Muscle and Bone 101: Rebuilding Lost Muscle and Bone

By Editorial Team -

What is Muscle Loss?

Muscle atrophy, the wasting or loss of muscle tissue, can occur astonishingly quickly, posing serious challenges for individuals recovering from prolonged illness or extended periods of inactivity.



A 2017 study in the Journal of Cachexia, Sarcopenia, and Muscle revealed that just three days of simulated bed rest resulted in a more than 10 percent loss of muscle tissue and increased fatty infiltration of the muscle.

“Believe it or not, you can start losing significant muscle mass in just five days of inactivity,” fitness and nutrition expert JJ Virgin told The Epoch Times. She noted that athletes can see the effects of reduced activity within about three weeks if they don’t maintain their workout routines.

Everson A. Nunes, a postdoctoral fellow at McMaster University, noted the variability in muscle loss during inactivity. In an email to The Epoch Times, he said that healthy young individuals can lose about 0.8 percent of muscle per day during a week of leg immobilization.

Aging and Atrophy

Aging is a significant contributor to muscle atrophy. Our bodies naturally lose muscle mass and strength as we age, a process known as sarcopenia. This decline begins as early as age 30, with muscle mass decreasing by 3 percent to 8 percent per decade, and the rate of loss doubling at about age 60, making it even more challenging to maintain muscle health, according to Virgin.

Rebuilding Strength at Any Age

Many believe that muscle atrophy is irreversible, particularly as people age, based on the misconception that older adults can’t build muscle.

“This simply isn’t true,” Virgin said. “Muscle plasticity, the ability of muscles to regenerate and grow, persists throughout life. With the right training and nutrition, you can rebuild muscle at any age.”

Recovery for older adults often requires more time and a more focused approach than it does for younger people. In young, healthy adults, muscle mass recovery following disuse atrophy is usually complete, but in older people, it is often delayed and sometimes incomplete.

Practical Exercises for Rebuilding Muscle After Inactivity

After a prolonged period of inactivity or illness, rebuilding muscle should be approached gradually and safely.

“Ideally, you want to get up and moving as quickly as possible,” Virgin said.

Virgin advises starting with simple isometric exercises involving holding a contraction without movement, such as planks. These exercises are beneficial for those with limited mobility, as they help rebuild strength with minimal injury risk and require no equipment. This approach allows muscles to engage even if walking is not possible.

As recovery progresses, incorporating resistance training becomes essential. Virgin recommends exercises that mimic daily activities, such as squats, bent-over rows, and dips. Starting with body weight or light resistance bands helps focus on proper technique before gradually increasing the resistance. Using a full range of motion and engaging the core are crucial for effective muscle rebuilding.

For individuals unable to handle significant resistance due to injury, blood flow restriction training (BFRT) offers an effective alternative. This involves exercising while wearing bands or other devices that restrict blood flow. For example, while lifting a weight with the arm, a person may have a band tied around the arm similar to the tourniquet applied when giving a blood sample.

According to a study in the Journal of Lifestyle Medicine, BFRT can “prove to be a boon in many conditions such as muscle weakness and degeneration.” It can be an essential treatment in preventing disuse atrophy during the initial days of bed rest in post-surgical patients.

Maintaining consistent activity is key to recovery. Virgin suggests tracking daily steps and gradually increasing them. Adding a weighted vest, known as a rucking vest, can enhance strength and endurance.

Once a basic fitness level is established, high-intensity interval training (HIIT) can be introduced. HIIT involves short bursts of intense activity followed by rest periods or lower-intensity exercise. This method aids muscle building and growth hormone release, while improving cardiovascular health and boosting metabolism.

“Recovery strategies should also include adequate rest and stress management, as elevated stress hormones like cortisol can further impair muscle recovery and overall health,” Virgin said.

Nutrition’s Role in Muscle Recovery

Nutrition plays a pivotal role in muscle recovery and overall health during and after injury or illness. A 2020 review in Nutrients emphasizes that periods of disuse combined with poor dietary intake can accelerate muscle loss and weaken strength, especially in older adults.

“Protein is essential for muscle repair and growth,” Virgin said. Ensuring an optimal protein intake is critical, with a minimum of 100 grams per day, and ideally 1 gram or more per pound of ideal body weight.

However, Nunes noted that merely increasing protein intake does not prevent muscle loss. “Muscles need to be put to work in order to decrease the level of loss during inactivity or disease,” he wrote.

