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INSIDE HEALTH 鈥� Programme 2.

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TX:听 15.01.19听 2100鈥�2130

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PRESENTER:听 MARK PORTER

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PRODUCER:听 PAMELA RUTHERFORD

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Porter

Hello. 听Coming up in the next half hour:听 Muscles 鈥� why we should all be doing more to stay strong.听 And treating short-sightedness with eye drops 鈥� commonplace in some parts of the world, but not here in the UK.

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But we start with medicines or rather a lack of them. 听Millions of people prescribed run-of-the-mill drugs for conditions like arthritis and high blood pressure are finding that their pharmacy can鈥檛 supply their usual pills.

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Margaret McCartney is in our Glasgow studio. 听What is the situation like in Scotland Margaret?

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McCartney

Well I think it鈥檚 just as bad, I mean NHS England have said that there is an unprecedented number of medicines in short supply and I don鈥檛 see anything different happening up here.听 It is a complete nightmare.听 So, you鈥檙e busy, you expect to be busy when you鈥檙e on call, you know, you expect, when you鈥檙e duty doctor, to have a lot of stuff to do and that鈥檚 great if it鈥檚 stuff that鈥檚 really useful for patients but what you鈥檙e finding, actually, is it鈥檚 just trying to find standard medications that should be in stock and we鈥檙e not able to get hold of.听 It鈥檚 a hassle for us, it鈥檚 a hassle for the patients, it鈥檚 a hassle for the pharmacists, it鈥檚 completely pointless because this really should be sorted out centrally.听 And it means that we鈥檙e not getting to do more important work because we鈥檙e doing this hasslely stuff instead.

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Porter

To be clear, it鈥檚 not generally a risk to patient鈥檚 health, this is about the hassle of the patient having to come back and see you and get another drug prescribed, you having to prescribe it?

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McCartney

Yeah and quite often it鈥檚 just to do with dosages or strength or preparation or a different generic brand, for example.听 We talked about shortages of epi-pens, adrenaline auto-injectors, last year on Inside Health and that鈥檚 a good example of one that was, I think, slightly more frightening to be running out of, I think the supply problems for that have more or less sorted themselves out.听 But this is like common or garden stuff, things like naproxen, epilepsy drugs, HRT 鈥� stuff that really is basic core medicine, nothing fancy.

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Porter

Well Ben Merriman is a pharmacist working in a GP surgery in South Cumbria.

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Merriman

It鈥檚 always been an issue, getting hold of certain things but for the last 18 months it has been increasingly troublesome.

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Porter

Do you remember ever being this much of a problem?

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Merriman

I鈥檝e been qualified for 12 and a half years and this last 12 months has been the worst I can recall.听

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Porter

Yeah, well I鈥檝e been in the business a bit longer than that and I think it鈥檚 the worst 12 months I can recall as well.听 What sort of drugs are we talking about?

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Merriman

We鈥檙e talking about really kind of basic common medicines, medicines for blood pressure like Losartan and Ramipril, really basic things to help people healthy.听 There鈥檚 a few medicines for epilepsy quite worrying 鈥� things like lamotrigine or sodium valproates, some epileptics may take to control seizures.听 We have medicines to help with joint pain, so things like alopurinol for gout or naproxen as an anti-inflammatory.

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Porter

But what about common drugs like, I mean, furosemide, which is a water tablet, a diuretic, I mean these are commonly available, generally, cheap as chips medicines, I鈥檝e never given it a second thought that people wouldn鈥檛 be able to get a drug like that?

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Merriman

Yeah, I mean furosemide to a pharmacist or a GP is like paracetamol or aspirin to a patient, it鈥檚 stuff that you kind of don鈥檛 even think about as being unavailable, it鈥檚 unthinkable that we鈥檙e unable to get hold of this sort of medicine.听 And unfortunately, it鈥檚 really causing 鈥� not only is it causing stress for the likes of myself and for yourself, telling a patient 鈥� I鈥檓 sorry, I cannot get the medicine that you need to keep you well, it is of course causing an awful lot of stress, an awful lot of anxiety which nobody really wants patients to experience.

