Sarcopenia: an Aging Perspective and Management
                    Options

Ana M Teixeira; Shiva E Nosrani; Mohsen Parvani; João Viola; Shaghayegh Mohammadi

doi:10.1055/a-2577-2577

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2025; 46(11): 789-808
DOI: 10.1055/a-2577-2577

Review

Sarcopenia: an Aging Perspective and Management Options

Authors

Ana M Teixeira

¹Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal

²Research Center for Sport and Physical Activity (doi: 10.54499/UIDP/04213/2020), CIDAF-UC, Coimbra, Portugal
Shiva E Nosrani

¹Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal

²Research Center for Sport and Physical Activity (doi: 10.54499/UIDP/04213/2020), CIDAF-UC, Coimbra, Portugal
Mohsen Parvani

¹Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal

²Research Center for Sport and Physical Activity (doi: 10.54499/UIDP/04213/2020), CIDAF-UC, Coimbra, Portugal
João Viola

¹Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
Shaghayegh Mohammadi

³Faculty of Physical Education, Department of Pathology and Corrective Exercises, University of Guilan, Rasht, Iran (the Islamic Republic of)

Abstract

There is no doubt that sarcopenia is one of the most defining characteristics of aging that negatively impacts the people’s health and quality of life. The condition is characterized by the progressive and generalized loss of muscle mass and strength, affecting physical performance. It is part of aging but can be exacerbated by pathophysiological conditions like cancer and several factors such as a sedentary lifestyle, poor nutrition, chronic diseases, falls and immobilization. Numerous cellular mechanisms have been implicated in its pathogenesis, including hormonal changes, mitochondrial dysfunctions, altered apoptotic and autophagic signaling, muscle fiber composition, and inflammatory pathways. To prevent sarcopenia, exercise is one of the most effective strategies as it has a strong influence on both anabolic and catabolic muscle pathways and helps improve skeletal muscle function. A well-rounded, multicomponent exercise program that targets muscle strength, aerobic capacity, and balance is recommended for optimal results. While nutrition is essential for muscle maintenance, relying solely on dietary interventions is unlikely to fully address sarcopenia. Therefore, a combination of adequate nutrition and regular exercise is recommended to promote muscle health and function. The purpose of this study is to review sarcopenia from an aging viewpoint and discuss the role of exercise and nutrition as prevention and management options.

Keywords

older adults - exercise training - nutritional supplementation - gut microbiota - muscle function loss

