2 and preventing sarcopenia, will likely have a tremendous impact on patients and society, especially in view of the current demographic trends.
The ageing muscleSkeletal muscle is the largest organ in the body, accounting for up to 40% of body mass. The primary role of skeletal muscle is to allow one to maintain posture and, by contraction, to move the skeletal system. Skeletal muscle is one of the most plastic tissues in the human body. It is able to regenerate completely in response to injury (Chargé and Rudnicki 2004) or increase in mass, strength and efficiency following repeated physical exercise stimuli (Hughes et al. 2018). Nevertheless, almost half of the skeletal muscle mass is expected to be lost over a lifetime (Janssen et al. 2002). Skeletal muscle mass peaks in a person's mid-20s, after which the decline is thought to be gradual. However, the first changes become notable after the 5 th decade of life (Lexell et al. 1988). Thereafter, the rate of muscle loss starts to accelerate (Janssen et al. 2002), which also becomes apparent from the changes in total energy expenditure (Speakman and Westerterp 2010). Besides the primary role of skeletal muscle in movement, it also has an important role in metabolism, thermoregulation and is the largest store of glucose and amino acids in the body (Shulman et al. 1990).Therefore, losing muscle mass, besides impairing physical functioning, also has metabolic implications, which links it with other age-related diseases, such as type 2 diabetes (Park et al. 2007).The underlying causes of loss of muscle strength and quality with age are hypothesised to be caused by hallmarks of ageing, such as loss of proteostasis, altered cellular communication and stem cell exhaustion (López-Otín et al. 2013a). This manifests itself as, among other things, decreased innervation (Gonzalez-Freire et al. 2014), decreased muscle regeneration (Carosio et al. 2011), decreased protein synthesis (Balagopal et al. 1997), decreased circulating anabolic hormones (Sakuma and Yamaguchi 2012), low-grade inflammation (Dalle et al. 2017), decreased mitochondrial capacity (Carter et al. 2015) or a Chapter 1 Chapter 1 10MR scanners are not portable and therefore on-site measurements are not possible. In the most recent decades, there has emerged a novel method to non-invasively assess muscle mitochondrial capacity in vivo, namely near-infrared spectroscopy (NIRS). This method offers solutions for the practical disadvantages inherent to 31 P-MRS, such as increased portability and relatively lower costs.
A novel method to measure mitochondrial capacity non-invasively, using near-infrared spectroscopyNIRS assessment of mitochondrial capacity makes use of light in a specific region in the nearinfrared light spectrum (700-850 nm), of which a significant amount can penetrate biological tissues, where the major absorbing chromophores are haemoglobin and myoglobin. Haemoglobin and myoglobin have oxygen-dependent absorption changes in this spectrum, making it possible to distinguish oxyhaemoglobin/myoglobin (...