Virgin also recommends incorporating 15 grams of essential amino acids with one to two meals a day to provide the necessary nutrients for healing and preventing muscle breakdown. Additionally, extra collagen, either as a supplement or through bone broth or bone broth protein powder, can be beneficial at an intake of 15 grams to 30 grams daily.

Virgin highlighted creatine’s benefits for enhancing performance and recovery, making it a valuable addition to any recovery regimen.

The Mental Grit Behind Physical Recovery

Nunes noted that the mental factor directly affects nutrition, sleep, and overall activity levels.

“Mental resilience is absolutely crucial in physical recovery,” Virgin said. It greatly affects the speed and completeness of recovery from illness, injury, or prolonged inactivity.

When physical strength is weakened, mental grit is essential for maintaining focus, discipline, and positivity, enabling adherence to recovery protocols and coping with the often slow and frustrating healing process.

“It’s like armor for your psyche, protecting and propelling you forward even when the going gets tough,” Virgin said, underscoring the importance of a strong mindset.

Cultivating mental resilience during recovery involves several key strategies, she said.
  • Embrace a positive outlook. It’s not just about thinking happy thoughts but strategically viewing challenges as opportunities for growth and learning.
  • Visualize. Picture yourself healed, strong, and thriving, which can help steer your subconscious toward those outcomes.
  • Practice resilience-building techniques. Gratitude journaling and mindfulness meditation are beneficial. These practices reduce stress and improve overall mental well-being.
  • Build Your Community. Being surrounded by people who uplift and encourage provides emotional comfort and practical help, motivating adherence to recovery goals.

Ozempic and Muscle Loss

The issue of muscle mass versus fat becomes particularly critical as the world turns to a new class of drugs to aid in weight loss.
Medications such as Ozempic, known for their appetite-suppressing effects, promise significant weight loss and are gaining popularity. According to a May KFF health tracking poll, 12 percent of Americans have used the drug. A 2023 study in The Lancet confirms its efficacy, showing that adults lose about 15 percent of their body weight on average with GLP-1 agonists.
Dr. Peter Attia, a physician specializing in longevity, wrote on his website, “Not all weight loss is healthy.”
A 2021 clinical trial in the New England Journal of Medicine highlights a concerning downside: With GLP-1 agonists such as Ozempic, about 40 percent of the weight lost is lean mass, including muscle.

“GLP-1 agonists have been celebrated for their potency in reducing body mass, but lean mass accounts for an alarming proportion of this weight loss,” Dr. Attia wrote.

Dr. Attia also said that while GLP-1 agonists such as Ozempic can offer health benefits for obese individuals, they come with risks, especially for those with minimal weight to lose. He added that even obese patients can’t always afford significant lean mass loss, particularly those with sarcopenic obesity—a condition marked by excess fat and low skeletal muscle, common in older adults.

“Further reductions in lean mass among those with too little to begin with could pose a greater threat to health and longevity than the presence of excess fat,” Dr. Attia warned.

Lean mass loss is not exclusive to weight loss drugs. When individuals lose weight, they typically shed a combination of fat and fat-free mass, including muscle. Dr. Abud Bakri, an internal medicine doctor, wrote on social media platform X, “ALL caloric restriction causes lean tissue loss, whether that’s through GLP-1, surgery, or aggressive dieting.”

The amount of muscle lost during a caloric deficit depends on factors such as protein intake, resistance training, hormonal status, sleep quality, and many other variables, Dr. Bakri told The Epoch Times in an email.

“Muscle loss is the Achilles’s heel of most conventional weight loss efforts, including GLP-1 agonists, that virtually guarantees that weight is regained as fat,” Dr. William Davis, cardiologist and author of the book “Super Gut,” told The Epoch Times.

“Obesity, at its core, is a disease of the muscle,” Dr. Lyon said in her Ted Talk. “We don’t have a battle of the belly. What we have is a battle of the bicep.”

Muscles and Immunity

Muscles are often viewed primarily as contributors to movement and metabolism, but recent studies show that muscles also enhance immune function.
A 2022 study in Experimental Gerontology shows that resistance exercise, such as weightlifting, boosts immunity by activating key immune pathways and reducing inflammation. Reviewing 30 studies, researchers found that just one session of resistance exercise can enhance immune cell function, but regular workouts over weeks are needed for lasting benefits.
A Journal of Immunology Research study demonstrated that strength training induces significant changes in physiological and immunological biomarkers. Even a single strength training session increased the number of white blood cells and other immune cells, directly enhancing immune function.