Full Text

References

References
1 Kirk B, Cawthon PM, Arai H. et al. The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS). Age Ageing 2024; 53: afae052
2 D’Angelo E, Marzetti E, Calvani R. et al. Impact of physical activity on the management of sarcopenia. J Gerontol Geriatr 2019; 67: 46-51
3 Carvalho do Nascimento PR, Bilodeau M, Poitras S. How do we define and measure sarcopenia? A meta-analysis of observational studies. Age Aging 2021; 50: 1906-1913
4 Petermann-Rocha F, Balntzi V, Gray SR. et al. Global prevalence of sarcopenia and severe sarcopenia: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13: 86-99
5 Cruz-Jentoft AJ, Bahat G, Bauer J. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16-31
6 Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 2016; 7: 28-36
7 Murat K, Kaymak B, Frontera WR. et al. Diagnosing sarcopenia: Functional perspectives and a new algorithm from ISarcoPRM. J Rehabil Med 2021; 53: 2806
8 Shafiee G, Keshtkar A, Soltani A, Ahadi Z, Larijani B, Heshmat R. Prevalence of sarcopenia in the world: A systematic review and meta- analysis of general population studies. J Diabetes Metab Disord 2017; 16: 21
9 Chen L-K, Liu L-K, Woo J. et al. Sarcopenia in Asia: Consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15: 95-101
10 Chen L-K, Woo J, Assantachai P. et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 2020; 21: 300-307
11 Studenski SA, Peters KW, Alley DE. et al. The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 2014; 69: 547-558
12 Bhasin S, Travison TG, Manini TM. et al. Sarcopenia Definition: The Position Statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatrics Soc 2020; 68: 1410-1418
13 Ackermans L, Rabou J, Basrai M. et al. Screening, diagnosis and monitoring of sarcopenia: When to use which tool?. Clin Nutr ESPEN 2022; 48: 36-44
14 Coletta G, Phillips SM. An elusive consensus definition of sarcopenia impedes research and clinical treatment: A narrative review. Ageing Res Rev 2023; 86: 101883
15 Sayer AA, Cruz-Jentoft A. Sarcopenia definition, diagnosis and treatment: Consensus is growing. Age Aging 2022; 51: afac220
16 Voulgaridou G, Tyrovolas S, Detopoulou P. et al. Diagnostic criteria and measurement techniques of Sarcopenia: A critical evaluation of the Up-to-date evidence. Nutrients 2024; 16: 436
17 Dennison EM, Sayer AA, Cooper C. Epidemiology of sarcopenia and insight into possible therapeutic targets. Nat Rev Rheumatol 2017; 13: 340-347
18 Peterson SJ, Braunschweig CA. Prevalence of Sarcopenia and Associated Outcomes in the Clinical Setting. Nutr Clin Pract 2016; 31: 40-48
19 Du Y, Wang X, Xie H. et al. Sex differences in the prevalence and adverse outcomes of sarcopenia and sarcopenic obesity in community dwelling elderly in East China using the AWGS criteria. BMC Endocr Disord 2019; 19: 109
20 Hwang J, Park S. Sex differences of sarcopenia in an elderly Asian population: The prevalence and risk factors. Int J Env Res Public Health 2022; 19: 11980
21 Beaudart C, Reginster J-Y, Slomian J, Buckinx F, Locquet M, Bruyère O. Prevalence of sarcopenia: The impact of different diagnostic cut-off limits. J Muscoluskelet Neuronal Interact 2014; 14: 425-431
22 Della Peruta C, Lozanoska-Ochser B, Renzini A. et al. Sex differences in inflammation and muscle wasting in aging and disease. Int J Mol Sci 2023; 24: 4651
23 van der Hoek MD, Nieuwenhuizen AG, Kuda O. et al. Intramuscular short-chain acylcarnitines in elderly people are decreased in (pre-) frail females, but not in males. FASEB J 2020; 34: 11658-11671
24 Maher AC, Fu MH, Isfort RJ, Varbanov AR, Qu XA, Tarnopolsky MA. Sex differences in global mRNA content of human skeletal muscle. PLoS One 2009; 4: e6335
25 Montero D, Madsen K, Meinild-Lundby AK, Edin F, Lundby C. Sexual dimorphism of substrate utilization: Differences in skeletal muscle mitochondrial volume density and function. Exp Physiol 2018; 103: 851-859
26 Huang X, Chen M, Xiao Y. et al. The influence of biological sex in human skeletal muscle transcriptome during ageing. Biogerontology 2024; 25: 461-478
27 Anker SD, Morley JE, Von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 2016; 7: 512-514
28 Beaudart C, Zaaria M, Pasleau F, Reginster JY, Bruyère O. Health outcomes of sarcopenia: A systematic review and meta-analysis. PLoS One 2017; 12: e0169548
