Muscles vanish after 40: The silent body breakdown most Indians are ignoring

Most of us worry about weight gain as we grow older. Very few think about muscle loss. But that’s exactly what creeps up quietly with age. Sarcopenia is the medical term for it, the gradual, involuntary loss of muscle mass and strength as we get older. And it’s far more common than people realise.Dr. Pradeep Kocheeppan, Consultant Orthopaedics at Apollo Hospitals, Bannerghatta Road, Bengaluru, says Indians, especially South Indians, are genetically predisposed to having lower muscle mass compared to many Western populations. Add to that a comfortable lifestyle, desk jobs, long hours on screens, and very little physical strain, and you have a recipe for widespread muscle loss.Think about how we use our bodies today. Doors open with a push. Groceries get delivered. Most work happens with a click or swipe. The upper limbs, in particular, don’t get much resistance-based activity anymore. Over time, this lack of use leads to what doctors call disuse atrophy. And as we age, the decline becomes more noticeable.On a biological level, sarcopenia mainly affects type 2 muscle fibres, the fast-twitch fibres responsible for power and quick movements. These are the fibres that help you catch yourself when you trip or lift something heavy. Type 1 fibres, which support endurance, are relatively less affected. That’s why older adults may still manage slow activities but struggle with sudden bursts of strength.When it comes to building or maintaining muscle, one size doesn’t fit all. The type of training you choose should match your goal, says Dr. Pradeep Kocheeppan and shares the common types of fitness training for muscles. So what should you choose? If your goal is appearance, hypertrophy may help. If you’re an athlete in boxing or wrestling, power and strength matter more. If general fitness is your aim, endurance work is useful. But when it comes to preventing age-related muscle loss, Dr. Kocheeppan is clear, strength training is essential.After the age of 40, muscle loss accelerates, especially the type 2 fibres. Without strength training, this decline is almost inevitable. Ideally, adults over 40 should include at least 20 minutes of strength and power exercises several times a week.Yet, gyms are often filled with younger people. Senior adults are underrepresented. Part of the problem, according to Dr. Kocheeppan, is the lack of trainers trained specifically to guide older individuals safely. But that shouldn’t stop people from starting. Proper supervision and gradual progression can make strength training safe at almost any age.A structured approach matters. Doctors often assess something called 1RM, one repetition maximum, which measures the maximum weight a person can lift once. Strength training usually works at 80 percent or more of that capacity, with fewer repetitions. Power training uses lighter weights, around 30 to 50 percent of 1RM, but at higher speeds.Strength improves muscle mass. Power improves the speed of movement. Together, along with endurance and functional work, they form a balanced fitness routine.Muscle doesn’t just help you move. It supports your bones. Bones respond to the stress placed on them by muscles. Without muscle training, bone strength also suffers.“If a DEXA scan shows reduced bone density, exercise becomes even more critical. But sometimes, exercise alone isn’t enough,” Dr. Pradeep Kocheeppan said. “In patients who come in late, medications may be needed. Certain anabolic agents can stimulate muscle response when combined with exercise. Optimising vitamin D and B12 levels is also crucial. Doctors may check parathyroid hormone levels and, if appropriate, use medications that can improve bone density significantly,” the doctor said. “Newer drugs, such as romosozumab (marketed as Evenity), target specific pathways involved in bone loss and can improve bone density when taken monthly under supervision. There are also medications like ibandronic acid and injectable treatments such as denosumab that help maintain or improve bone mass,” the doctor added. Traditionally, bone loss was considered irreversible. Today, with a mix of targeted exercise and medical therapy, progression can be slowed, and in some cases, bone density can improve.Muscle and bone health are not cosmetic concerns. They determine independence. They influence balance, mobility, and the ability to recover from illness or injury.Good muscle strength supports strong bones. Strong bones support an active life. And that, ultimately, translates into a better quality of life.Ageing is inevitable. Muscle loss doesn’t have to be.Medical experts consultedThis article includes expert inputs shared with TOI Health by: Dr. Pradeep Kocheeppan, Consultant Orthopaedics at Apollo Hospitals, Bannerghatta Road, BengaluruInputs were used to explain what is muscle loss and how Indians are prone to it.