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Porter

Now normally we can 鈥� in most cases 鈥� prescribe a suitable alternative and I presume that鈥檚 part of your role, I mean it鈥檚 certainly something 鈥� we don鈥檛 have a pharmacist in my practice so the doctors are doing it 鈥� but is that something you鈥檙e doing and how much of your time is it taking up?

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Merriman

Yeah, I mean this is actually kind of forming an essential part of my day, I would spend maybe half an hour to an hour each and every day dealing with this sort of problem 鈥� we can鈥檛 get hold of drug X right this patient has got this condition, what other medicines can they have?听 It鈥檚 not something that鈥檚 particularly bothersome for me but it does take an awful lot of time and it鈥檚 time that I could be spending with patients, helping improve their health.

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Porter

Now many of these drugs are one or two pounds for a month鈥檚 supply, aren鈥檛 they, that鈥檚 the sort of money we鈥檙e talking about?

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Merriman

Absolutely, yeah, we鈥檙e talking a few pence for a tablet, if that.听 Unfortunately, what鈥檚 happening is because we鈥檙e seeing shortages of certain medicines, unfortunately, market forces apply to pharmaceuticals, in the same way they apply to anything else 鈥� so if there鈥檚 a sudden shortage in the market then all of a sudden, we could be paying four or five pounds for something where we normally pay 40 or 50pence. 听听And ultimately, it鈥檚 the NHS that has to pay for this.

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Porter

Being Inside Health, we are, of course, very cynical, I mean is there any market manipulation going on, do you get a sense that somebody somewhere is playing foul here by restricting supply to bump prices up, could that be an issue?

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Merriman

I鈥檝e nothing in concrete to say that is what is happening but there was an example that I came across in March of last year, regarding a drug called bicalutamide, it鈥檚 a drug to help 鈥� kind of keep on top of prostate cancer 鈥� and this drug had been unavailable for about three or four months and then all of a sudden my pharmacy received some of these and just out of interest I checked the expiry date and they expired in April 2019, which meant that they had 13 months of life left.听 Out of interest I googled the manufacturer and they鈥檙e meant to last for three years from the date they are made.听 So, essentially, this product has presumably been sitting on a shelf somewhere for the past 23 months.听 Is somebody playing the system here?听 Is there any stockpiling going on to lead to shortages to then create artificially high prices?听 I don鈥檛 know.

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Porter

And Ben is far from alone.听 Ash Soni is a community pharmacist and President of the Royal Pharmaceutical Society. I asked him if he鈥檚 struggling with supplies.

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Soni

Completely, when I鈥檓 in my pharmacy I see exactly the same thing 鈥� same drugs, same issues, same problems 鈥� and actually it鈥檚 that bit that Ben highlighted about the patient, being able to turn round to them and say 鈥� having to turn round to them and say 鈥� I鈥檓 really sorry, I can鈥檛 get hold of your medication at the moment.听

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Porter

Because the price difference is huge, I mean talking naproxen, this common anti-inflammatory, what would you have paid for that normally?

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Soni

Oh normally, historically, naproxen 250 about 80p鈥�

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Porter

For a month鈥檚 supply?

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Soni

鈥�for a month鈥檚 supply.

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Porter

And what鈥檚 it now?

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Soni

I bought it on Friday at 拢6.49 a box.

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Porter

And it鈥檚 the same drug, same production costs.

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Soni

Absolutely, nothing鈥檚 changed, apart from the fact of the price I鈥檓 paying.听 And therefore, potentially, the NHS is paying.

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Porter

Okay, let鈥檚 ignore stockpiling and market manipulation for a moment, what other factors might be responsible?听 Everyone talks about Brexit, let鈥檚 deal with that first of all.

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Soni

So, Brexit is an interesting play in this, it isn鈥檛 there at the moment, we鈥檙e too early.听 If you think about the fact that Brexit is two months away, for people to be stockpiling for that length of time they are going to be holding stock for a long time and even for the big companies that鈥檚 a lot of challenge.

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Porter

So, what鈥檚 at play then?