Dr. Ryan Steele, assistant professor at Yale School of Medicine, said that strength training boosts the immune system by reducing inflammation. “Strength training also exerts a potent anti-inflammatory effect immediately after a training session,” he said.
Strength training changes the levels of proteins called cytokines, which help control immune responses. It also increases regulatory T cells, which keep the immune system in balance and prevent it from attacking the body’s own tissues.

Muscles and Immunity: A 2-Way Street

The relationship between muscles and the immune system is reciprocal. Muscles support immune function, and the immune system aids muscle repair and growth. When muscles are damaged from exercise or injury, immune cells rush to clear debris and initiate muscle regeneration.
A 2022 study in PeerJ showed that macrophages, a type of immune cell, are crucial for muscle repair. Initially, they create an inflammatory environment to remove damaged cells and pathogens. Later, they transition to an anti-inflammatory role, releasing growth factors and signals that promote tissue repair and growth. This dual function ensures efficient muscle recovery and adaptation, leading to stronger, more resilient muscles.

This dynamic interplay between muscle tissue and the immune system underscores the importance of maintaining muscle mass—not just for physical strength but for overall immune health.

As Dr. Gabrielle Lyon notes in her book “Forever Strong,” muscle is the organ of longevity and vitality. Its health and function are essential for overall well-being, including the immune system. This insight makes it clear: Building muscle is a crucial strategy for a healthier, more resilient life.

“Research clearly shows that skeletal muscle plays a role in regulating a healthy immune system,” Dr. Lyon wrote. “The condition of your muscle tissue can heighten disease processes or correct metabolism as well as the underlying disease.”

Muscles Secrete Myokines

Every time muscles contract during exercise, they release proteins called myokines, a type of cytokine. These proteins act as messengers, regulating various body functions, including the immune system.
According to a 2021 study published in Endocrine Reviews, “Recent advances show that skeletal muscle produces myokines in response to exercise, which allow for crosstalk between the muscle and other organs, including [the] brain, adipose tissue, bone, liver, gut, pancreas, vascular bed, and skin, as well as communication within the muscle itself.”

Two crucial myokines released during exercise are interleukin-6 (IL-6) and interleukin-15 (IL-15). IL-6 is released during aerobic exercise, such as running, and helps regulate inflammation, boosting the immune response.

According to the National Institute of Health, IL-15, released during resistance training such as weightlifting, supports the growth and function of T cells and natural killer cells, which are vital for fighting infections and cancer.

In addition to IL-6 and IL-15, exercise triggers the release of other important myokines, such as interleukin-7 (IL-7) and myostatin.

Donald Layman, a metabolism expert with a doctorate in nutrition science, told The Epoch Times, “IL-15 and IL-7 enhance the immune system by boosting the development of T-cells and B-cells, which are crucial for fighting infections.”

Normally, IL-6 is linked to inflammation, especially when paired with another protein called TNF-a, he said. However, when muscles release IL-6 during exercise, it does not cause this harmful inflammation. Instead, it helps strengthen the immune system without any inflammatory damage.

A 2024 study published in Frontiers in Immunology found that acute exercise significantly increases circulating IL-15 levels, enhancing immune function. The study showed that IL-15 levels rise within one hour of exercise.
“Typically, muscle’s effects on the immune system go unseen,” Dr. Lyon wrote in her book. “We are looking into ways to analyze blood markers to gauge the effectiveness of skeletal muscle as an organ system.”

Muscles Produce Glutamine

Glutamine, a nonessential amino acid, is crucial for muscle function and immune health. According to a study in Nutrients, about 80 percent of the body’s glutamine is stored in skeletal muscles, where its concentration is 30 times higher than in the blood. “The body’s glutamine availability and metabolism are directly associated with the skeletal muscle tissue,” the authors note.

Mr. Layman told The Epoch Times that the body releases glutamine into the blood to support immune cells such as leukocytes and macrophages. “Glutamine is a primary fuel for immune cells,” he said.

He said that muscles produce glutamine from branched-chain amino acids (BCAAs). As muscles metabolize BCAAs, they create glutamine, which is then released into the bloodstream. However, high glucose levels, common in high-carbohydrate diets or diabetes, reduce glutamine production. He emphasized the vital role of muscle-derived glutamine in maintaining a robust immune system.

