Sarcopenia (Age-Related Muscle Loss): Symptoms, Exercise and Protein

8%Muscle mass that can be lost each decade (Cleveland Clinic)

1 in 2Nearly half of adults over the age of 80 are affected (Harvard Health)

121 trialsCochrane review of resistance exercise in older adults; 6,700 participants

2–3 times a weekExercise frequency used in most of the trials

What is it?

Muscle loss begins gradually in the 30s and 40s and speeds up between the ages of 65 and 80. With age the body no longer makes protein as well as it used to, hormones change, and muscle fibres decrease in number and size.

Physical inactivity is the main factor that speeds this up. Being overweight or underweight, long-term conditions such as heart disease, diabetes and COPD, osteoporosis and osteoarthritis, smoking and alcohol also raise the risk. Losing weight without exercising can lead to muscle loss as well.

Symptoms

Muscle weakness (the most common symptom)
Tiring quickly, loss of stamina
Difficulty with daily activities
Walking slowly
Trouble climbing stairs
Poor balance and falls
Visibly thinner muscles

Check yourself

A five-question screen: SARC-F

This is a short questionnaire that doctors use to screen for sarcopenia. Give each question 0, 1 or 2 points and add them up.

StrengthHow much difficulty do you have lifting and carrying a 4.5 kg load? None: 0 · Some: 1 · A lot or unable: 2
WalkingHow much difficulty do you have walking across a room? None: 0 · Some: 1 · A lot, with aids or unable: 2
Rising from a chairHow much difficulty do you have getting up from a chair or bed? None: 0 · Some: 1 · A lot or unable without help: 2
StairsHow much difficulty do you have climbing a flight of ten stairs? None: 0 · Some: 1 · A lot or unable: 2
FallsHow many times have you fallen in the past year? None: 0 · 1–3 times: 1 · 4 or more: 2

If your total is 4 or more, see your doctor for a detailed assessment. This questionnaire is a screen and does not make a diagnosis; a low score does not rule out sarcopenia either.

How is it diagnosed?

There is no single test. According to the European consensus report, assessment starts with muscle strength: if strength is low, sarcopenia is suspected; if muscle mass is also shown to be low, the diagnosis is confirmed; and if physical performance is poor as well, sarcopenia is considered severe.

Handgrip strengthMeasured with a hand dynamometer; a simple indicator of muscle strength.
Chair stand testThe time taken to stand up and sit down repeatedly without using the arms is measured.
Walking speedUsual walking speed over a short distance is measured.
Timed up and go testThe time taken to rise from a chair, walk a few metres and return is measured.
Measuring muscle massDone with DXA (the scanner also used to measure bone density) or bioelectrical impedance.

What does the evidence say?

The Cochrane review of resistance exercise in older adults covers 121 trials and 6,700 participants. In most trials the exercise was done 2–3 times a week at moderate or high intensity. The results:

Muscle strength increases markedly.
Rising from a chair becomes faster.
Walking speed increases slightly (by 0.08 metres per second).
Pain decreases in people with osteoarthritis.
Serious side effects are rare; the most commonly reported problem is muscle soreness.

This review covers older adults in general, not only people diagnosed with sarcopenia. Even so, this and similar research is the basis for recommending strengthening exercise in sarcopenia.

What can be done?

Resistance exerciseThe cornerstone of treatment. Done with body weight, resistance bands or weights on at least two days a week, and made harder over time.
ProteinCleveland Clinic advises aiming for 20–35 grams of protein at each meal. Spread protein across the day rather than loading it into one meal.
Food sourcesMeat, fish, eggs, dairy products, pulses, nuts and soya products.
Kidney cautionIf you have kidney disease or a history of kidney stones, do not increase your protein without asking your doctor.
MedicationThere is no approved medicine for sarcopenia.
Regular check-upsTell your doctor about weight loss, loss of appetite and falls.