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Soni

So, there are a number of factors.听 The first is, potentially, there is some market manipulation going on but I think that鈥檚 quite a small piece of this because actually in a way you鈥檝e got to have a shortage 鈥� enough of a shortage to be able to create that.听 We know there are certain laboratories that are currently closed, the HMRA closed down one supplier 18 months ago now, and they haven鈥檛 been able to reopen their factories yet, that鈥檚 going to automatically create a shortage because they were producing quite a lot.听 You鈥檝e got the fact that the global market is growing, we鈥檝e got the developing world is developing and as a result there are greater demands for drugs from there.听 You start taking India, China, Brazil, Russia into account and take their populations into account, that鈥檚 not just a small growth it鈥檚 huge.听 And then from a market perspective, if I鈥檓 the manufacturer of a product and you turn round to me and say, well actually if I sell it to Germany they鈥檙e going to pay me a fiver, if I sell it to the UK it鈥檚 going to be a 拢1, where am I going to sell it, I鈥檓 a global company and I鈥檝e got the same issue?

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Porter

Is that a major issue here in the UK that there鈥檚 so much pressure on prices that we鈥檙e expecting people to have drugs that cost 80p for a month鈥檚 supply that actually the manufacturers are 鈥� it鈥檚 too low, there isn鈥檛 enough meat on the bone for them?

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Soni

Absolutely, there is no doubt, whatsoever, that鈥檚 happening.听 If 鈥� in fact to the point where I had a conversation with Teva, because I have a particular patient that takes鈥�

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Porter

Who are big manufacturers.

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Soni

Big manufacturer, massive manufacturer globally.听 And they make a product called lamotrigine, which Ben referred to, and there鈥檚 a shortage of that.听 Teva have just discontinued it because it didn鈥檛 make economic sense for them to continue to make it.听 Well, that鈥檚 the type of thing, again, that鈥檚 suddenly created more shortages in the market because if you can鈥檛 manufacture a price which is going to justify delivering it then you鈥檙e not going to manufacture it.

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Porter

The current situation is we鈥檝e got patients wasting their time going back and forth to the pharmacy, we鈥檝e got pharmacists wasting their time dealing with the patients, we鈥檝e got doctors, like me, having to rewrite prescriptions.听 What鈥檚 going to change, this has got to change, hasn鈥檛 it, it can鈥檛 carry on like it is?

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Soni

Well one way or another we鈥檝e got to find different ways to be able to deal with that.听 And the thing that strikes me is that one of the things that we鈥檝e got potentially coming into effect is the Serious Shortages Protocol.听 Now this isn鈥檛 what this was designed for, this is designed for Brexit.听 What it does, it empowers pharmacists to make the changes that currently we鈥檙e having to send that patient back to the doctor and the doctor having to make the change on the prescription and then the patient having to bring the prescription back and then me being able to give what I鈥檝e got.听 And by the time they come back, on occasions, we鈥檝e run out of that as well.听 We鈥檝e had that happen.听 But this 鈥� effectively this protocol very clearly defines at national level what changes can but also what cannot be made.听 So, I know there have been some issues round anti-epileptic drugs and people worried about 鈥� oh well, the pharmacist will just change my anti-epilepsy drugs 鈥� no, it鈥檚 very clear those type of drugs will not be changed without the authority of the prescriber because you鈥檝e got the history and the knowledge about the drugs that patient may have taken before.

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Porter

And the idea is this makes it quicker and simpler, that somebody comes with a prescription from me, you can give what you鈥檝e got in stock effectively?

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Soni

Absolutely, it鈥檚 very much about that.听 So, take naproxen as an example, we鈥檝e had stages where we鈥檝e had naproxen 250, we鈥檝e had naproxen 500 鈥� which they鈥檙e different strengths 鈥� but then we鈥檝e had slow release versions 鈥� GR versions as they鈥檙e called 鈥� and depending on what鈥檚 available at a particular time we鈥檒l have one out of four or maybe two out of four and actually what we need to be able to do is say 鈥� well, this is what I can get today, this, under this protocol mean I can give this instead.听 And for that to happen automatically without me having to defer back to you as a doctor.

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Porter

And when鈥檚 this going to happen?

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Soni

So, we鈥檙e expecting this protocol to be in place in the next couple of weeks, it鈥檚 part of the Brexit plan, as part of the strategy for the regulations to be laid.

