Sarcopenia in Women and the aquatic environment By Dr. Binal Dave (PT)

Sarcopenia is a condition commonly associated with aging and characterized by loss of muscle mass, strength, and function. Deterioration of muscular fitness negatively impacts the ability to perform everyday tasks, which may eventually lead to loss of independence. This article is intended to bring awareness to the disorder and reassurance to older adults that the aquatic environment can benefit those with, or at risk for developing, sarcopenia. Symptoms, risks, causes, treatments, and research will be discussed as well as a few ways to mitigate sarcopenia within the water world.

In elderly women, reduced body activity and changes in endogenous hormonal balance, such as estrogen levels decline, cause an increase of visceral fat mass, and a reduction of muscle mass as well as muscle strength. As a result, older women are more susceptible to present sarcopenia, as opposed to young women and men.


There is no specific degree of muscle mass loss, and no test exists, that will diagnose sarcopenia; however, individuals with this condition may experience: (Raj 2018 & WebMD 2018)

  • Unintentional weight loss
  • Weakness, loss of stamina
  • Reduction in muscle size
  • Unsteady gait
  • Trouble climbing stairs
  • Difficulty lifting familiar objects
  • Poor balance, leading to an increased fall risk.

Risk Factors/Causes

Age. The International Osteoporosis Foundation reports that muscle mass starts to diminish by the time a person reaches age 40. Sarcopenia affects approximately 10 percent of people over the age of 60, at which time the loss of muscle tissue often becomes swift (Tekton 2020).

Malnutrition. Older adults are prone to a reduction in food intake which may result in malnutrition. Malnutrition can cause protein deficiency, which further fuels muscle loss, because protein-rich foods build and mend muscle fibres (IOF 2017).

Lifestyle. Having a sedentary lifestyle translates to muscle inactivity and, therefore, decreases in muscle mass and strength (IOF 2017).

Inflammation. Diets high in pro-inflammatory foods can often induce chronic low-grade inflammation which adversely affects muscle mass and strength (Greco et al., 2019).

Hormonal imbalance. Growth hormone regulates production of the insulin growth factor 1 and both substances are crucial protein anabolic agents for body balance. However, the concentration of some {source L} hormones, including growth hormone and insulin-like growth factor, can become depressed or out-of-balance, contributing to loss of muscle mass and strength (Vale et al., 2017).


Physiotherapy Interventions to Minimise or Reverse Sarcopenia


Resistance exercise training:

The effects of resisted exercise on ageing muscles are the same as for young muscles:

Improved muscle strength

Increased muscle power - power is a product of both strength and speed. Optimal power reflects how quickly you can exert force to produce the desired movement Improved muscle composition

Increased muscle quality from resistance training is a common finding in older adults, and in men there appears to be no difference in young versus old [29], but there is a study that suggests that older women have a blunted response relative to younger women [30].

Frequency of resistance training

Studies have demonstrated that resistance training regimes performed once, twice or even three times a week all result in strength improvements [22].

Length of training programme

There are many studies which clearly demonstrate that older people who participate in resistance training programs lasting at least 6 to 12 weeks will show increase in both strength and mobility function[31][32][33].

Beneficial Aquatic Facts

Water possesses many unique properties and operates according to various principles and laws of motion allowing the water world to be a safe, comfortable, and effective medium for anyone of any age to better their strength, flexibility, balance, cardiorespiratory health, and functional fitness.

This may be reassuring to individuals who cannot tolerate land-based training and are vulnerable to age-related muscle wasting. Consider the following water facts:

Buoyancy assists in increasing range of motion (ROM) that, consequently, facilitates everyday routines such as looking over one's shoulder to check for traffic or reaching up to put dishes away. And, because better ROM usually allows an individual to participate more fully in exercise, improvements in muscular health and physical strength often result. Buoyancy reduces the effects of gravity so there is less pounding of the joints, allowing individuals to move freely and with decreased pain while water walking/running or performing any one of the other numerous aquatic activities (Neff et. al., 2019 & AEA 2018).

