Up to 45% of people living with rheumatic diseases This could lead to sarcopenia, a slow but steady loss of muscle mass and strength that often goes unnoticed until serious mobility problems arise. This situation is of particular concern to rheumatologists, who emphasize that it is a preventable complication if addressed early.
Sarcopenia, beyond simply being "weak" or feeling weak, It limits independence for basic tasks such as getting up from a chair, climbing stairs, or walking.In Spain, the Spanish Society of Rheumatology (SER) emphasizes that the right combination of strength exercise, a well-planned diet, and good inflammation control can make the difference between maintaining autonomy or depending on help in daily life.
What is sarcopenia and why does it affect so many rheumatic patients?
Sarcopenia is defined as a progressive and generalized loss of muscle mass accompanied by a decrease in strength and physical performanceIt is not only a consequence of aging, but is aggravated by chronic inflammatory diseases and by a sedentary lifestyle, something common in those who suffer from joint pain.
According to the SER, this problem is especially relevant in rheumatic pathologies such as rheumatoid arthritis, systemic lupus erythematosus, or spondyloarthritiswhere chronic inflammation and, sometimes, certain treatments can contribute to muscle loss. It is also more frequently observed in people with osteoarthritis and osteoporosis, two diseases very common in the elderly population.
In many cases, a vicious cycle: pain and inflammation lead to less movementInactivity reduces muscle mass and strength, and this muscle loss further worsens functional capacity and quality of life. Without specific intervention, this process can progress for years without the patient even being aware that their muscles are deteriorating.
Experts warn that sarcopenia increases the risk of disability, falls, fractures and loss of autonomyIn patients with rheumatic diseases, all of this adds to the already known impact of joint pain and stiffness, so the risk of functional dependence is even greater if preventive action is not taken.
The voice of Rheumatology: preventing sarcopenia is possible
From the Spanish Society of Rheumatology, the rheumatologist Raquel Almodóvar, from the Alcorcón University Hospital Foundation (Madrid)She emphasizes that sarcopenia in people with rheumatic diseases is not an inevitable outcome. She stresses that it can be prevented and, in many cases, reversed with a well-organized intervention plan.
The specialist explains that the key lies in a multidisciplinary approach that combines three pillars: regular strength and endurance exercise, adequate nutrition (with special attention to quality proteins and vitamin D) and rigorous control of the inflammation characteristic of rheumatic diseases.
Almodóvar insists that early identification is fundamental: The sooner a loss of strength or muscle mass is detected, the more time there is to act.To this end, he encourages patients to discuss with their rheumatologist any feelings of weakness, difficulty getting up from a chair, walking at a good pace, or carrying bags that they could previously carry without a problem.
Coinciding with the celebration of World Day of Physical ActivityThe Spanish Society of Rheumatology (SER) has emphasized that simply recommending "more movement" is not enough. For rheumatic patients at risk of sarcopenia, a specific and tailored exercise plan is necessary, combining strength and endurance training and taking into account the condition of their joints and their individual pain levels.
Reumafit: Guided exercise for people with rheumatic diseases
To support this change of approach, the Spanish Society of Rheumatology has the project ReumafitThis initiative, launched in 2020 and coordinated by Dr. Almodóvar herself, aims to make physical activity accessible to people with rheumatic diseases in a safe, guided, and realistic way.
Within this project, the following have been developed Specific materials and resources on sarcopenia in rheumatic patientswith practical recommendations on what type of exercises to do, how to progress, and what precautions to take. The idea is to make physical exercise less incompatible with joint pain and more an integral part of treatment.
Reumafit's content highlights that exercise not only improves the mobility of the musculoskeletal system, but also influences the muscle metabolism through different mechanical, hormonal, metabolic and regenerative pathwaysThanks to these mechanisms, both strength and muscle mass increase, key aspects for slowing down sarcopenia.
This type of program also aims Overcoming the fear of exercise in people with chronic painOften, the fear of worsening symptoms leads to avoiding physical activity, when in reality a well-structured training program can relieve pain, improve function, and help control inflammation.
Strength and endurance training: the central pillar against sarcopenia
Rheumatologists place particular emphasis on the True prevention and treatment of sarcopenia involves strength trainingIt's not just about walking or doing some aerobic exercise, but about working the muscle against external resistance on a regular basis.
This strength training is based on muscle contractions against resistance such as weights, dumbbells, gym machines or elastic bandsResistance opposes the action of the muscle, which must work harder to contract, thus stimulating its growth and improving its functional capacity.
