Sarcopenia in Older Adults: Evidence-Based Exercise Tips for Physios

Sarcopenia, the age-related loss of muscle mass, strength, and physical performance, affects up to 50% of nursing-home residents, significantly increasing the risk of falls, fractures, hospital stays, and premature death. A recent systematic review and meta-analysis by Lu et al. (2021) explored how different exercise modes impact muscle strength and physical performance in older adults with sarcopenia. Here’s a breakdown of their findings and what it means for us Physios:

About the Study:

Lu and colleagues (2021) systematically reviewed 26 studies (25 randomised controlled trials and one non-RCT) involving 1,191 older adults diagnosed with sarcopenia. They compared three key exercise modalities:

• Resistance Training (RT)
• Mixed Training (MT; combinations of resistance, aerobic, balance, and gait training)
• Whole Body Vibration Training (WBVT)

The primary outcomes assessed were improvements in knee extension strength (KES), Timed Up and Go (TUG), gait speed (GS), and Chair Stand (CS) performance.

What the Research Found:

• Resistance Training (RT) was consistently the most effective method:
• Mixed Training (MT) also showed good outcomes, though slightly less impactful than RT:
• Whole Body Vibration Training (WBVT) was the least effective, though it still offered some benefits:

Why These Exercises Work (and How Well):

• Resistance Training: High-intensity, targeted muscle contractions effectively counter muscle atrophy by promoting muscle fibre hypertrophy, enhancing neuromuscular control, and boosting strength.
• Mixed Training: Incorporates diverse functional movements, benefiting overall coordination, balance, and aerobic capacity, thus enhancing general mobility and physical function.
• Whole Body Vibration: Though less effective overall, WBVT can improve neuromuscular activation, particularly beneficial for those unable to perform conventional exercises.

Actionable Tips for Physios:

• Prioritise Resistance Training: Focus on moderate-to-high intensity (60-85% 1RM) and Emphasise exercises targeting lower-limb strength, particularly knee extensions and squats.
• Incorporate Mixed Modalities: Add aerobic, balance, and gait training for comprehensive improvement and design sessions mimicking functional tasks to boost everyday performance.
• Whole Body Vibration as an Alternative: Use WBVT for frail patients or those with limited exercise capacity and set optimal parameters - frequency around 40 Hz, total exposure approximately 10 minutes per session.
• Ensure Adequate Exercise Dosage: Sessions of 20-60 minutes, 2-3 times weekly for at least 12 weeks to achieve significant outcomes.
• Regularly Monitor Progress: Frequently reassess strength and physical performance metrics (KES, TUG, GS, and CS) to refine training programs effectively.

Final Thoughts:

This study by Lu et al. (2021) reinforces the power of structured resistance training and highlights that a mixed approach can also effectively maintain and improve functional outcomes. Whole-body vibration might still hold some merit, particularly as an accessible alternative for those unable to perform conventional training.

So, keep your exercise prescription targeted, practical, and evidence-based. Your patients—and their quality of life—will thank you!

Want to take a deep dive into this paper? Read the full text article here

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