A study in Frontiers in Physiology reinforces this idea. “Studies have shown the importance of a healthy, in constant contraction skeletal muscle to keep glutamine at optimal levels to assist the immune response,” the authors stated. Regular exercise helps maintain these levels, ensuring robust immune function.

Muscles Improve Circulation

Muscle mass plays a crucial role in maintaining a robust immune system through its impact on circulation. When muscles contract during physical activity, they help move lymph and blood throughout the body. This movement is vital for the immune system as it ensures that immune cells are effectively distributed and can reach infection sites quickly.

The lymphatic system is a network of tissues and organs that help rid the body of toxins and waste. It is a key component of the immune system.

Unlike the cardiovascular system, the lymphatic system does not have a pump (like the heart) to move lymph fluid. Instead, it relies on muscle contractions to push the lymph through lymphatic vessels. Regular muscle activity can enhance this process, promoting better immune surveillance and response.

“Muscles are intricately tied to the movement of fluid in your body. They are the second pump to your heart and one of the only movers of your lymphatic fluid,” Beret Loncar, a licensed massage therapist in New York City, told The Epoch Times. “And because they are tied to your lymphatic fluid, they are also tied to your immunity in a passive way.”

Muscle Activity Reduces Chronic Inflammation

Chronic inflammation can weaken the immune system and lead to various health issues, including autoimmune diseases and chronic conditions. Regular exercise and muscle contractions release anti-inflammatory myokines such as IL-10 and IL-37, which help regulate the body’s inflammatory response.


How Exercise Can Help Promote Stronger Bones

According to Dr. Michael Greger, bone health follows a "use it or lose it" approach.3 That's because like our muscles, bones are living, breathing organisms that constantly break themselves down to be replaced anew. And just like your muscles get stronger through exercise, the same occurs with your bones.

For example, a study4 published in 2021 noted that exercise — especially during your youth — is a crucial factor in determining bone strength in adulthood. According to published research, the impact our bodies absorb during exercise stimulates bone growth, thereby leading to increased bone mineral density:5

"From a mechanically centric point of view, activities that generate higher intensity or quicker loads (such as resistance training and leaping) are excellent for promoting bone health because they stimulate existing bone cells in a significant way …

Mechanical forces applied to bone tissue induce the movement of interstitial fluid along tubules and bone cell pores, thereby causing cell-level shear stress and deformation of bone cell plasma membrane. These changes lead to the beginning of the bone remodeling process and stimulate bone resorption and formation cycles."

In this regard, resistance training as well as engaging in higher-impact activities are ideal for boosting bone mineral density. However, don't discount aerobic exercise just yet — it may still exert a positive effect.

According to the same study,6 aerobic exercise can positively influence bone density by boosting nutrient transport as well as creating hormonal interactions that promote bone formation. Moreover, aerobic exercise plays a role in mitochondrial repair that may influence bone health.

Up the Intensity to Magnify the Benefits

Going deeper into how exercise promotes healthy bones, intensity is a crucial factor — not just the fact you need to exercise. It's been observed that adding intensity and weight "have a strong and consistent positive effect on bone development."7 In other words, your bones become more resilient when subjected to greater (but controlled) amounts of force.

This hypothesis is supported by other published research. In a meta-analysis published in 2023 involving postmenopausal women,8 researchers explained the crucial role of intensity in helping boost bone mineral density:

"We established that high-intensity and high-impact exercises are effective in improving, or at the very least maintaining, bone density in the lumbar spine and femur in postmenopausal women. An exercise protocol including high-intensity resistance exercises and high-impact training is shown to be most effective in improving bone density and other parameters of bone health."

Similar observations were made by another study.9 Out of 100 trials reviewed, researchers noted that low-intensity exercises were not effective in stimulating the skeletal system to increase bone density. But, as expected, studies that used moderate- to high-level intensity impact and resistance protocols showed notable benefits for bone density.

While upping the exercise intensity has its benefits, take care not to overdo it for the sake of increasing bone density. According to a study published in Aging and Disease, doing high-intensity exercises can eventually backfire on your health, as explained by the authors:

"Excessive high-intensity exercise does not benefit bone health but induces a high level of oxidative stress in the body, which has a negative impact on bone tissue.

Regular moderate exercise can improve the body's antioxidant defense ability, inhibit an excessive oxidative stress response, promote the positive balance of bone metabolism, delay age-related bone loss and deterioration of bone microstructures and have a prevention and treatment effect on osteoporosis caused by many factors."

