In 2015, two grandfathers from China went viral, earning them the nicknames “hottest grandfather” and “muscular grandfather” respectively.
The former was Beijing-based Wang Deshun, then 79, whose toned physique and fierce attitude during his shirtless catwalk during that year’s China Fashion Week took the world by storm. The latter was Guangzhou native Shen Hua, then 81, whose daily one-hour high-intensity strength-training sessions at the gym thoroughly impressed netizens.
Building our muscles is probably the last thing on our mind as we age, so it is probably even more impressive that these two men only started working out seriously at the ages of 50 and 70 respectively.
Wang, whose daily routine includes three hours a day at the gym doing a combination of weights, cardiovascular exercises and stretching, started his workouts as part of maintaining his career as an artiste and actor. Shen, on the other hand, started working out as a way to slow down the process of ageing.
For the rest of us though, the process is more likely to be the opposite – we are more likely to grow more sedentary the older we get, especially after retirement.
Consultant geriatrician Professor Dr Tan Maw Pin notes that because of our Asian respect for elders, we tend to rush to relieve those older than us of physical chores, for example, carrying items or household work. This, however, does them no favours as it deprives their muscles of use.
“Unfortunately, a lot of our older people, because they don’t maintain their muscle strength, it deteriorates so fast that usually by the time they retire, they already need some form of care because they can no longer be independent, so they cross the threshold of disability,” she says.
It also does not help, she adds, that Malaysians in general tend to lead a more sedentary lifestyle. “This is even more apparent when they fall ill,” says the Universiti Malaya lecturer. “Because they have low muscle strength to begin with, as soon as they fall ill, their muscles start shrinking away.”
When seniors fall
Prof Tan notes that the World Health Organisation (WHO) has been emphasising on physical activity for all ages for years. In fact, one of the WHO’s physical activity recommendations for adults aged 65 and above specifically states that they should do muscle-strengthening exercises involving the major muscle groups two or more days a week.
Another recommendation is that: “Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on three or more days per week.”
Falls are a major concern when it comes to senior citizens as they can lead to disability, loss of independence, and even death. The US Centres for Disease Control and Prevention (CDC) reports that one in five falls lead to serious injuries such as broken bones and head trauma.
And even when a fall does not result in a serious injury, many elderly who have experienced one become scared of falling again, and thus, limit their physical activities. This, ironically, actually increases their risk of falling again.
According to the WHO, falls are the second leading cause of accidental or unintentional injury deaths worldwide (after road traffic injuries), and adults aged 65 and over are the ones suffering the highest number of deaths and injuries.
In Malaysia, a 2015 study published in the Medical Journal of Malaysia found that one in five (19.1%) of those aged 60 and above had experienced falls.
And it is not just the effect on the health of the affected person that is an issue; there is also the matter of cost. While the main focus tends to be on the healthcare cost, e.g. hospital bills, Prof Tan says: “The other issue is social care.
“We all know that the social care bill is now going up a lot when it comes to the general population – a lot of family members are crying out because they can no longer hire maids to help their older folks.
“And when the older person needs care, they are now spending a lot of money to hire private nurses, or even, sometimes they have to give up work themselves, and occasionally, when they have no choice – they cannot give up work and they cannot hire anybody – they put the older person in a nursing home.
“And all this is because the older person is dependent, and a large cause of the dependency is low muscle strength – they cannot do things for themselves.”
Males not as strong
According to Prof Tan, our muscle strength gradually increases from the time we are born to around the age of 25.
“At that point, we know that muscle bulk starts going down, muscle strength starts going down, but the rate of decline is really dependent on the person’s physical activity, and also, if they have been unlucky enough to have illnesses, then it deteriorates more quickly.”
In general, males tend to have much more muscle strength than females, thanks to the influence of higher levels of the testosterone hormone. Shares Prof Tan: “When we test muscle strength in my practice, we use a grip-strength dynamometer, and we know that on average, men can actually grip 10kg more than women.
“But very interestingly, when we did research to determine the normal range for Malaysians, we found that the discrepancy between men and women in Malaysia is a lot less than the discrepancy in other societies.” She says with a smile that it may be because our women are “much more industrious”.
There is also no significant difference in walking speed, a measure of fitness, between Malaysian men and women, she adds.
“The truth is, in our society, a lot of our men are very sedentary, and as soon as they retire, actually take on less physical activity than their spouses. So we have a huge issue in that men are very unhealthy,” she says.
This is especially as women, particularly those of the generation that are senior citizens now, tend to do almost all of the housework. They are also more diligent about taking care of their health and exercising, compared to men.
Exercise and diet
However, the problem is that the exercises senior citizens tend to do are not for building their strength or muscles. Prof Tan notes that one of the building blocks of muscles is resistance exercise, or strength training.
“A lot of people fail to realise this, so they keep on exercising and wonder why they are not getting their muscles,” she says. “It’s because they are just doing cardiovascular exercise – they just walk in the park. So they are just exercising their hearts, which is good, but often, our older generation think that strength training is not relevant to them.”
She suggests that older people can take up tai chi, which is good for maintaining balance and incorporates some strength training. There are also bodyweight exercises, which require no equipment and can be done at home, and the free outdoor gym equipment in public playgrounds or padang.
However, strength training is not enough if the person does not consume the building blocks of muscle, i.e. protein, sufficiently in the first place.
“Unfortunately, our Eastern diet, especially for the older generation, probably doesn’t contain as much protein – traditionally, our cuisine has a lot of carbohydrates. And also, there’s currently a lot of misgivings about protein, because people think protein cause gout and kidney problems,” she says, adding that for the kidneys, protein consumption only causes problems in very severe kidney disease.
“Another issue is that you need teeth to eat protein. A lot of older people had very poor dental care – prior to this, they couldn’t afford dental care – so, no teeth, cannot bite,” she adds.
While Prof Tan says that the quality of a person’s daily diet should be of utmost importance, supplementation is recommended for the elderly if they fall ill or are recovering from illness. Over the past decade or so, the amino acid leucine has been singled out for its critical role in muscle-building.
According to Prof Tan, the consumption of leucine helps to both reduce skeletal muscle loss and encourage the building of such muscles in the elderly who are ill or recovering from illness. In fact, there is now an even more refined version of this essential amino acid. (An essential amino acid is one that cannot be synthesised by the human body and needs to be obtained through our diet.)
According to Prof Tan, HMB (ß-hydroxy ß-methylbutyrate) is the useful part of leucine, which is a large molecule.
“It would do the same thing as leucine,” she says. “But if your body is not working so well (due to illness), you probably ought to have the essential ingredient because your body might not be breaking down leucine in the right way.”
She stresses that improving muscle health can, and should, be done at any age. “Even if your muscle strength deteriorates, it’s not too late; you can still do something. We have proof that even at 90 years old, we can still restore muscle strength.”
Prof Tan was speaking to the media during a recent interview session on muscle health and the importance of nutrition in this area organised by Abbott Malaysia.