Muscle weakness raises the risk of falls and fractures. See also the guides on preventing falls and osteoporosis.

Exercises at home

Six exercises to strengthen the muscles

These are the exercises recommended by the UK’s National Health Service (NHS) for people who have not exercised for a while. Do them on at least two days a week. Use a sturdy chair without wheels; start slowly and increase the repetitions over time.

Sit-to-stand from a chair

Sit towards the front of a sturdy chair without arms, feet hip-width apart. Lean slightly forwards and stand up slowly, using your legs rather than your arms. Stand tall, then sit down slowly. The slower, the better.

5 repetitions; increase as it gets easier

Heel raises holding the counter

Heel raises

Hold the back of a chair or a worktop. Lift both heels off the floor as far as is comfortable, then lower slowly and with control. When it gets easier, try it without holding on.

5 repetitions; increase as it gets easier

Standing hip abduction

Sideways leg lift

Hold the back of a chair or a worktop. Lift one leg out to the side as far as is comfortable; keep your back and hips straight and do not lean to the side. Lower slowly and repeat with the other leg.

5 repetitions with each leg

Standing hip extension

Backward leg lift

Hold the back of a chair or a worktop and stand tall. Lift one leg straight behind you without bending the knee; do not arch your lower back. You will feel the back of your thigh and your buttock working.

5 repetitions with each leg; hold for up to 5 seconds at the top

Wall press-up

Stand an arm’s length from a wall. Place your hands flat on the wall at chest height, fingers pointing up. Keep your back straight; slowly bend your elbows, keeping them close to your body, and bring yourself towards the wall. Then slowly push back.

5–10 repetitions, 3 sets

Biceps curl

Hold a light weight; a filled water bottle is enough. Start with your arm by your side. Slowly bend your elbow to bring the weight to your shoulder, then lower slowly. You can do this standing or sitting.

5 repetitions with each arm, 3 sets

Video

Videos on sarcopenia

From the YouTube channels of Mayo Clinic and the National Institute on Aging in the United States.

Muscle loss and ageing

A video about the muscle loss that comes with age.

Four lower body strength exercises

Four leg-strengthening exercises for older adults.

The videos belong to the Mayo Clinic and National Institute on Aging channels.

Frequently asked questions

Can lost muscle be regained?

Age-related muscle loss cannot be prevented entirely, but it can be slowed, and muscle strength can be increased even in later life. In the Cochrane review of 121 trials, older adults who worked their muscles against resistance became markedly stronger and rose from a chair faster.

I go for walks; isn’t that enough?

Walking is valuable for your heart and stamina, so keep it up. But the type of exercise recommended for sarcopenia is strengthening exercise that works the muscles against resistance: movements using your own body weight, resistance bands or weights. Do both.

Should I use protein powder?

Food is the best source: meat, fish, eggs, dairy products, pulses and nuts. Spread protein across the day rather than loading it into one meal. If you cannot get enough from food, a supplement may help; ask your doctor first. Protein alone is not enough; it works together with exercise. If you have kidney disease or a history of kidney stones, do not increase your protein without asking your doctor.

Is weight training safe in later life?

According to the Cochrane review, serious side effects of resistance exercise are rare; the most commonly reported problem is muscle soreness. Start light and build up gradually. If you have heart disease, uncontrolled blood pressure or have had recent surgery, ask your doctor before you start.

When should you see a doctor?

See a doctor without delay if you have any of the following:

Sudden weakness of the face, arm or leg; slurred speech (call 112)
Weakness that worsens quickly over days or weeks
Unintended, unexplained weight loss
Repeated falls
Chest pain, dizziness or feeling faint during exercise

Sources

Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2009;(3):CD002759.
Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31.
Cleveland Clinic. Sarcopenia. Last updated 2 April 2026.
Restivo J. Muscle loss and protein needs in older adults. Harvard Health Publishing. 14 August 2024.
NHS. Strength exercises. Page last reviewed 28 February 2024.