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Ash Soni, suggesting there is some light at the end of the tunnel. 听And there is more information on the rule changes he mentioned on the Inside Health page of the Radio 4 website.

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Short-sightedness or myopia is a growing problem. 听The number of children with myopia in UK has doubled in the last 50 years, with one in seven teenagers now affected. 听And it鈥檚 even more common elsewhere.

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Actuality

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Tan

My name is Donald Tan, I鈥檓 the Arthur Lim Professor at the Singapore National Eye Centre.听 Today, globally, one in four people in the world are myopic and that means you can鈥檛 see without glasses, right?听 There are studies to show that by 2050 half the world, one in two individuals globally, will be myopic.听 It鈥檚 astonishing.听 The reason why there is a current global epidemic of myopic in which the myopic rates around the world are gradually but surely increasing is not the genes, genes don鈥檛 change, it is the environment.听 One of the strongest evidence we have is that outdoor activities are protective, so if you do more sports, you鈥檙e outdoors more, maybe lighting, maybe relaxing your eyes into the distance when you鈥檙e playing games, that helps to reduce myopia.

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Porter

And this is why children in Singapore are being encouraged to keep myopia at bay by going outdoors to play.

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Actuality 鈥� children playing

Keep myopia at bay, go outdoors and play.

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Porter

But there鈥檚 another approach to tackling myopia that is popular in that part of world that鈥檚 almost unheard of here 鈥� atropine eye drops. 听And Donald Tan is one of the researchers investigating the preventive powers of a drug better known in the UK for treating worrying slow heart rates, or as an ancient beauty product that dilates the pupils to make the user look more alluring.

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Tan

Atropine is an old drug, we鈥檝e been using it for years, it鈥檚 used in cardiology.听 It鈥檚 based on a plant, belladonna, but it is actually a neurotransmitter.听 So, we can use this in the form of eye drops to change or alter eye growth and it reduces myopia because myopia is basically a condition where the length of the eyeball is too long, it just grows too much in childhood.听 And when people started using atropine, we quickly realised that it seems to reduce this abnormal eye growth.听 And so, it reduced myopia.

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Porter

Atropine may be a popular remedy in Asia, but it鈥檚 hardly used at all in Europe. 听However, that could soon change thanks to a new study. 听Called CHAMP-UK it is being led by Professor Augusto Azuara-Blanco from Queen鈥檚 University, Belfast, who has more than a professional interest in myopia.

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Azuara-Blanco

Actually, for me it鈥檚 a bit of a personal story because my daughter she鈥檚 short-sighted and she started wearing glasses when she was about seven and I wanted to get hold of atropine and I couldn鈥檛.听 And then, of course, my academic background thought perhaps we should do a trial and that鈥檚 how I started performing.

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Porter

Why is it used in other parts of the world but not here?

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Azuara-Blanco

Well I think it鈥檚 mainly in Europe mainly because the regulatory agencies haven鈥檛 approved and mainly because we don鈥檛 have perhaps very strong evidence that it works in our populations.

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Porter

You say we haven鈥檛 got strong evidence that it works but does it work?

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Azuara-Blanco

So, some years ago there was a trial in Singapore, they were trying to have lower doses and lower doses of this atropine to see whether it could still work but without all the side effects of blurring the vision and dilating the pupils.听 And they found 鈥� it was a surprising finding 鈥� because the lowest concentration in this trial, which are very low, like a hundredth of the concentration that we use in the clinic, appeared to be the most effective.听 And we couldn鈥檛 understand why.

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Porter

And this would be using the drug daily, regularly, all the time to prevent the natural progression of short-sightedness鈥�

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Azuara-Blanco

Well again that鈥檚 a very good question.听 The trials from Singapore treated kids for two years and then they stopped and looked what happened after stopping the drops.听 And again, most interestingly, the group that had the lowest concentration appeared to remain stable and in some children with higher concentration, although it was effective, there appeared to be a rebound effect, so the myopia progressed after stopping the treatment.

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Porter

So, it sort of caught up basically, yeah鈥�

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Azuara- Blanco

Yes.

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Porter

鈥�they came off the treatment and it bounced back.听 But for the group given the lowest concentration there seemed to be some sustainable benefit?

