Putting Pep in Their Step: Supporting Patients with Age-Related Muscle Decline


Table of Contents

1. Prevalence and Symptoms of Age-Related Muscle Decline

2. The Mitochondria’s Role in Muscle Health

3. Exercise and Nutrition Interventions for Age-Related Muscle Decline

4. Nutrients to Support Age-Related Muscle Decline

5. Pure Encapsulations Nutrient Solutions

6. Summary

7. Resources



Skeletal muscle is the predominant tissue in the human body, comprising 40% of overall body weight.[1] We rely on our skeletal muscle for numerous physiological functions including movement, maintaining posture, generating force, metabolism and respiration.1


As people age, so do their skeletal muscles.


Prevalence and Symptoms of Age-Related Muscle Decline

Age-related muscle decline can begin at age 30.3 More pronounced in sedentary individuals, muscle mass can be lost at a rate of 1% per year.[2] Loss of muscle mass can also be accompanied by atrophy of muscle fibers and reduced muscle function and strength. This gradual decrease can progress, with an individual losing up to one-third of their muscle mass by age 80.2

Loss of muscle mass and strength in older individuals could contribute to fall risk, reduced mobility, loss of independence, and ability to perform daily functions.2


The Mitochondria’s Role in Muscle Health

Skeletal muscle is a tissue with high energy demands and mitochondria are primarily responsible for meeting this demand. Mitochondria not only power muscle contraction by supplying ATP, they also undertake other critical functions, including moderating intracellular calcium, cell proliferation, signaling, regulation of redox states and immune response.[3]

Well-functioning mitochondria are essential for maintaining cellular homeostasis and muscle health. Cellular mitochondrial health is maintained by growing the mitochondrial pool through mitochondrial biogenesis, through preserving fusion and fission and by ensuring the removal of dysfunctional mitochondria through mitophagy.

Mitophagy is a selective autophagy process that serves as the mitochondria’s own quality-control mechanism and involves removing and recycling dysfunctional mitochondria.[4] Mitophagy helps preserve only healthy mitochondria for the mitochondrial pool.

Just as skeletal muscle function can change as the human body ages, mitochondria are also subject to the effects of aging, as shown in the illustration below.

These age-associated changes in mitochondria can lead to altered mitophagy [5],[6],[7],[8]

When mitophagy is altered, it can lead to the accumulation, rather than clearance, of less-functional mitochondria.

Accumulation of these mitochondria can contribute to energy deficit and changes in the balance between anabolic and catabolic processes — important determinants of muscle mass, function, motor neuron and muscle fiber health. [8],[9][10]

Mitochondria can quickly adapt to changing conditions triggered by systemic or cellular challenges.3

Supporting mitochondrial function helps reduce loss of muscle mass and function and benefit overall health, specifically by enhancing mitochondrial dynamics and mitophagy.3

Both sedentary and physically active are susceptible to age-related muscle decline, yet the degree of severity is highly variable and dependent upon multiple risk factors beyond mitochondrial health, including hormone and cytokine balance, malnutrition and degree of physical activity. [11]


Exercise and Nutrition Interventions for Age-Related Muscle Decline



Lack of exercise is believed to be the leading risk factor for age-related muscle loss.11

Both resistance and aerobic training have been shown to improve the health of skeletal muscle by impacting mitochondrial quality and increasing muscle strength and function in older patients. [11],[12],[13],[14]

Individually tailored exercise programs can support healthy aging and be a means of prevention and intervention for age-related muscle decline.

In clinical studies demonstrating the benefits of aerobic, resistance or combined exercises, exercise was performed at least 2-3 times per week, for 30-60 minutes each session, for at least 8-12 weeks.12,13

When recommending exercise as a therapeutic option for patients, the duration of sessions, amount of weight, distance, and number of exercises should increase gradually based on each individual’s capability and improvement.


Forty percent of older individuals do not meet the recommended .8g/kg protein intake requirements in their diet.[15] Poor protein intake, combined with decreased absorption and intake of other nutrients that are essential for muscle health like amino acids and vitamins and minerals, put older individuals at a greater risk of reduced muscle protein synthesis or “anabolic resistance” and muscle loss.[16] In addition, changes in mitochondrial function that also occur with aging can contribute to oxidative stress and favor catabolism of the muscle.[17],[18],[19]

Two ways to support age-related muscle decline in the older patient involve assessing their protein and antioxidant intake. Recommended adequate protein in the older patient is 0.8 gm/2.2 lbs of body weight up to age 65, and 1 gm/2.2 lb of body weight after age 65.[20]

In a systematic review of 19 observational studies and 9 randomized-controlled trials, Besora-Moreno et al revealed that a higher intake of antioxidant foods was associated with better muscle preservation outcomes.[21] A meta-analysis of 4 randomized-controlled trials by the same authors found that that higher fruit and vegetable consumption and supplemental protein each significantly improved20 adherence to a Mediterranean diet, which promotes a high intake of proteins, fibers and polyphenols, combined with an individualized exercise regimen can be an effective approach to age-related muscle changes in the aging patient.

Nutrients to Support Age-Related Muscle Decline

Along with adequate protein, a phytonutrient rich diet and exercise, focusing on nutrients that support cellular, mitochondrial and muscle health can help improve patient outcomes.

