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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M909-M910 (2003)
© 2003 The Gerontological Society of America

EDITORIAL

Editorial: Sarcopenia Revisited

John E. Morley

Division of Geriatric Medicine, Saint Louis University, and Geriatric Research, Education and Clinical Center, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.

"I can do anything now at 90 that I could at 18, which shows how pathetic I was at 18."—George Burns

IN November 1995, the Journals published a supplement on sarcopenia (1–5). This issue represented the pivotal moment in establishing the importance into the study of sarcopenia (muscle wasting) as a major geriatric problem. Since then it has been recognized that sarcopenia is a key factor in the pathophysiology of the development of frailty (6–10) and mobility decline (11–17). In addition, loss of muscle mass and its reversal have been associated with falls (18,19), cognitive decline (20), depression (21), and mortality (22).

In this issue of the Journals, we are beginning to publish a series of articles exploring the understanding of the pathophysiology of sarcopenia at the beginning of the 21st century (23–29). Previously, review articles have attempted to codify this knowledge base (30,31). However, the diversity of factors involved, namely, hormones such as testosterone, growth hormone, insulin growth factor-1, and dehydroepiandrosterone (32–38), cytokines (39–41), nutritional factors (42–47), vascular disease (9), and lack of physical activity (48–51) have made it extremely difficult for any one group of authors to fully cover the nuances of the subject. We believe that the articles being published in this and a subsequent issue of the Journals provide an excellent overview of sarcopenia from which future scientific advances will logically develop (23–29).

Four articles have attempted to establish the major causes of sarcopenia from an epidemiological perspective (52–55). These articles have implicated the age-related decline in testosterone, lack of physical activity, inadequate caloric intake, and a decline in insulin growth factor-1 as key factors in the pathogenesis of sarcopenia. All of these are potential reversal factors.

However, as has been clearly demonstrated multiple times in the pages of the Journals, exercise and particularly resistance exercise, remains the most efficacious way to increase muscle mass and strength (56–64). So until modern gene therapy or bionics provides a "magical" cure for sarcopenia, exercise will remain the major way in which those of us who are aging can prevent and reverse muscle loss. The challenge to the gerontologist interested in health promotion (65,66) is to find a way to help older persons to continue to exercise over prolonged periods of time, as is done by master athletes (67,68).

Acknowledgments

Address correspondence to John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104. E-mail: morley{at}slu.edu

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