29 Kushkestani M, Parvani M, Moghadassi M. et al. Investigation of life expectancy in community-dwelling elderly men in Iran and its related factors. J Aging Sci 2020; 8: 1-10
30 Beaudart C, Rizzoli R, Bruyère O, Reginster JY, Biver E. Sarcopenia: Burden and challenges for public health. Arch Public Health 2014; 72: 45
31 Kushkestan M, Nosrani SE, Parvani M. et al. Active lifestyle prevent sarcopenia in older men. J Life Med Res Rev 2023; 1: 35-40
32 Yeung SSY, Reijnierse EM, Pham VK. et al. Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2019; 10: 485-500
33 Zhang X, Huang P, Dou Q, Wang C, Zhang W, Yang Y. et al. Falls among older adults with sarcopenia dwelling in nursing home or community: A meta-analysis. Clin Nutr 2020; 39: 33-39
34 Matsumoto H, Tanimura C, Tanishima S, Osaki M, Noma H, Hagino H. Sarcopenia is a risk factor for falling in independently living Japanese older adults: A 2-year prospective cohort study of the GAINA study. Geriatrics Gerontology Int 2017; 17: 2124-2130
35 Wilson D, Jackson T, Sapey E, Lord JM. Frailty and sarcopenia: The potential role of an aged immune system. Ageing Res Rev 2017; 36: 1-10
36 Cheng MH, Chang SF. Frailty as a Risk Factor for Falls Among Community Dwelling People: Evidence From a Meta-Analysis. J Nurs Scholarsh 2017; 49: 529-536
37 Halfon M, Phan O, Teta D. Vitamin D: A Review on Its Effects on Muscle Strength, the Risk of Fall, and Frailty. Biomed Res Int 2015; 2015: 953241
38 Ponti F, Santoro A, Mercatelli D. et al. Aging and imaging assessment of body composition: From fat to facts. Front Endocrinol (Lausanne) 2019; 10: 861
39 Di Monaco M, Castiglioni C, Bardesono F, Freiburger M, Milano E, Massazza G. Is sarcopenia associated with osteoporosis? A cross-sectional study of 262 women with hip fracture. Eur J Phys Rehabil Med 2022; 58: 638-645
40 Petermann-Rocha F, Chen M, Gray SR, Ho FK, Pell JP, Celis-Morales C. Factors associated with sarcopenia: A cross-sectional analysis using UK Biobank. Maturitas 2020; 133: 60-67
41 Taniguchi Y, Makizako H, Kiyama R. et al. The association between osteoporosis and grip strength and skeletal muscle mass in community-dwelling older women. Int J Env Res Public Health 2019; 16: 1228
42 Frost HM. Bone’s mechanostat: A 2003 update. Anat Rec 2003; 275A: 1081-1101
43 Kaji H. Interaction between muscle and bone. J Bone Metab 2014; 21: 29-40
44 Kaji H. Effects of myokines on bone. Bonekey Rep 2016; 5: 826
45 Bikle DD, Tahimic C, Chang W, Wang Y, Philippou A, Barton ER. Role of IGF-I signaling in muscle bone interactions. Bone 2015; 80: 79-88
46 Kirk B, Al Saedi A, Duque G. Osteosarcopenia: A case of geroscience. Aging Med (Milton) 2019; 2 (03) 147-56
47 Hirschfeld HP, Kinsella R, Duque G. Osteosarcopenia: Where bone, muscle, and fat collide. Osteoporos Int 2017; 28: 2781-2790
48 Moriwaki K, Matsumoto H, Tanishima S. et al. Association of serum bone- and muscle-derived factors with age, sex, body composition, and physical function in community-dwelling middle-aged and elderly adults: A cross-sectional study. BMC Musculoskelet Disord 2019; 20: 276
49 Skrzypczak D, Ratajczak AE, Szymczak-Tomczak A, Dobrowolska A, Eder P, Krela-Kaźmierczak I. A vicious cycle of osteosarcopenia in inflammatory bowel diseases—aetiology, clinical implications and therapeutic perspectives. Nutrients 2021; 13: 293
50 Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: A bidirectional relationship. Diabetes Obes Metab 2019; 12: 1057-1072
51 Hong S, Chang Y, Jung H-S, Yun KE, Shin H, Ryu S. Relative muscle mass and the risk of incident type 2 diabetes: A cohort study. PLoS One 2017; 12: e0188650
52 Ábrigo J, Elorza AA, Riedel CA. et al. Role of Oxidative Stress as Key Regulator of Muscle Wasting during Cachexia. Oxid Med Cell Longev 2018; 2018: 2063179
53 Sachs S, Zarini S, Kahn DE. et al. Intermuscular adipose tissue directly modulates skeletal muscle insulin sensitivity in humans. Am J Physiol Endocrinol Metab 2019; 316: E866-E879
54 Bai T, Fang F, Li F, Ren Y, Hu J, Cao J. Sarcopenia is associated with hypertension in older adults: A systematic review and meta-analysis. BMC Geriatr 2020; 20: 279
55 Oktay AA, Lavie CJ, Kokkinos PF, Parto P, Pandey A, Ventura HO. The interaction of cardiorespiratory fitness with obesity and the obesity paradox in cardiovascular disease. Prog Cardiovasc Dis 2017; 60: 30-44
56 Coelho Júnior HJ, Aguiar Sda S, Gonçalves Ide O.. et al. Sarcopenia Is Associated with High Pulse Pressure in Older Women. J Aging Res 2015; 2015: 109824