By introducing these types of exercises into your weekly routine, you can achieve to increase muscle mass and improve strength, power, and resistance to fatigue of the trained muscle groups. This change translates, in daily life, into greater ease in getting up, standing, or walking at a suitable pace without becoming exhausted after a few minutes.
Furthermore, strength training doesn't just benefit the muscles. It also It strengthens nearby tissues such as tendons, bones, ligaments, and cartilage.This is particularly important for people with rheumatic diseases, who often experience bone fragility or joint overload. All of this contributes to reducing the risk of falls and fractures.
The positive effects also extend to cardiovascular and pulmonary system, metabolism, immune system and mental healthRegular strength training is associated with improved mood, better cognitive ability, and, according to various studies, a lower risk of death from any cause, provided it is maintained in the medium and long term.
How much and how to train: practical recommendations
One of the most frequent questions among patients is how much physical activity they need to notice changes. Dr. Almodóvar points out that, in the context of sarcopenia, it can be It is sufficient to dedicate between one and one and a half hours per week to strength training.always adapted to the abilities of each person and spread over several sessions.
Going to a gym is not essential: working with elastic bands, small weights, or even your own body weight It can be very effective if performed consistently and following a proper progression. Assisted squats, heel raises, arm exercises with resistance bands, or repeatedly standing up from a chair are examples of simple movements with a high impact.
Specialists recommend starting with light loads and few repetitionsPaying attention to technique and avoiding sudden movements. As the body adapts and strength improves, resistance or the number of sets can be increased, always under professional supervision if there are any doubts or significant limitations.
It is important to note that the Exercises should be adapted to the condition of the affected jointsIn phases of intense inflammatory flare-up it may be necessary to reduce the load or modify some movements, but the general idea is to maintain the highest possible level of activity without worsening the pain or inflammation.
For many people with rheumatic diseases, having the advice from a physiotherapist or a professional specializing in therapeutic exercise This can make all the difference when designing a safe and effective program. A personalized plan helps build confidence and avoid both overexertion and inactivity due to fear.
The role of nutrition: quality protein and vitamin D
Along with exercise, the Nutrition plays a key role in the prevention and treatment of sarcopeniaMuscle needs "building materials" to maintain and repair itself, and those materials are primarily dietary proteins, which provide the amino acids necessary for muscle synthesis.
SER reminds us that Proteins are an essential macronutrient for gaining or maintaining muscle mass and strengthFor older adults, current recommendations suggest an intake of 1 to 1,2 grams of protein per kilogram of body weight per day. For patients with chronic rheumatic diseases, this amount can be increased to 1,2–1,5 grams per kilogram of body weight, always taking into account each individual situation.
Prioritization is advised high-quality protein from healthy foodsExamples include chicken, turkey, fish, legumes, eggs, and certain dairy products. Spreading protein intake throughout the day, rather than concentrating it in a single meal, promotes better utilization by the muscles.
Another key player in this context is the Vitamin D, a deficiency of which has been linked to muscle weakness and an increased risk of fallsIn rheumatic patients, it is not uncommon to find low levels of this vitamin, so it is often necessary to monitor it and, if appropriate, resort to supplements under medical prescription.
Generally speaking, following a Mediterranean diet pattern A diet rich in fruits, vegetables, legumes, whole grains, olive oil, and fish is associated with positive effects on muscle function and overall health. This type of diet also helps control inflammation and reduce cardiovascular risk, two very important aspects in rheumatic diseases.
A joint strategy to preserve quality of life
Sarcopenia in the context of rheumatic diseases implies a major challenge for public health in Spain and EuropeBut it's also an opportunity to act in time. With a good diagnosis, proper follow-up, and the active involvement of patients and professionals, it's possible to slow its progression and reduce its consequences.
The message that rheumatologists convey is clear: It's not just about treating joint disease, but also about taking care of the muscle.Integrating strength training, reviewing diet, and keeping inflammation under control should be as much a part of the therapeutic plan as medications or regular medical check-ups.
For people with rheumatic diseases, assuming that Movement and lifestyle habits are a central part of the treatment It may require a change of mindset, but it opens the door to maintaining autonomy and the ability to perform daily activities without depending on others for a longer period of time.
With resources like Reumafit, the support of scientific societies like the SER, and greater awareness of the importance of muscle strength, There are increasingly more tools available to patients and professionals. to confront sarcopenia and gain years of life with better health and functionality.