Muscle strength is important for all demographics and is tied to overall health.
In a now iconic 1972 advertisement for Charles Atlas bodybuilding training, a “98-pound weakling” is insulted and gets sand kicked in his face by a much more “buff” and muscular man on the beach. Though it is an old advertisement, being muscular has always been synonymous with strength and health. Indeed, many people equate muscle strength with fitness and health, which is why people of all ages and fitness levels are concerned about maintaining muscle mass as well as the ability to quickly recover from muscle strain and stress.
And they are not wrong. Maintaining strong muscles is important, but not just for the athletic crowd—it is particularly important for older people, who lose muscle mass as they age, which in turn can be associated with a greater risk of falls and fractures.
Conversely, having good muscular strength is associated with a healthy body weight, along with other health benefits. “Building strength can also boost mood and energy levels while promoting healthy sleep patterns. Developing muscular strength helps to build strong, healthier muscles and bones, which promotes good posture and relieves back pain. When you build muscle strength, you’ll have more stability, balance and flexibility, making injuries and falls less likely,” said Kevin DeMeritt, founder and owner of Chil Wellness, a California-based manufacturer.
Maintaining muscle strength is a legitimate health concern for people of all ages but is a particular concern for those who are older.
“Primary sarcopenia, a decrease in muscle mass and function, is primarily seen in the elderly with upwards of 50 percent of the population over the age of 80 affected. However, secondary sarcopenia can result from muscle loss due to malignancy, rheumatoid arthritis and increased body fat from a lack of physical exercise. The muscle loss from any of these internal or external factors has a direct impact on mortality and disability in the population,” said Devon Ackroyd, DC, MS, CSCS, CCSP, ICSC, advanced practice clinician at Logan University (Chesterfield, MO).
But even younger people can start to feel the effects of loss of muscle mass, particularly after the age of 35, said DeMerritt, especially if they do not engage in strength training. It is not only older people who are concerned about muscle tone but athletes as well. “For the elderly, maintaining muscle strength is often tied to maintaining an independent lifestyle. For athletes, maintaining muscle strength is important to maintain performance,” said Céline Torres-Moon, science writer for Protocol for Life, a manufacturer headquartered in Illinois.
Causes and Consequences of Muscle Problems
The causes of muscle problems are multifactorial, said Torres-Moon. “For example, they can stem from overexertion, improper nutrition and/or vitamin D deficiency,” she explained.
Chris Kidawski, master trainer with Pso-Rite, a manufacturer based in Florida, agreed that the causes of muscle issues are multifold. In his opinion, they derive from “A lack of understanding of how the body really works, for one. Two would be the amount of quality sleep we get. Three would be stress. Four would be nutrition, and five would be proper technique when performing an activity,” he said.
Kidawski specifically pointed to postural issues based on inactivity as a primary problem. “When we sit at the computer all day, and the fascia of our hips tighten up and mold into that sitting position, it becomes nearly impossible to run frequently without injury. To maintain proper form/posture, we need to overcompensate for the damage gravity does. This means getting our muscles, bones, tendons and ligaments stronger as we age.”
A sedentary lifestyle is often a culprit in producing lack of muscle mass; this lack of exercise can be a vicious cycle.
“Without exercise and healthier eating habits, muscle strength and mass will decrease more rapidly, leading to more health issues which, in turn, create a more sedentary lifestyle and even more loss of muscle,” said DeMeritt.
“Sedentary lifestyles are a very common cause, but also we see muscle weakness and lack of stamina in those whose primary form of exercise does not include resistance training. The lack of proper nutritional support is also a large factor in the reduction of nerve cells sending signals to the brain to the muscles to start movement. Also, the prevalence of conditions related to blood sugar imbalances reduces the body’s ability to turn protein into energy. These blood sugar imbalances also affect hormones such as testosterone and growth hormone, both which are needed to maintain muscle mass,” said Danielle Baumgart, president of Priority One, a manufacturer based in Washington State.
Even if you’re getting what you think is enough exercise, if your muscles do not recover properly, that can lead to its own set of problems. Though “inflammation” often signifies negative connotations, Baumgart explained that muscles build due to the inflammation process. “Your body needs some amount of inflammation, like when it is repairing the tiny tears that are created while exercising; this is what increases the muscles’ strength,” she said.
She further explained that proper recovery is a twofold process: “Active recovery is the best way to keep your muscles flexible and healthy, which means slow walking, stretching or other low heart rate but still active movement, and adding nutritional support such as a proteolytic enzyme on an empty stomach after hard exercise bouts will help your body recover and build that strength.”
Dr. Ackroyd added that muscle recovery problems are largely a result of lack of rest between exercise sessions.
