Dominic Stone
Muscle wasting, or atrophy, is the decrease in size and wasting of muscle tissue. There are three types of muscle atrophy: physiologic, pathologic, and neurogenic. Physiologic atrophy is caused by not using the muscles enough, often due to seated jobs, health problems that limit movement, or decreased activity levels. Pathologic atrophy is associated with aging, starvation, and diseases such as Cushing's disease. Neurogenic atrophy is caused by an injury to, or disease of, a nerve that connects to the muscle. This type tends to occur more suddenly than physiologic atrophy. Muscle atrophy can often be reversed with exercise, physical therapy, and improved nutrition.
| Characteristics | Values |
|---|---|
| Type | Physiologic, Pathologic, Neurogenic |
| Causes | Lack of physical activity, ageing, nerve injury, disease, malnutrition, genetic factors |
| Diseases | Neuromuscular diseases, cancer, chronic inflammatory diseases, acute critical illness, muscular dystrophy, amyotrophic lateral sclerosis (ALS), dermatomyositis, Guillain-Barré syndrome |
| Symptoms | Loss of movement, loss of strength, muscle weakness, muscle pain, muscle stiffness, difficulty performing daily activities, poor balance, slow walking, trouble climbing stairs, frequent falls |
| Treatments | Exercise, improved nutrition, physical therapy, ultrasound therapy, surgery, medication, dietary changes, supplements |
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What You'll Learn
Lack of physical activity
Muscle atrophy, or muscle wasting, is a decrease in muscle size and muscle tissue. Physiologic atrophy, or disuse atrophy, is caused by not using muscles enough. This can be due to a sedentary lifestyle, desk jobs, or health problems that limit movement. Even minor muscle atrophy can cause a loss of movement or strength.
Disuse atrophy can be treated with regular exercise, physical therapy, and better nutrition. Exercises can include swimming or other rehabilitation exercises. Physical therapy can include ultrasound therapy, which uses sound waves to aid in healing. In some cases, surgery may be necessary to correct contracture deformity. A healthy diet, including high-quality proteins, can also help treat disuse atrophy.
Disuse atrophy can occur when a person remains immobile while recovering from an illness or injury. It can also be caused by certain medical conditions, such as arthritis, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), or dermatomyositis. In addition, aging can lead to sarcopenia, an age-related progressive loss of muscle mass and strength.
Overall, lack of physical activity can lead to muscle atrophy through a combination of immobility, illness, injury, and certain medical conditions. Treatment options include exercise, physical therapy, surgery, and nutritional interventions.
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Ageing
The ageing process involves several changes that contribute to sarcopenia. One key factor is a reduction in nerve cells responsible for transmitting signals from the brain to initiate muscle movement. Additionally, lower levels of certain hormones, such as growth hormone, testosterone, and insulin-like growth factor, are observed. The body also experiences a decreased ability to convert protein into energy, impacting muscle maintenance. These factors collectively result in muscle wasting.
The rate of muscle loss varies, with inactive individuals experiencing a more rapid decline. Research indicates that between the ages of 60 and 70, there is an estimated loss of 12% of muscle mass, increasing to 30% in those over 80. This loss significantly affects an individual's ability to perform daily activities, leading to slower movement and a loss of balance. It is important to note that everyone loses muscle mass over time, but people with sarcopenia exhibit a more accelerated rate of muscle loss.
The development of sarcopenia is influenced by additional risk factors beyond ageing. Physical inactivity or a sedentary lifestyle is a significant contributor to muscle wasting. Studies suggest that maintaining an active lifestyle as one ages can substantially reduce the risk of sarcopenia. Even with regular exercise, spending a large portion of the day sitting or lying down can still promote muscle loss.
Diet also plays a crucial role in muscle health during ageing. A poor-quality diet, specifically one lacking sufficient calories and protein, is a risk factor for sarcopenia. A low protein intake is associated with increased inflammation and a higher risk of muscle weakness. Ensuring adequate calorie and protein consumption is essential for maintaining muscle mass and strength as we age.
While ageing is a predominant factor in muscle wasting, it is important to note that sarcopenia is not inevitable. Through regular physical activity, especially resistance exercises, and a balanced diet, the effects of sarcopenia can be mitigated and even reversed to some extent. Additionally, supplements such as vitamin D, omega-3 fatty acids, and creatine may also help combat age-related muscle loss.