57 Han K, Park Y-M, Kwon H-S. et al. Sarcopenia as a determinant of blood pressure in older Koreans: Findings from the Korea National Health and Nutrition Examination Surveys (KNHANES) 2008–2010. PLoS One 2014; 9: e86902
58 Chen K, Zhou M, Wang X, Li S, Yang D. The role of myokines and adipokines in hypertension and hypertension-related complications. Hypertens Res 2019; 42: 1544-1551
59 Damluji AA, Alfaraidhy M, AlHajri N. et al. Sarcopenia and Cardiovascular Diseases. Circulation 2023; 147: 1534-1553
60 Attaway A, Bellar A, Dieye F, Wajda D, Welch N, Dasarathy S. Clinical impact of compound sarcopenia in hospitalized older adult patients with heart failure. J Am Geriatrics Soc 2021; 69: 1815-1825
61 Del Buono MG, Arena R, Borlaug BA. et al. Exercise Intolerance in Patients With Heart Failure. J Am Coll Cardiol 2019; 73: 2209-2225
62 Emami A, Saitoh M, Valentova M. et al. Comparison of sarcopenia and cachexia in men with chronic heart failure: Results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Eur J Heart Fail 2018; 20: 1580-1587
63 Zhang N, Zhu W-L, Liu X-H. et al. Prevalence and prognostic implications of sarcopenia in older patients with coronary heart disease. J Geriatr Cardiol 2019; 16: 756-763
64 Kang DO, Park SY, Choi BG. et al. Prognostic impact of low skeletal muscle mass on major adverse cardiovascular events in coronary artery disease: A propensity score-matched analysis of a single center all-comer cohort. J Clin Med 2019; 8: 712
65 Jun JE, Choi MS, Park SW. et al. Low skeletal muscle mass is associated with the presence, incidence, and progression of coronary artery calcification. Can J Cardiol 2021; 37: 1480-1488
66 Pizzimenti M, Meyer A, Charles AL. et al. Sarcopenia and peripheral arterial disease: A systematic review. J Cachexia Sarcopenia Muscle 2020; 11: 866-886
67 Taniguchi R, Deguchi J, Hashimoto T, Sato O. Sarcopenia as a possible negative predictor of limb salvage in patients with chronic limb-threatening ischemia. Ann Vasc Dis 2019; 12: 194-199
68 Mori H, Tokuda Y. Differences and overlap between sarcopenia and physical frailty in older community-dwelling Japanese. Asia Pac J Clin Nutr 2019; 28: 157-165
69 Carmeli E. Frailty and Primary Sarcopenia: A Review. In: Pokorski M, ed. Clinical Research and Practice. Cham: Springer Int Publ; 2017. pp. 53-68
70 Reijnierse EM, Trappenburg MC, Blauw GJ. et al. Common ground? The concordance of sarcopenia and frailty definitions. J Am Med Dir Assoc 2016; 17: 371
71 De Dobbeleer L, Beyer I, Njemini R. et al. Force-time characteristics during sustained maximal handgrip effort according to age and clinical condition. Exp Gerontol 2017; 98: 192-198
72 Knoop V, Costenoble A, Debain A. et al. The interrelationship between grip work, self-perceived fatigue and pre-frailty in community-dwelling octogenarians. Exp Gerontol 2021; 152: 111440
73 Najm A, Niculescu A-G, Grumezescu AM, Beuran M. Emerging Therapeutic Strategies in Sarcopenia: An Updated Review on Pathogenesis and Treatment Advances. Int J Mol Sci 2024; 25: 4300
74 Larsson L, Degens H, Li M. et al. Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol Rev 2019; 99: 427-511
75 Sheth KA, Iyer CC, Wier CG. et al. Muscle strength and size are associated with motor unit connectivity in aged mice. Neurobiol Aging 2018; 67: 128-136
76 Moreira-Pais A, Ferreira R, Oliveira PA, Duarte JA. A neuromuscular perspective of sarcopenia pathogenesis: Deciphering the signaling pathways involved. GeroScience 2022; 44: 1199-1213
77 Sugita S, Fleming LL, Wood C. et al. VAChT overexpression increases acetylcholine at the synaptic cleft and accelerates aging of neuromuscular junctions. Skelet Muscle 2016; 6: 31
78 Cai Z, Liu D, Yang Y. et al. The role and therapeutic potential of stem cells in skeletal muscle in sarcopenia. Stem Cell Res Ther 2022; 13: 28
79 Tan KT, Ang SJ, Tsai SY. Sarcopenia: Tilting the Balance of Protein Homeostasis. Proteomics 2020; 20: 1800411
80 Sandri M, Barberi L, Bijlsma AY. et al. Signalling pathways regulating muscle mass in ageing skeletal muscle. The role of the IGF1-Akt-mTOR-FoxO pathway. Biogerontology 2013; 14: 303-323
81 Bodine SC, Baehr LM. Skeletal muscle atrophy and the E3 ubiquitin ligases MuRF1 and MAFbx/atrogin-1. Am J Physiol Endocrinol Metab 2014; 307: E469-E484