“Individuals not properly recovering often see plateaus in strength or endurance gains due to the muscles’ inability to properly heal or significant delayed onset muscle soreness (DOMS) that might prevent the individual from lifting/training to a capacity that promotes increased adaptation. Soreness resulting in a lack of strength or range of motion could show up asymmetrically, which would potentially put the individual at an increased risk of injury or overloading certain tissues. Lastly, when an individual attempts to exercise through muscle soreness due to a lack of recovery, continually seeing a lack of improvement can cause a direct effect on the motivation to continue. Individuals will often cease exercise after ‘overdoing it’ on their initial return to the gym,” he said.
“Our muscles don’t grow while you are working out; they grow while resting in between your workouts. Working out, specifically weightlifting and body weight exercises, creates micro-tears in your muscles. If you don’t give them adequate time to heal, then the tears grow and your muscles feel inflamed, swollen and exhausted,” said Dr. DeMeritt, adding that this can lead to overtraining syndrome, which can then compromise your immune system and cause chronic joint and muscle pain.
Kidawski explained the process of muscle tissue repair with an illustrative example. “Imagine this: You are trying to repair a crack in your driveway with cement. Every time the cement looks like it will cure, you step all over it, making the repair less than optimal. The next day you do the same thing, as well as the next day, and the next, and the next. After a week, your driveway is a serious eyesore. This is what happens to the body when we do not let things settle and restore our soft tissue with recovery work. Exercise is catabolic, meaning that it breaks tissue down. We need periods of rest with frequent massage work to help things heal properly,” said Kidawski.
There are many avenues people can take to ensure muscles properly recover after training; perhaps one of the most important is hydration with the right cocktail of electrolytes, Torres-Moon pointed out. “Post-workout, the right combination of carbohydrates, amino acids and proteins helps to maintain and build muscle mass,” she said.
Other approaches, added Kidawski, include contrast baths, infrared saunas, cryotherapy chambers, good nutrition, deep sleep and meditation. His company, Pso-Rite, manufactures tools to “…help open up the fascial net in the human body to clear waste, restore form and function, to create a free, better, movement.
All of our tools are built for a specific function, i.e., hip, back, spine, neck, but they can also work on almost every other area in the human body. They are also aggressive enough to where our patrons will almost never outgrow them,” he said.
But perhaps the answer to maintaining muscle health is as straightforward and simple as daily physical activity. “Following the recommendations of reaching 150 minutes of moderate intensity physical activity each week can go a long way in preserving muscle health. After physical activity, my next suggestion would be ensuring that you are consuming a nutritious diet by getting enough macronutrients to meet your energy and protein needs and adequate micronutrients to support bodily function,” said Christopher Fahs, PhD, SCSC, associate professor at Logan University.
In addition to the natural approaches listed above, many athletes as well as those at risk of losing muscle mass due to aging choose to take supplements. For example, essential amino acids are muscle retention.
NOW Health Group, a subsidiary of Protocol for Life, manufactures some products for practitioners who want to help their patients maintain a healthy muscle mass, including Plant Protein Complete, a vegan protein blend of pea, hemp and quinoa and pea protein, a vegan source of amino acids that contain arginine and branched chain amino acids (BCAAs).
Priority One, founded in 1987, manufactures Proto-Zyme, a proteolytic enzyme that Baumgart said helps with soreness after strenuous exercise and relief of joint pain; proteolytic enzymes help break down protein. Additional nutrients in Proto-Zyme include zinc, lysozyme, cellulose and thymus.
Another Priority One product is Healthy Glucose, which helps support blood sugar and helps to balance hormones, which in turn plays an important role in building muscle. And the company’s DHEA supplement (dehydroepiandrosterone—a hormone produced by adrenal glands) helps increase the DHEA levels, as this hormone declines significantly with the aging process. “By supplementing it we can help our bodies continue to build muscle and maintain strength,” said Baumgart.
Kidawski added that certain ingredients are effective for muscle recovery, including curcumin, which helps with inflammation; omega-3 oil with DHA and EPA, which helps regulate anabolic hormones to promote muscle retention and repair; amino acid blend to help with muscle recovery; and L-tyrosine which helps increase maximum muscle contraction ability.
Dr. Fahs said that evidence shows that creatine, protein and polyunsaturated fatty acids generally increase or at least help preserve muscle mass and function.
“Creatine is an amino acid that can be synthesized by your body or obtained through diet and supplements. It is part of phosphocreatine (PCr), which helps generate and regenerate adenosine triphosphate (ATP) within muscle cells. Supplementing with creatine can increase the PCr stores in the muscles, essentially increasing short-term energy supplies that can help with strength and power activities. Protein is an important macronutrient that stimulates muscle protein synthesis (MPS). Specifically, the amino acid leucine appears to be the trigger for MPS. Polyunsaturated fatty acid’s role in muscle health is likely due to its effects on inflammation. Specifically, omega-3 fatty acids are linked to the production of anti-inflammatory markers while omega-6 fatty acids are connected to the production of proinflammatory markers. Thus, a balance of omega-3 and omega-6 is suggested for optimal health,” he said, adding that if a person is physically active and eating a nutritious diet, he believes the need for supplements is low.