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Azuara-Blanco

Yeah.

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Porter

So, the situation was that you wanted to use atropine drops in your own child?

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Azuara-Blanco

Yeah.

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Porter

You weren鈥檛 convinced by the evidence out there, so what are you doing about it?

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Azuara-Blanco

The way of trying to do that is to do a trial to ask whether this low dose atropine works well and is safe and well tolerated in children with myopia in the UK.

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Porter

So, you鈥檙e looking for efficacy, number one, to see whether it actually works鈥�

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Azuara-Blanco

Works.

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Porter

鈥�and the implications of this research are quite profound, this is a very cheap medication, potentially, it鈥檚 very easy to administer, hopefully at low doses have very few side effects.听 And we鈥檙e talking about it being able to halt the progression, that鈥檚 what you would aim for, that鈥檚 what you would regard as a good result?

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Azuara-Blanco

I think yes, I think that will be a very good result because again those 鈥� we know that there are substantial problems with progression of myopia to very high levels, we know that some of these people will have a substantial and significant risk of visual loss later on in life.听 So, stopping myopia, that will be very good news for everybody.

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Porter

How does it feel to be running a trial that could have such huge ramifications?

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Azuara-Blanco

This is what I like to do, I mean I鈥檓 a clinician and I enjoy very much trying to improve patients鈥� vision and outcomes but the possibility of having a more widespread contribution I think that鈥檚 what excites me.

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Porter

When do you think you might get an answer, if all goes well?

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Azuara-Blanco

Okay, so within three years, four at the most, I think we鈥檙e going to have a definite answer.

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Porter

So, your daughter might not benefit but maybe her daughter might one day?

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Azuara-Blanco

Absolutely, hopefully.

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Porter

Augusto Azuara-Blanco talking to me in Belfast. 听More information, as ever, on our website, where you can also find out how to get in touch.

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Tracey emailed Inside Health to ask about weight loss, or, in her case, weight gain.

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Tracey (email)

I am a life-long member of Weight Watchers and recently, ahead of a mountain climb, I have been in training to get fitter. 听According to my gym鈥檚 computer I had 鈥榯rained like a sportsperson鈥� and I had also been very careful with what I ate. 听So, I was surprised to find, at my weekly weigh-in, that I had put on 2.5lbs.听 Still, I took comfort in believing that muscle in my body weighs more than fat.

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However, that evening I received an e-mail from Weight Watchers stating that even though I鈥檇 had a small weight gain, I wasn鈥檛 to worry and they would help me find my way back to healthy eating. 听All very dispiriting.

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Is my 鈥渕uscle weighs more than fat鈥� justification wrong?

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Porter

Well I know just the person to ask 鈥� Jason Gill, Professor of Cardiometabolic Health at the University of Glasgow.

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Gill

So, technically, a lot of people say muscle is heavier than fat, so muscle is more dense than fat, muscle is about 15% more dense than fat.听 So, if you take a unit volume of muscle and a unit volume of fat the muscle will be heavier by about 15%.

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Porter

So, what鈥檚 happening in Tracey鈥檚 body?听 Presumably, she has burnt some fat but she鈥檚 put on some muscle and that鈥檚 why her weight鈥檚 crept up.

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Gill

Yes, so we often see this scenario, people start to exercise and don鈥檛 lose weight.听 And what鈥檚 happening is you are losing fat and you tend to be putting on a bit of lean mass or muscle mass.听 And we know, for example, that if you do some exercise and don鈥檛 lose weight you can actually lose about 25% of the dangerous visceral fats, this is the fat which surrounds your internal organs.听 So, you鈥檙e clearly improving your health but it might not be indicated when you step on the scales.

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Porter

And that fat is important because this is the metabolically bad fat, this is the unhealthy fat?

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Gill

This is the unhealthy fat which increases risk of diseases like Type 2 diabetes, yes.

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Porter

But you stand on the scales and you could be a bit disillusioned because we鈥檝e been 鈥� it鈥檚 been drilled into us hasn鈥檛 it that it鈥檚 the weight that matters.