Urolithins are unique natural metabolites of intestinal bacteria that are produced by commensal microbiota after consuming foods rich in ellagitannins and ellagic acid — major health promoting constituents of pomegranates, nuts and berries. These unique polyphenols undergo metabolism by intestinal bacteria to small, highly absorbable metabolites called urolithins, which mediate the widely acclaimed health benefits of pomegranates and other ellagitannin-rich foods.[22],[23]  Urolithin A also supports muscle function in preclinical models, improving endurance and exercise capacity in both young and age-related models of muscle decline.[24]

B vitamins are essential to basal mitochondrial function, serve as metabolic coenzymes and/or methyl donors.

PQQ provides B vitamin-like activity with unique antioxidant properties. PQQ supports mitochondrial, neuronal and cellular function, at least in part, by activation of Nrf2 and antioxidant gene expression. PQQ may also help to maintain cytokine balance.

Amino Acids are the building blocks for all proteins, making them essential for several body functions, including fluid balance, enzyme production, cellular repair and energy metabolism.[25],[26] Proper intake of amino acids is important for the synthesis, repair and metabolism of muscle, cells and tissues.


Pure Encapsulations® Nutrient Solutions

Pure Encapsulations® offers high-quality supplements that are FREE FROM unnecessary additives and many common allergens for patients who may need support for age-related muscle changes. We offer nutrients individually and in combination to meet all your patients’ unique needs.

Klean Athlete® and Douglas Laboratories® are Pure Encapsulations partner brands.

Klean Athlete is our dedicated sports nutrition brand designed to power peak performance through optimal health. By harnessing the science of sports nutrition, Klean Athlete delivers safe, NSF Certified for Sport® supplements to support healthy, active lifestyles. Klean Athlete is trusted by over 350 professional and collegiate sports teams, and is the preferred brand of many of the world’s top coaches, trainers and health professionals.

Douglas Laboratories has been dedicated to meeting the needs of healthcare professionals for over 65 years. As a globally recognized leader in innovative, science-based nutritional supplements, we strive to support healthcare professionals as they help their patients discover the potential for healthy living, today and in the future.

Cellular Health

Renual enhances mitochondrial renewal to support energy output/energy production. Features Mitopure Urolithin A to power muscle function, increase cellular energy and promote healthy aging. Research indicates that urolithin A enhances autophagy, the natural process of cellular renewal in which the body degrades and recycles cellular components, as well as mitophagy, the clearance and recycling of older and dysfunctional mitochondria. Resveratrol offers support for longevity, metabolic health, and mitochondrial function.[27],[28] CoQ10 is a key nutrient used in the energy production pathway.[29]

Suggested use: Take 2 capsules, 1-2 times daily, with or between meals.

Ultra B Complex w/PQQ combines essential B vitamins with PQQ to support cellular energy production and mitochondrial bioenergetics and function. It also contains alpha lipoic acid and luteolin for enhanced antioxidant and cellular support.

Suggested use: Take 1 capsule, 1-2 times daily, with meals.

Muscle Health

Muscle Protect with HMB supports healthy muscle mass and function, provides anabolic muscle building support attenuates muscle protein breakdown and preserves lean muscle mass in aging adults. Formulated with clinically studied HMB® and Amino 9™, a leucine-rich blend of essential amino acids (EAAs) combined with vitamin D3 and glutamine.

Suggested use: 1 scoop, 1-2 times daily

KLEAN Isolate™ supplies 20 grams of high-quality whey protein isolate in each serving. The dietary protein provided by Klean Isolate™ supplies essential amino acids, including branched chain amino acids that participate in many of the body’s metabolic and physiologic systems.

With no additional flavorings or sweeteners, Klean Isolate™ can easily be added to any beverage to enhance daily protein and amino acid intake.

Suggested use: Adults take 1 scoop daily mixed with 10-12 oz. of water or other beverage (cool or room temperature), or as directed. For best results, take within 45 minutes after being active.

KLEAN Plant-Based Proteinby Klean Athlete® supplies a blend of pea and organic brown rice protein to provide amino acids for muscle protein synthesis. ProHydrolase® enzymes are included to break down protein for increased amino acid absorption and to ease digestion, along with Sunfiber® for gastrointestinal health.‡  

Suggested use: 1 scoop daily mixed with 10-12 ounces of water or other beverage, or as directed by a trainer, coach or health professional.

Digestive Support

Digestive Enzymes Ultra w/ Betaine HCl contains an extensive profile of betaine HCl and digestive enzymes to support protein, carbohydrate, fat, fiber and dairy digestion while promoting enhanced nutrient bioavailability and absorption. Encourages optimal gastric pH with betaine HCl, which is important for the enhanced digestion of protein and other nutrients for daily wellness and healthy neurotransmitter synthesis.[30]



Loss of muscle mass and strength can significantly impact an individual’s well-being and ability to live independently. Providing patients with targeted, personalized nutrition and exercise interventions to enhance anabolic processes and cellular health can greatly influence their quality of life now, and as they age.

Pure Encapsulations® provides uniquely formulated products made with high-quality, pure ingredients backed by verifiable science to complement your plan of care.



Drug-Nutrient Interactions Checker: Offers scientifically supported, clinically relevant information along with relevant product suggestions.

You can also explore Pure Encapsulations® to find On-Demand LearningClinical Protocols, and other resources developed with our medical and scientific advisors.



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