With an ageing UK population, age-associated health problems have become core business for the NHS. As England’s Chief Medical Officer, Professor Chris Whitty, highlighted in his 2023 report - ‘Health in an Ageing Society’, research to improve the health of older people and those living with multiple long-term conditions (MLTC, also known as multimorbidity) is a key priority.
In recent decades, significant advances have been made in our understanding of the fundamental biology of ageing. By working across disciplines, there is now a major opportunity to translate this knowledge into advances in the prevention, diagnosis and treatment of common age-related conditions including sarcopenia and MLTC.
Building on our internationally-recognised expertise on ageing, sarcopenia and MLTC, our vision is to enable a step-change in translational ageing research and seize this opportunity. By working across traditional disciplinary boundaries and placing patients and the public at the heart of our research activity we are delivering significant health benefits for people across the life course, including in old age.
Deep-phenotyping for discoveryOur Muscle Ageing and Sarcopenia Lifecourse study is a unique population-based resource that combines clinical, sociodemographic and lifestyle data with biological samples, including muscle biopsies, that is providing novel insights on mechanisms and risk factors underpinning sarcopenia and MLTC
Experimental medicine ageing studiesOur innovative MLTC registry (MULTIPLE) and REVITALiSE sarcopenia platform trials recruit older people to enable experimental medicine testing of multiple candidate interventions, giving mechanistic insights and robust evidence for future large-scale clinical trials
Translation into practiceOur work with regional, national and international partners is improving guidance and education, and informing best practice on diagnosis and management of sarcopenia and MLTC via our Benchmarking Exercise Programme for Older People (BEPOP) and other initiatives
Our programme of work encompasses detailed observational studies to characterise muscle health, multiple long-term conditions, and the impacts of ageing; novel experimental medicine platform trials to evaluate novel interventions, and innovative programmes to deliver effective implementation, ensuring that research breakthroughs in ageing, sarcopenia and MLTC are pulled through to benefit patients.
Our research has national and international impact, facilitated by our leadership roles of initiatives including the MLTC Cross-NIHR Collaboration (CNC), the British Geriatrics Society and the Global Leadership Initiative in Sarcopenia (GLIS).
An introduction to research seeking to understand how muscle works, why we become less strong as we age, and how we can improve muscle strength.
This short video showcases how our Theme designs and delivers successful public engagement events to disseminate our research, in partnership with our public collaborators.
To the Recording
Journal: Clinical Science
Authors: Antoneta Granic, Karen Suetterlin, Tea Shavlakadze, Miranda D. Grounds, Avan Aihie Sayer
Summary: This review examines how the nine classic hallmarks of ageing, including mitochondrial dysfunction and cellular senescence, contribute to sarcopenia, the age-related decline in skeletal muscle mass and function. We further highlight five novel hallmarks specific to skeletal muscle ageing: inflammation, neural dysfunction, extracellular matrix dysfunction, reduced vascular perfusion, and ionic dyshomeostasis.These hallmarks are interconnected and may significantly influence sarcopenia development. However, there is limited research involving older women, which is needed to understand the complex interplay of these hallmarks and their clinical implications for developing effective interventions to mitigate sarcopenia and improve quality of life in the ageing population.
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Journal: Nature Reviews Disease Primers
Authors: Avan Aihie Sayer, Rachel Cooper, Hidenori Arai, Peggy M. Cawthon, Marie-Josiane Ntsama Essomba, Roger A. Fielding, Miranda D. Grounds, Miles D. Witham and Alfonso J. Cruz-Jentoft
Summary: Building on the success of the International Sarcopenia Translational Research Conference, this paper, led by members of the ASM theme and involving contributors from around the world, continues our work to highlight the importance of sarcopenia. It does this by providing a state-of-the-art summary of the latest research on sarcopenia, including evidence on the diagnosis, epidemiology, biological mechanisms, and management of sarcopenia. The aim of this high-profile review is to reach and educate a wide audience including biomedical scientists and clinicians in the early stages of their careers.
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Journal: Age and Ageing
Authors: Christopher Hurst, Sian M Robinson, Miles D Witham, Richard M Dodds, Antoneta Granic, Charlotte Buckland, Sarah De Biase, Susanne Finnegan, Lynn Rochester, Dawn A Skelton, Avan Aihie Sayer
Summary: Resistance exercise training is a first-line treatment for sarcopenia, yet the optimal exercise prescription remains uncertain and current delivery in clinical practice is variable.
In this paper we provide pragmatic guidance for prescribing and delivering resistance exercise to older people living with sarcopenia in clinical practice.
The proposed resistance exercise prescription outlined in this paper supports clinicians and exercise practitioners to deliver high quality exercise programmes to older adults with sarcopenia in clinical practice.
Improved exercise prescription and delivery in clinical practice will ultimately translate into better outcomes for people living with sarcopenia.
Journal: European Geriatric Medicine
Authors: Rachel Cooper, Jonathan G. Bunn, Sarah J. Richardson, Susan J. Hillman, Avan Aihie Sayer, Miles D. Witham
Summary: In this paper we outline a set of principles to guide selection of long-term conditions when studying multiple long-term conditions (MLTC) in a hospital setting. We then apply these principles to identify a list of 60 conditions (and ICD-10 codes for each of these conditions) that we recommend are utilised when conducting research on MLTC in hospital-based populations in the UK and other countries with similar population health profiles. Our work addresses the need for greater transparency and consistency in the approach to the definition of MLTC and provides clear recommendations for those conducting research on MLTC in the hospital context.
Journal: The Lancet Healthy Longevity
Authors: Witham MD, McDonald C, Wilson N, Rennie KJ, Bardgett M, Bradley P, Clegg AP, Connolly S, Hancock H, Hiu S, Nicholson K, Robertson L, Simms L, Steel AJ, Steves CJ, Storey B, Wason J, von Zglinicki T, Sayer AA
Summary: Clinical trials for older people have historically been challenging to design and recruit to, hence few trials have been done to test interventions for sarcopenia. In this phase II, multicentre trial, we tested the medication metformin (which has been used to treat diabetes for many years) as a treatment for sarcopenia in 72 people aged 65 and over with sarcopenia recruited from two UK centres. Our trial design made it easy for older people to take part, with many study visits done in participants own homes. Almost everyone who started the trial completed it successfully - a major step forward in our ability to deliver trials for people with sarcopenia. However, metformin did not improve muscle strength or physical performance and did not improve quality of life in older people with sarcopenia. Importantly, metformin was not well tolerated and caused frequent side effects, even at the low dose we used. Metformin is therefore unlikely to be useful as a treatment for sarcopenia in older people who are already significantly affected by muscle weakness.
AGE Research Group
ART of Healthy Ageing Network
ADMISSION Collaborative
Benchmarking Exercise Programme for Older People (BEPOP)
Let's Talk Research NIHR INCLUDE project
Director NIHR Newcastle BRC, William Leech Professor of Geriatric Medicine and Theme Co-Lead for Ageing, Sarcopenia and Multimorbidity
Professor of Trials for Older People, BRC PPIE Academic Lead and Theme Co-Lead for Ageing, Sarcopenia and Multimorbidity
McArdle Chair in Ageing, Professor of Translational Epidemiology, BRC Theme Leadership Track for Ageing, Sarcopenia and Multimorbidity and BRC Interdisciplinary Research Academic Lead
NIHR Academic Clinical Lecturer, BRC Theme Leadership Track for Ageing, Sarcopenia and Multimorbidity and BRC Equality, Diversity, and Inclusion Academic Co-Lead