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Gill

Yeah, weight does matter but it鈥檚 not the only thing that matters.听 So, one of the things you can think about is if you鈥檙e not losing weight you might find your waist circumference is getting smaller, so sometimes you find that your trousers fit a little bit more loosely, your clothes fit a little bit better but the scales are not telling you the story that you want them to.听 And I think you should look at these indicators as well.听 So, if your trousers are fitting a bit more loosely, you鈥檙e going to be doing yourself some good.

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Porter

Paradoxically is there not a danger if we concentrate purely on the weight side of things that we look at what the scales are telling us and if we just, for instance, lost weight through calorie restriction of some sort, that actually that might not be as healthy as doing some weight loss calorie restriction and some exercise?

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Gill

So, weight loss is generally beneficial if you are too heavy.听 And even if you don鈥檛 do any exercise and lose weight just through eating less, the evidence suggests that you are getting a clear benefit from that.听 When you lose weight through just restricting the amount of food you eat, about a quarter to a third of the weight that you lose is actually muscle, it鈥檚 lean tissue, so for every 10 pounds of weight that you lose you鈥檙e probably losing maybe seven pounds of fat and three pounds of muscle or lean tissue.听 And what happens when you do some exercise is you can actually preserve the lean tissue when you lose weight, so more of the weight that you lose is fat.

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Porter

So, a combination regime would be a good idea.听 What happens if you just go for exercise alone, so you don鈥檛 change what you鈥檙e eating but you decide that you try and get in shape and lose some weight purely by doing exercise 鈥� does that work?

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Gill

So, if you do enough exercise yes it does work.听 The thing is you have to do a lot of exercise to see a benefit there.听 The average person who, says, does a half hour brisk walk or a half hour jog might burn two to four hundred calories and if you sort of calculate how many calories you need to lose a kilogram of fat it鈥檚 about 7,700 calories you need to lose a kilogram of fat.听 So, you have to do a lot of walking or running.听 So, if you鈥檙e just trying to lose weight by exercise, it鈥檚 unlikely to be very successful and you probably need to restrict the amount of food you eat and do a bit more physical activity to maximise the benefit there.

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Porter

Does exercise have a significant impact on the rate at which we might burn fat?听 I mean if you do exercise do you burn more fat than somebody who doesn鈥檛 鈥� calorie for calorie 鈥� or is it just about the calorie balance?

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Gill

You do burn more fat.听 So, what we鈥檝e shown and others have shown as well is that if you do an exercise session and you measure the type of calories you are burning over the next day or so, what you find is you鈥檙e not necessarily burning very many more total calories but you鈥檙e burning a bigger proportion of calories from fat.听 And if we think about it, to lose fat what we need to do is burn more fat calories than we are consuming, if we want to reduce the amount of fat in our body.听 So, by increasing the number of fat calories that we are burning, that鈥檚 one of the reasons why exercise could help reduce fat mass and to cause fat loss without necessarily causing weight loss, which is one of the reasons why we see when people exercise and don鈥檛 lose weight, they can actually lose substantial amounts of fat.

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Porter

And is there evidence that the sort of fat that they鈥檙e burning and losing, hopefully, is likely to be this more dangerous visceral fat or does it come from all over the body including the visceral fat?

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Gill

So, the evidence is that however you lose weight it seems to be the more dangerous visceral fat and ectopic fat, so ectopic fat is fat in places where it shouldn鈥檛 be, so we鈥檝e got ectopic fat in the liver, for example and the evidence is that when you lose fat, by whatever means, we tend to lose the more dangerous visceral and ectopic fat first.听 So, when you exercise and you鈥檙e not really losing a lot of overall body fat, necessarily, you are disproportionately losing fat from the dangerous places.听 So, the first bit of fat that you lose, however you lose the fat, is giving you the most benefit.

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Porter

Jason Gill.

听

Well, Tracey may be fitter and stronger following her training, but the same can鈥檛 be said for most of us, particularly as our muscles start to shrink and weaken with age, a process known as sarcopenia, and something that happens to us all to some degree. 听Never heard of it? 听Well, you are not alone.

听

Rheumatologist Elaine Dennison is Professor of Musculoskeletal Epidemiology at the University of Southampton.

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Dennison

Our knowledge about muscle and really our appreciation of how important it is, I think has been quite sort of late, quite slow, relative to a lot of other conditions.

