moderate and
severe sarcopenia with functional and physical
disability. According to the study, the probability
of disabilities and impairments was about thrice as
high in elderly women and twice as high in elderly
men having the condition of severe sarcopenia as
compared to those who had normal SMI (Skeletal
Muscle Index). The results supported the
association of skeletal muscle loss with functional
disability and physical dysfunction after managing
the potential confounders. Moreover, impairments
and disabilities were higher in moderate sarcopenia
as well, however, after the adjustment of possible
extraneous variables such as race, age, comorbidity
and behaviors related to health, no such association
was found with moderate sarcopenia. More
profound study led to the result that functional
abilities would be limited if the skeletal muscle loss
is progressed to such an extent such that muscle
mass in relation to the weight of the body is thirty
percent lower than the mean of younger
individuals. This led to the conclusion that age-
related muscle loss affects functional impairment.
In sample of elderly people of Mexican American
including white men and women, Baumgartner et
al. (4) manifested in the study that age-related
reduced skeletal muscle mass was independently
related with physical disability. Goodpaster et al.
(11) conducted almost a similar research on the
muscle mass loss and quality of life in elderly
people. In this study, it was stated that aged-related
skeletal muscle loss is related to disability,
functional disablement, increased dependency and
above all, risk of falls in elderly people. Older
people who have sarcopenic obesity rather than just
proportionate sarcopenia tend to have a likelihood
of gait problems, falls and above all, disability.
This was further investigated by Baumgartner et
al.(12) in an 8 year longitudinal study, whereby, it
was found that older individuals who had ‘obese
sarcopenia’ were predicted to have greater
tendency of physical disabilities, falls and gait or
balance abnormalities than those individuals who
had only sarcopenia or obesity. In addition to this,
older individuals with morbidity and severe
sarcopenia have a greater risk of developing
physical disability. In a longitudinal study
conducted by Janssen (13), a number of men and
women were examined in the “Cardiovascular
Health Study”. 79% greater probability of
disability was reported for those individuals who
had severe sarcopenia and it was not much
inconsistent than those who had moderate
sarcopenia as contrasted with individuals of normal
muscle mass. After several years, the follow up led
to the conclusion that physical disability is much
likely to occur in individuals having severe
sarcopenia.
Conclusions
The conclusion therefore leads to the fact that age-
related reduction in muscle mass is associated with
physical disability. Moreover, as the age advances,
the prevalence of physical disability also increases.
Therefore, it is necessary that early interventions
should be given on timely screening of sarcopenia
in older population in order increase their
independent living.
Recommendations
It is highly recommended that muscle loss should
be detected early and interventions should be given
on time to maintain the quality of life in elderly
adults. Progressive resisted exercises must be
started to modify the effects of sarcopenia and
reduce the decline of muscle mass.
Limitations
This research has limitations in regard to
screening because the individuals were selected
entirely with the help of a questionnaire.
However, more valid results could be obtained if
appendicular muscle mass is calculated with the
help of DEXA.
References
1. Morley JE, Baumgartner RN, Roubenoff R,
Mayer J, Nair KSJJoL, Medicine C. Sarcopenia.
2001;137(4):231-43.
2. Kehayias JJ, Fiatarone MA, Zhuang H,
Roubenoff RJTAjocn. Total body potassium and body
fat: relevance to aging. 1997;66(4):904-10.
3. Roubenoff RJCJoAP. Origins and clinical
relevance of sarcopenia. 2001;26(1):78-89.
4. Baumgartner RN, Koehler KM, Gallagher D,
Romero L, Heymsfield SB, Ross RR, et al. Epidemiology
of sarcopenia among the elderly in New Mexico.
1998;147(8):755-63.
5. Evans WJ, Lexell JJTJoGSABS, Sciences M.
Human aging, muscle mass, and fiber type
composition. 1995;50(Special_Issue):11-6.
6. Verdijk LB, Koopman R, Schaart G, Meijer K,
Savelberg HH, van Loon LJJAJoP-E, et al. Satellite cell
content is specifically reduced in type II skeletal
muscle fibers in the elderly. 2007;292(1):E151-E7.
7. Vandervoort AAJM, Medicine NOJotAAoE.
Aging of the human neuromuscular system.
2002;25(1):17-25.
8. Ling SM, Conwit RA, Ferrucci L, Metter
EJJAopm, rehabilitation. Age-associated changes in
motor unit physiology: observations from the
Baltimore Longitudinal Study of Aging.
2009;90(7):1237-40.
9. Drey MJWMW. Sarcopenia – pathophysiology
and clinical relevance. 2011;161(17):402-8.
10. Janssen I, Heymsfield SB, Ross RJJotAGS. Low
relative skeletal muscle mass (sarcopenia) in older
persons is associated with functional impairment and
physical disability. 2002;50(5):889-96.
11. Goodpaster BH, Study ftHA, Park SW, Study
ftHA, Harris TB, Study ftHA, et al. The Loss of Skeletal
Muscle Strength, Mass, and Quality in Older Adults:
The Health, Aging and Body Composition Study. The
Journals of Gerontology: Series A. 2006;61(10):1059-
64.
12. Baumgartner RN, Wayne SJ, Waters DL,
Janssen I, Gallagher D, Morley JEJOr. Sarcopenic
obesity predicts instrumental activities of daily living
disability in the elderly. 2004;12(12):1995-2004.
13. Janssen IJJotAGS. Influence of sarcopenia on
the development of physical disability: the
Cardiovascular Health Study. 2006;54(1):56-62.