Chil Wellness manufactures several products with CBD to support muscle and joint relief, including Aspen’s Maximum Relief Salve, Aspen’s Maximum Relief Roll-On, and Sport Muscle Recovery Balm. Soon the company will be releasing a product called Professional Strength Lotion to be used with laser therapy, massage and ultrasound therapy, which will be rolled out to practitioners in the coming weeks. The company increased the CBD content per ounce as well as the menthol “… so that the patient feels an effect immediately while also opening up vasodilation to help the other ingredients, like the magnesium, to penetrate deeper into the body,” said DeMeritt.
Enzyme Science, a manufacturer based in Florida, offers MyoMend which contains proteolytic enzymes to support overall muscle function. “This is an ideal partner, and in many cases a replacement, to traditional herbal remedies. Proteolytic enzymes, also known as proteases, work systemically to help break down damaged proteins, speeding up recovery and promoting flexibility and mobility,” said Ryan Sensenbrenner, director of marketing. Another product, (PEA)+, supports discomfort associated with stiffness and compromised tissue function as a result of overexertion and contains a blend of PEA, sourced from safflower seed paired with curcumin.
The market for supplements took a bit of a nosedive in 2020, directly attributable to the pandemic and the closing of workout facilities. “It seems that the demand is partially recovering in 2021. The outlook is generally positive,” said Torres-Moon.
Baumgart said that Generation X is now in the drivers’ seat regarding trends in this category. “We have been described as deeply skeptical but absolutely brand loyal; Gen Xers are now the sandwich generation, meaning we are helping make health decisions for ourselves, our children and our aging Boomer parents.”
DeMeritt said he is seeing a steady increase in demand from consumers in the 21-35 age bracket, particularly as they are able to get back to the gym, though the steadiest long-term increases have come from the Baby Boomer category.
As gyms begin to reopen and people start to work out regularly again, the market for muscle-related supplements may well trend upward.
Practitioners and Patients
Unless a patient complains of a specific problem or injury, muscle health often does not come up at regular health assessments, which is why it is important for practitioners to address these issues with patients and make any recommendations, accordingly.
Torres-Moon suggested that practitioners address if there are deficiencies in key vitamins and minerals that affect muscle function as well as a patient’s individualized nutritional needs. “The nutritional needs of a bodybuilder in his 20s will be very different from a casual runner in her 70s. Sports nutrition has evolved into its own specialty with nutritional recommendations tailored to the type of sport, the level it is practiced, the age of the patients, etc.,” she said.
Baumgart added it was important to talk to patients about their specific exercise and recovery routines. “Simply asking how many times a week a person is exercising isn’t enough. It’s been proven that cardio alone will not help with sarcopenia and though it has its place, true healthy aging needs resistance training and nutritional support.”
Kidwaski suggested that practitioners speak with their patients about regular movement and the proper consumption of protein. “As we age, we lose range of motion and muscle. The easiest way to keep both of these is moving the body through a full range of motion doing deep knee bends, burpees, and overhead presses combined with eating grass-fed beef and sustainably harvested meats and/or fish,” he said.
“Teach them how the body works. Learn about fascia,” he added. “Understand that everything in the body is connected and moves faster than the speed of thought. Teach people that movement is healing and vice versa. Focus on holistic supplements and natural foods rather than plastic water and sugar-filled treats.
Dr. Ackroyd noted that practitioners need to educate patients on “… recommended recovery times, movements to promote edema reduction to decrease muscle soreness, and workout cycling to decrease overload. Additionally, they must provide advice on the nutritional impact a healthy diet has on muscle recovery, hypertrophy and endurance. If the nutritional component is not within your area of expertise, consider co-managing the individual with a practitioner within the field of dietetics,” said Dr. Ackroyd.
“When it comes to muscle and joints, the first recommendation would be to try and get inactive people active again and doing some kind of exercise three to five times a week. The second recommendation is to try and help people with the pain that comes with exercise, especially in the beginning. If the practitioner is able to help people endure the discomfort in an easy reasonable manner, the exercise tends to last longer and be more enjoyable. If they can help people get to a consistent routine, people will mentally start to feel better about themselves as well,” said DeMeritt.
Healthy Take Aways
• Muscle issues are common in those over 60 and in athletes but younger people are concerned about keeping up muscle strength.
• Regular exercising is important for maintaining muscle mass but so is recovery in between exercise times.
• Primary sarcopenia, a decrease in muscle mass and function, is primarily seen in the elderly with upwards of 50 percent of the population over the age of 80 affected.