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Porter

Well, let鈥檚 unpick the muscle story.听 What happens to muscles as we age?

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Dennison

What normally happens is that we get loss of the amount of muscle we have, weakening, so loss of strength of the muscle that we have and that impacts what we can do, so our physical performance.听 So, normally what we see is that actually people have smaller muscles that aren鈥檛 as strong and if we test their muscle strength and what they鈥檙e able to do, that tends to be less strong in later life compared to, say, mid-life or earlier on.

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Porter

And when does that process start in most people?

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Dennison

Depressingly early actually, I think probably the sort of peak muscle mass is probably sort of 30-40, I mean certainly you can chart changes from 50, but 30-40 is quite a key time actually.

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Porter

Can you give us an idea of the rate of loss?听 I mean assuming somebody reaches peak muscle mass by the end of their 30s, how quickly are they likely 鈥� I know it depends on their lifestyle 鈥� but typically, for the average person, how quickly are they likely to lose bulk?

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Dennison

Yeah, so the figure that鈥檚 normally quoted, certainly past the age of about 50, is about 1% a year, so that gives you a sense of the loss of muscle mass.

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Porter

What are the implications of losing muscle bulk and strength?听 I mean obviously, you become weaker, I think all of our listeners would expect not to be able to run as fast or to lift as heavy weights as they get older, but what are the implications that you see as a clinician?

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Dennison

Yeah, so, I mean the implications can be huge.听 So, as a clinician obviously one thing we tend to see are more falls but also it translates into difficulty 鈥� actually with managing day-to-day activities.听 And you see interrelationships, so for example, if someone has osteoarthritis 鈥� wear and tear arthritis 鈥� of the knee, one of the things that, as a rheumatologist, we鈥檒l often say to people is that it鈥檚 really important that actually they maintain their muscle strength around that joint because actually that seems to help with levels of pain and ability to cope with that arthritis.听 So, often the muscle is protective for the joints.

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Porter

But this is often a vicious downward spiral for many people, isn鈥檛 it, I mean they have problems with their knees so they avoid exercise because they feel they鈥檙e going to wear the joint out and it hurts.听 They might move from a house to a bungalow, so they don鈥檛 have to manage stairs, they might have a chair that propels them out of their seat, so that they find it easier to stand up 鈥� all of which, of course, is making them weaker.

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Dennison

Absolutely, absolutely and that 鈥� it is very much a vicious cycle, which is why prevention is really important and obviously we have to do everything we possibly can to try and stop development of sarcopenia.听 But actually, for people who are thinking well actually perhaps I鈥檓 already weaker than I would like to be, there are studies that show that these things can be reversable and actually with the right exercise programmes and things you can really improve your muscle mass and strength and function.听 So, the situation鈥檚 never hopeless, there are always things that we can do.

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Porter

Well, let鈥檚 look at prevention first of all, Elaine, what piece of single advice do you think is most important for people listening who are concerned that they may be getting weaker?

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Dennison

Resistance exercise seems to be key.听 So, incorporating some kind of exercise into your daily routine, three times a week, that has got a significant resistance component to it.听 And obviously, that can be in a gym setting but it doesn鈥檛 have to be.听 But that kind of regular commitment is what you need.

听

Porter

Of course, another problem is that a lot of middle-aged, certainly, people concentrate mostly on cardiovascular fitness, you know we鈥檝e been taught for decades that it鈥檚 good to run, to cycle, to swim, to use stepper machines and while they must 鈥� they might all help your muscles they鈥檙e not building strength across the whole system, are they?

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Dennison

No, and that鈥檚 the thing, it鈥檚 always difficult isn鈥檛 it, when people get conflicting advice about what they should do to try and promote their health.

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Porter

The heart鈥檚 an important muscle but it鈥檚 not the only one.

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Dennison

Yeah, there are others.

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Porter

Elaine Dennison.

听

And the latest guidelines on exercise, including resistance and weights, are on our website.

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Just time to tell about next week鈥檚 programme, when we return to one of our favourite themes 鈥� conflict of interest. 听Is it right for charities and public health bodies to work closely with drinks manufacturers 鈥� alcoholic or sugary?

听

ENDS