Sarcopenia, the age-related loss of muscle mass and strength, often begins as early as in a person’s 40s and progresses with age, contributing to declines in metabolic health, increased risk of falls and fractures, and loss of independence. Despite common perceptions that muscle deterioration is an inevitable consequence of aging, evidence shows that individuals have significant control over how much muscle mass they lose and at what rate.

Jordan D. Metzl, MD, a sports medicine physician at the Hospital for Special Surgery in New York City, emphasized that skeletal muscle plays a crucial role not only in movement but also in regulating metabolism, inflammation, and overall systemic resilience. “Muscle is increasingly viewed as a core determinant of health span,” he said, highlighting how maintaining muscle function impacts daily activities like climbing stairs and recovering from illness.

One factor complicating muscle maintenance with age is what experts call “anabolic resistance,” a physiological decline in the body’s responsiveness to exercise and protein intake. As muscle fibers shrink and motor units become less efficient, the same exercise routines yield diminishing returns, making it necessary to progressively increase the intensity of resistance training to see continued benefits.

Metzl advises that resistance training should be an integral part of health care for older adults rather than an optional activity. He recommends two to four strength-training sessions per week, involving full-body exercises that include squat, hinge, push, and pull movements. The key is progressive overload—gradually increasing the difficulty to stimulate adaptation throughout the muscle tissue—even in patients into their 70s and 80s.

In addition to exercise, protein intake should be increased with age to counter reduced muscle sensitivity. Older adults are encouraged to consume 25 to 35 grams of protein per meal multiple times daily to optimize muscle repair and growth. Adequate recovery—incorporating sufficient rest, nutrition, and sleep—is also critical. Metzl cautions that increasing training volume without proper recovery can hinder progress and raise injury risk.

While certain supplements like creatine monohydrate may offer modest improvements in combination with exercise, they cannot replace the fundamental requirement of mechanical load on muscles. Hormonal and peptide therapies remain under investigation and do not currently substitute for the established benefits of strength training and nutrition.

Metzl’s approach challenges the notion that age-related muscle loss must be passively accepted. He notes that recognizing the extent of one’s influence over muscle health can prevent a self-fulfilling cycle of declining activity and worsening muscle loss. “Muscle remains one of the most responsive tissues in the body at any age, but only if it is consistently challenged, adequately fueled and properly recovered,” he said.

Through targeted resistance training, increased protein consumption, and appropriate recovery strategies, older adults can significantly slow or even reverse aspects of sarcopenia, thereby enhancing their functional abilities and overall health span well into advanced age.