Viscosity, or the friction between molecules which makes molecules cling to each other and to a submerged human body, causes resistance to motion. Water supplies significantly more resistance to motion than air. Viscous resistance encourages muscle strengthening with or without aquatic equipment and, furthermore, movements performed underwater are resisted in all directions, thus working muscles in pairs (Grevelding 2015).

Drag is a powerful tool to use for exercise regression and progression. It is the resistance you feel to movement in the water and is a function of viscosity, frontal shape, size, and the relative velocity between the exerciser and the water. Muscle load decreases on land when you achieve a sustained speed, but water exercise provides a constant muscle load through full range of motion. Additionally, drag is experienced with each movement and in all directions. By changing the surface area and/or shape of the body or the body part and by altering movement speed, individuals can make an exercise more intense or easier to perform (AEA 2018).

Speed of movement can be an effective means to train muscles. Since the resistance of the water increases with the speed of movement, additional muscular effort and more muscle fibre recruitment are required (Neff et. al., 2019 & AEA 2018).

Aquatic Exercise vs. Sarcopenia

Most authorities agree that exercising is the most effective way to fight sarcopenia (Thorpe 2017), so let's see how we can use aquatic exercise to our advantage in the battle against muscle deterioration.

A basic aqua class to mitigate sarcopenia might look like this:

  • Total body warm-up
  • Muscular strength training with aquatic equipment
  • Muscular endurance training
  • Aerobic training
  • Cool-down and stretches to include balance training

Muscular strength refers to the amount of force a muscle can manufacture with a single maximal effort. Training for strength involves greater resistance with fewer repetitions than endurance training. The focus is on using the resistance of the water in conjunction with the application of acceleration (force) and aquatic equipment, such as foam dumbbells, rigid hand paddles, or lower body fins. Strength training may be advanced by working to muscle fatigue and by introducing more intense resistance equipment. A few exercise options are breaststroke; shoulder abduction and adduction; knee flexion and extension; alternating front kicks; etc. (AEA 2018).

Muscular endurance is the capacity of a muscle to exert force repeatedly or to hold a static contraction over time. Train for endurance using moderate resistance with more repetitions than strength training. Using the resistance of the water is a superb way to boost and sustain muscular endurance. Resistance can be progressively increased by applying more force against the water's resistance, increasing surface area or lever length, or adding equipment (AEA 2018). Although muscular endurance is not specifically identified in the definition of sarcopenia, muscular strength and muscular endurance are interrelated; that is, training endurance is going to positively affect strength. Endurance exercise options are similar to strength options.

Aerobic or cardio exercise can induce skeletal muscle hypertrophy in sedentary older adults, according to several recent studies. The caveat? Resistance training and “cardio” training may produce similar physiological responses and adaptations where effort and duration are equivalent. Whether instructing or exercising, be mindful that the effectiveness of aerobic exercise training to stimulate skeletal muscle hypertrophy likely is contingent on obtaining adequate exercise intensity, duration, and frequency: (70-80% HRR; 30-45 minutes; 4-5 days per week) (Konopka and Harber 2014). Aquatic aerobic exercise examples (deep/shallow) include jogging, ankle reach front, kick, cross-country ski, and more.

Balance training is a valuable component of any class format, and it is incredibly fun and usually ignites laughter among class participants. Improving balance also reduces fall risk and enhances our odds for living independently into old age. Ideas to try

Walk on an imaginary “balance beam” in the pool. Progress the training by adding a stop-and-go element or by raising the hands out of the water

Experiment with various static stances: narrow, wide, staggered, tandem, single leg, etc.  Progress to closing eyes or turning the head while holding the stance. Create a dynamic scenario with partner work: one partner freezes in a stance, while the other partner makes waves, literally, increasing the balance challenge for the static partner.

Final Thoughts

Aquatic Therapist’s consider their participant's needs and the unique properties and principles of water when building an aquatic exercise class. They manipulate the water to help participants improve their quality of life and maintain independence. Since adaptations to any exercise training program are variable among the participants, an optimal exercise prescription for older adults maximizes beneficial adaptations while minimizing potential risk (Haynes et al., 2019).




Please enter first name