Older men (i.e., over 50 or 60) looking to build muscle need to be aware of how to overcome certain processes that may be hindering their progress, namely age-related sarcopenia and falling testosterone levels (i.e., andropause). As early as the fourth decade of life, men can begin to experience loss of muscle mass, termed sarcopenia, as muscle protein synthesis (MPS) declines and muscle protein breakdown (MPB) increases resulting in a negative muscle protein balance. All the while, the hormonal changes of andropause promote fat deposition and further muscle (and bone) loss. More than just a matter of not looking your best at the beach, these changes can increase risk of falls and fractures, metabolic dysfunction, the development of cardiac and respiratory disease, and even contribute to early mortality and reduced quality of life. The key to reversing these processes is meeting certain nutritional requirements, exercise, and achieving healthy testosterone levels.
Any intervention aimed at increasing muscle mass ideally must be paired with resistance training (RT) for success. Various categories of RT and some other types of exercise have been shown to improve muscle mass and strength in older adults – including eccentric (lengthening) exercise, stair descending, and both low-load (performed to volitional fatigue) and high-load RT. Low load resistance training may improve the metabolic health of the muscle as it increases the remodeling of mitochondrial network protein expression – combatting the mechanism behind age-related sarcopenia.
Resistance training increases MPS but also increases MPB, which can decrease muscle mass if there is a lack of proper nutrition. Consuming protein containing all the essential amino acids within 4 hours after a workout will increase MPS and result in a positive muscle protein balance. A study in older males found that >30g of milk protein (the type of protein used in the study) was necessary to maximally stimulate myofibrillar protein synthesis following resistance training.
Research has demonstrated that older adults may require higher amounts of dietary protein to overcome sarcopenia and build muscle – those eating at least 1.5g/kg/day saw significantly greater MPS than those consuming the RDA (0.8g/kg/day). Evenly distributing the protein throughout the day improved MPS rates by about 25% compared to eating the same amount of protein but in a skewed distribution, such as mostly at dinner. Consuming at least 0.4g/kg protein per meal and 3 to 4 meals per day was recommended by the researchers to maximize the opportunity for muscle protein synthesis. It should be noted that protein or amino acid supplementation works best when combined with exercise in order to increase skeletal muscle mass or strength in older adults. Additionally, protein digestion decreases with age, so perhaps assessing for and addressing hypochlorhydria or the need for enzyme supplementation could be advantageous.
Next to proper nutrition, adequate testosterone levels are also needed to maximize the gains achieved with resistance training. Compared with placebo, testosterone replacement in older men (>60yo) whose baseline total testosterone levels were between 100 to 400 ng/dL for 3 years was associated with modest but significantly greater improvements in stair-climbing power and muscle mass. An important take home point from this study is that they found that correcting low or suboptimal testosterone levels was supportive of muscle gains, and they did not give additional testosterone to men with adequate levels.
Just as with testosterone deficiency, vitamin deficiency should be addressed in order to optimize body composition. Having low vitamin D levels doubles the chance that older individuals will develop muscle wasting, but correcting this deficiency while also engaging in resistance training can improve muscle strength and performance more so than with exercise alone. Other supplements that have been found to improve gains in muscle mass and strength for older men when combined with exercise include creatine and whey protein. For older adults, leucine-enriched whey protein with vitamin D (without additional exercise) has been found to increase muscle mass (to a lesser extent than if it had been combined with resistance training), so this is a consideration in individuals with barriers to exercise.
In conclusion, in order to build and maintain muscle mass, older men need to eat adequate protein spaced evenly throughout the day, engage in regular resistance training, especially eccentric exercise, and maintain healthy testosterone and vitamin D levels. Supplementation with creatine, leucine and whey protein are additional considerations that may assist with building muscle.
While vitamin D levels can be tested in serum, the best way to assess for testosterone deficiency and to monitor testosterone therapy is by testing hormone levels in saliva, which isolates only the bioavailable portion. For a more comprehensive look at male hormone balance, consider including DHEA, progesterone, and estradiol levels as well. Improving hormone balance, vitamin D levels and protein intake will help older men get the most out of their workouts.