Five Exercises That Can Help Promote Bone Density

Now that you know the importance of moderate-intensity exercise for promoting bone health, what are exercises that fall under this category? Hinge Health10 recommends these five examples, which were chosen by licensed physical therapists.

Before trying these exercises, make sure to consult with your primary care physician. According to Greger,11 weight-bearing workouts may be detrimental to certain groups of people, such as those already diagnosed with severe osteoporosis or those who recently had fractures.

•Banded squat — According to board-certified physical therapist Mary Kimbrough, this exercise can help strengthen your hips and lower back, which are common areas affected with low bone density.

  1. Place a looped resistance band just above your knees.
  2. Stand tall with your feet hip-width apart.
  3. Hinge at the hips, lowering them into a squat until they're parallel with your knees. Stand tall again. Press your knees into the band, and pull your abdominal muscles for support.
  4. As you do each repetition, you'll feel the muscles in your legs, glutes and hips working.

•Wall pushup — Try this exercise to help strengthen the bones in your torso, particularly the shoulders, arms and upper back.

  1. Stand with your hands placed on a wall at chest height. Keep your arms straight and your feet a few steps away from the wall. Some of your weight will be supported through your arms.
  2. Bend through your arms to move your chest toward the wall. Stop when your head and chest get close to the wall.
  3. Focus on keeping your hips from dipping toward the wall as you hold this position.
  4. Push through your hands to straighten your arms and return to the starting position. As you do each repetition, you'll feel your arms, chest and shoulder muscles working.

•Side planks — Targeting your core, hip and shoulders, side planks are an effective full-body exercise, according to Kimbrough.

  1. Lie down on a gym or yoga mat on your side with your legs straight and feet together.
  2. Place a forearm on the floor, under your shoulder. Push through your feet and forearm to lift your hip toward the ceiling.
  3. Focus on squeezing your core muscles as you hold this position.
  4. Lower your hips back to the floor. As you do each repetition, you'll feel your hips, back, core and shoulder muscles working.

•Tandem balance — This exercise can help improve overall lower leg strength and balance, which can reduce your risk of falls.

  1. On a yoga mat, stand with your feet apart and your hands on your hips.
  2. Place one foot in front of the other. Position your heel directly in front of the toes of the other foot, like you're standing on a balance beam.
  3. Focus on keeping your hands on your hips. You'll notice that your body is moving a lot as it tries to maintain this position.
  4. Spread your feet apart to return to the starting position. As you do each repetition, you'll feel your lower leg, ankle and foot muscles activating.

•Flamingo — This exercise is an advanced version of Tandem Balance, since you'll be standing on one leg only.

  1. Stand next to a table but without touching it. It's there for support (if you need it), but try to do the exercise without using it.
  2. Bend one knee to lift your foot off the floor, balancing on the other foot. Then, return your foot to the floor. Don't worry if you're wobbling — pull in your abdominal muscles to support your balance.
  3. As you do each repetition, you might feel the muscles in your feet and ankles working.

In addition to these exercises, the National Institute of Arthritis and Musculoskeletal and Skin Diseases recommends the following activities that can help boost bone health:12

  • Weight-bearing exercises — Brisk walking, jogging, tennis, badminton and dancing
  • Resistance training — Free weights, bodyweight exercises and gym machines
  • Balance training — Tai chi, stepping on a wobble board and walking backward

Consider Using a Vibration Plate

Whole-body vibration (WBV) therapy is an exercise wherein you stand on a vibrating plate. As the energy transfers through your body, you're constantly balancing yourself even while in a stationary position. This physical exertion may produce benefits, according to researchers, including increased bone mineral density.

For example, a 2022 review13 of 14 randomized controlled trials noted that WBV therapy has a positive effect on patients diagnosed with knee osteoarthritis (OA). According to the research findings:

"Meta-analysis showed that low-frequency and high-frequency whole-body vibration had additional positive effects compared with strengthening exercises alone on pain, knee extensor muscle strength, and physical function in individuals with knee OA. Whole-body vibration with strengthening exercises can be incorporated into treatment protocols."

In another meta-analysis,14 researchers discovered that WBV therapy helped boost the bone mineral density of postmenopausal women, as well as reducing the risk of fractures in generally healthy adults. Moreover, WBV therapy may help in other aspects of health, such as helping boost cognitive function.15

For a deeper dive into the science behind WBV therapy, as well as exercises that you can do on a vibration plate, I recommend reading my article "Utilize the Power of Vibrations to Promote Wellness."

Sources and References


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