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Malnutrition
Muscle atrophy or wasting is the loss or thinning of muscle tissue. It can be caused by malnutrition, age, genetics, lack of physical activity, nerve problems, or certain medical conditions. Disuse (physiologic) atrophy occurs when muscles are not used enough, which can be due to a sedentary lifestyle, genetic disorders, or immobility resulting from a stroke or other medical conditions. Neurogenic atrophy, on the other hand, is caused by nerve problems or diseases that affect the nerves connecting to the muscles.
The impact of malnutrition on muscle wasting is not limited to the elderly. Muscle atrophy can occur in individuals with malnutrition across all age groups. Malnutrition can lead to a reduction in muscle mass and strength, causing physical weakness and impairing mobility. The combination of malnutrition and physical inactivity can exacerbate muscle wasting and negatively affect muscle strength and physical functioning in both the upper and lower extremities.
The treatment of muscle atrophy due to malnutrition involves addressing the underlying nutritional deficiencies. This may include dietary changes, supplements, or specific nutritional interventions recommended by a healthcare professional. Additionally, physical exercise plays a crucial role in preventing and treating muscle wasting. Exercise programs, including swimming and rehabilitation exercises, can help maintain and regain muscle mass and function.
It is important to note that muscle wasting due to malnutrition can be a complex issue, and the specific treatment approach may vary depending on the individual's overall health condition and other factors. Early identification and intervention are essential to prevent further muscle loss and improve clinical outcomes.
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Muscular dystrophy
There are several types of muscular dystrophy, each with its own unique features and symptoms. Some of the most common types include:
- Duchenne Muscular Dystrophy: This type of muscular dystrophy is one of the most well-known and commonly affects young boys. Symptoms include delayed milestones such as late walking, frequent falls, and difficulty with motor skills like running, jumping, or climbing stairs. Large calf muscles, muscle pain, stiffness, and learning or behavioural challenges may also be present.
- Becker Muscular Dystrophy (BMD): BMD is the second most common type and can affect both males and females, although it is more prevalent in boys. Symptoms can appear anytime between the ages of 5 and 60, but they typically manifest during the teenage years.
- Myotonic Dystrophy: This is the most frequently diagnosed type of muscular dystrophy in adults and affects both men and women equally. It is characterised by difficulty relaxing muscles after use and can impact the heart, lungs, and endocrine system, potentially leading to conditions like thyroid disease or diabetes.
- Congenital Muscular Dystrophies (CMD): CMD refers to a group of muscular dystrophies that are present at or near birth, causing overall muscle weakness, joint stiffness, or looseness.
- Emery-Dreifuss Muscular Dystrophy (EDMD): EDMD predominantly affects male children and young adults, causing muscle weakness in the shoulders, upper arms, and shins. It can also impact the heart, and in some cases, lead to fainting spells.
- Facioscapulohumeral Muscular Dystrophy (FSHD): FSHD affects the muscles in the face, shoulders, and upper arms. It usually manifests before the age of 20 and may cause mild hearing loss in addition to muscle weakness.
While there is currently no cure for muscular dystrophy, treatments are available to help manage symptoms and improve quality of life. These treatments may include physical therapy, ultrasound therapy, and in some cases, surgery. Additionally, regular exercise and proper nutrition can help to slow the progression of muscle wasting and improve overall health.
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Cancer
The exact mechanisms underlying cancer-related muscle wasting are not yet fully understood, but researchers have identified several potential causes. One of the key factors is the widespread inflammation that often accompanies cancer. Cancer cells release cytokines, which are small proteins that contribute to the loss of fat and muscle. They do so by disrupting the metabolic balance, causing muscle and fat cells to break down faster than they can be replenished. This results in an overall loss of muscle mass and function, known as cancer cachexia.
In addition, cancer treatments such as chemotherapy can also contribute to muscle wasting. The side effects of chemotherapy, such as nausea and vomiting, can lead to a reduced nutrient intake, further exacerbating the problem. Furthermore, muscle wasting may be a result of the cancer patient's inability to move due to their illness or the side effects of treatment, leading to a lack of physical activity and subsequent muscle atrophy.
The good news is that researchers are making progress in understanding and treating cancer-induced muscle wasting. Clinical trials are testing new treatments, including exercise- and nutrition-based interventions, as well as drugs that have shown promising results in maintaining lean muscle mass. Anamorelin, for example, is a drug that improves appetite and has shown promising results in treating cachexia.
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