Recognizing muscle health in healthy aging and non-communicable disease policy: a public health perspective.

Population aging and the rising burden of non-communicable diseases (NCDs) place sustained pressure on health systems. In this perspective, I argue that muscle health-muscle mass, strength, and physical function-should be recognized as an explicit and prognostically distinct target within policies for healthy aging and NCD prevention. Two arguments distinguish this from generic physical activity promotion: muscle strength predicts mortality, regardless of activity level, and the most significant gains are produced by resistance and multicomponent training rather than by aerobic activity alone. I summarize randomized evidence, including trials with follow-up to 36 months, highlighting that the benefits are more pronounced among individuals with demonstrable functional impairment-a finding that strengthens, rather than weakens, the policy case. I identify three recurring policy gaps: the limited use of feasible assessment tools in primary care, fragmented prevention efforts that under-prioritize resistance training, and the near absence of functional capacity in global NCD frameworks. Drawing on experiences from Japan, Europe, North America, and Brazil, I propose five operational priorities and examine the practical constraints on delivery-equipment, financing, workforce, cultural barriers, and long-term adherence-alongside the limits of the economic evidence, so that policy ambition is matched to the strength of the data.