Interventions for sarcopenia and muscle weakness in older people

Objective: three major strategies have been tested for combating the losses in muscle mass and strength that accompany ageing. Those strategies are testosterone replacement for men, growth hormone replacement and resistance exercise training. This review will cover the risks and benefits associated with each of these interventions. Methods: searches of PubMed and Web of Science through May 2004 yielded 85 relevant citations for the following descriptors: sarcopenia, aging/ageing, elderly, testosterone, hormone replacement, growth hormone, resistance training, exercise, muscle mass, nutrition and strength. Results and conclusions: testosterone replacement in elderly hypogonadal men produces only modest increases in muscle mass and strength, which are observed in some studies and not in others. Higher doses have not been given for fear of accelerating prostate cancer. Growth hormone replacement in elderly subjects produces a high incidence of side-effects, does not increase strength and does not augment strength gains resulting from resistance training. Some alternate strategies for stimulating the growth hormone/insulin-like growth factor (IGF) pathway continue to hold promise. The latter include growth hormone releasing hormone (GHRH) and the complex of IGF-I with its major circulating binding protein (IGF-I/IGFBP-3). Resistance training remains the most effective intervention for increasing muscle mass and strength in older people. Elderly people have reduced food intake and increased protein requirements. As a result, adequate nutrition is sometimes a barrier to obtaining full benefits from resistance training in this population.