From the Guidelines
To address sarcopenia, I recommend a combination of resistance training and adequate protein intake, with a minimum protein intake of 1.2–1.5 g/kg, and moderate-intensity exercise for a duration of 150 minutes per week, as supported by the most recent study 1.
Key Recommendations
- Resistance exercises 2-3 times weekly, focusing on major muscle groups with 8-12 repetitions per set
- Protein intake of approximately 1.2–1.5 g/kg, with branched-chain amino acids obtained from protein sources such as chicken, fish, eggs, nuts, lentils, and/or soy
- Moderate-intensity exercise for a duration of 150 minutes per week
- Frequent small meals, avoiding more than 4–6 hours between meals, and a bedtime snack containing protein and at least 50 g of complex carbohydrates
Rationale
Sarcopenia is a progressive muscle disease characterized by a decline in muscle mass and strength, common among older adults, and associated with an increased risk of negative health outcomes, including frailty, falls, functional decline, and mortality 1. The most recent study 1 highlights the importance of addressing sarcopenia in patients with nonalcoholic fatty liver disease, and provides guidance on dietary and exercise management.
Supporting Evidence
- A study published in 2022 1 emphasizes the role of nutrition in preventing or delaying the onset of sarcopenia and frailty, and highlights the importance of healthy eating and physical activity in older adults.
- Another study published in 2020 1 discusses the relationship between sarcopenia and poor clinical outcomes in surgical patients, and highlights the importance of assessing muscle mass and function in this population.
- The most recent study 1 provides guidance on dietary and exercise management for patients with sarcopenia, and emphasizes the importance of individualized dietary plans and moderate-intensity exercise.
From the Research
Definition and Causes of Sarcopenia
- Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life, and death 2.
- Primary sarcopenia is considered to be age-related when no other cause is evident, other than ageing itself, while secondary sarcopenia should be considered when one or more other causes are evident, such as activity-, disease-, or nutrition-related sarcopenia 2.
- The etiology of sarcopenia in the elderly is multi-factorial, and patients with disuse syndrome and deconditioning often complicate the diagnosis of not only activity-related sarcopenia, but also age-, disease-, and nutrition-related sarcopenia 2.
Treatment and Management of Sarcopenia
- Resistance training combined with supplements containing amino acids are the most effective for preventing and treating age-related muscle wasting and weakness 2.
- A comprehensive approach to sarcopenia treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking 2.
- High-intensity dynamic resistance exercise and whey protein supplementation have been shown to be effective in improving bone mineral density and sarcopenia parameters in older men with osteosarcopenia 3, 4.
- Leucine supplementation has a significant effect on muscle mass in elderly people with sarcopenia, and protein supplementation on top of resistance training is recommended to increase muscle mass and strength 5.
Importance of Resistance Training
- Resistance training is safe and effective to improve muscle mass, strength and physical performance in older adults and clinical populations 6.
- The focus should be on optimizing ways to prescribe resistance training and increase long-term adherence, rather than on slight modifications to sarcopenia definitions 6.
- High-intensity resistance training has been shown to be effective in maintaining or increasing bone mineral density and skeletal muscle mass index in older men with osteosarcopenia 4.