82 Pang X, Zhang P, Chen X, Liu W. Ubiquitin-proteasome pathway in skeletal muscle atrophy. Front Physiol 2023; 14: 1289537
83 Cuthbertson DJ, Babraj J, Leese G, Siervo M. Anabolic resistance does not explain sarcopenia in patients with type 2 diabetes mellitus, compared with healthy controls, despite reduced mTOR pathway activity. Clin Nutr 2017; 36: 1716-1719
84 Fry CS, Drummond MJ, Glynn EL. et al. Aging impairs contraction-induced human skeletal muscle mTORC1 signaling and protein synthesis. Skelet Muscle 2011; 1: 11
85 Castets P, Lin S, Rion N. et al. Sustained activation of mTORC1 in skeletal muscle inhibits constitutive and starvation-induced autophagy and causes a severe, late-onset myopathy. Cell Metab 2013; 17: 731-744
86 Ham DJ, Börsch A, Lin S. et al. The neuromuscular junction is a focal point of mTORC1 signaling in sarcopenia. Nat Commun 2020; 11: 4510
87 Bian A, Ma Y, Zhou X. et al. Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly. BMC Musculoskelet Disord 2020; 21: 214
88 Shin MJ, Jeon YK, Kim IJ. Testosterone and sarcopenia. World J Mens Health 2018; 36: 192-8
89 Du Y, Oh C, No J. Associations between sarcopenia and metabolic risk factors: A systematic review and meta-analysis. J Obes Metab Syndr 2018; 27: 175-185
90 Chen X, Ji Y, Liu R. et al. Mitochondrial dysfunction: Roles in skeletal muscle atrophy. J Transl Med 2023; 21: 503
91 Szentesi P, Csernoch L, Dux L, Keller-Pintér A. Changes in Redox Signaling in the Skeletal Muscle with Aging. Oxid Med Cell Longev 2019; 2019: 4617801
92 Bottoni A, Dos Anjos Garnes S, Lasakosvitsch F, Bottoni A. Sarcopenia: An overview and analysis of molecular mechanisms. Nutrire 2019; 44: 6
93 Budui SL, Rossi AP, Zamboni M. The pathogenetic bases of sarcopenia. Clin Cases Min Bone Metab 2015; 12: 22-6
94 Bellanti F, Lo Buglio A, Vendemiale G. Mitochondrial impairment in sarcopenia. Biology 2021; 10: 31
95 Ferri E, Marzetti E, Calvani R, Picca A, Cesari M, Arosio B. Role of age-related mitochondrial dysfunction in sarcopenia. Int J Mol Sci 2020; 21: 5236
96 Yoo S-Z, No M-H, Heo J-W. et al. Role of exercise in age-related sarcopenia. J Exerc Rehabil 2018; 14: 551-558
97 Triolo M, Hood DA. Manifestations of age on autophagy, mitophagy and lysosomes in skeletal muscle. Cells 2021; 10: 1054
98 Li W, Sheng RW, Cao MM, Rui YF. Exploring the Relationship Between Gut Microbiota and Sarcopenia Based on Gut–Muscle Axis. Food Sci Nutr 2024; 12: 8779-8792
99 Liu C, Cheung WH, Li J. et al. Understanding the gut microbiota and sarcopenia: a systematic review. J Cachexia Sarcopenia Muscle 2021; 12: 1393-1407
100 Haran JP, McCormick BA. Aging, frailty, and the microbiome—how dysbiosis influences human aging and disease. Gastroenterology 2021; 160: 507-523
101 Grosicki GJ, Fielding RA, Lustgarten MS. Gut Microbiota Contribute to Age-Related Changes in Skeletal Muscle Size, Composition, and Function: Biological Basis for a Gut-Muscle Axis. Calcif Tissue Int 2018; 102: 433-442
102 Shandilya S, Kumar S, Kumar Jha N, Kumar Kesari K, Ruokolainen J. Interplay of gut microbiota and oxidative stress: Perspective on neurodegeneration and neuroprotection. J Adv Res 2022; 38: 223-244
103 Bindels LB, Delzenne NM. Muscle wasting: The gut microbiota as a new therapeutic target?. Int J Biochem Biol 2013; 45: 2186-2190
104 Houghton D, Stewart CJ, Stamp C. et al. Impact of age-related mitochondrial dysfunction and exercise on intestinal microbiota composition. J Gerontol A Biol Sci Med Sci 2018; 73: 571-578
105 Sieber CC. Malnutrition and sarcopenia. Aging Clin Exp Res 2019; 31: 793-798
106 Fan J, Kou X, Jia S, Yang X, Yang Y, Chen N. Autophagy as a Potential Target for Sarcopenia. J Cell Physiol 2016; 231: 1450-1459
107 Park Y, Choi J-E, Hwang H-S. Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: A randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2018; 108: 1026-1033
108 Rafii M, Chapman K, Owens J. et al. Dietary protein requirement of female adults >65 years determined by the indicator amino acid oxidation technique is higher than current recommendations. J Nutr 2015; 145 145 18-24
109 Rafii M, Chapman K, Elango R. et al. Dietary protein requirement of men >65 years old determined by the indicator amino acid oxidation technique is higher than the current estimated average requirement. J Nutr 2016; 146: 681-687
110 Bauer J, Biolo G, Cederholm T. et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 2013; 14: 542-559
111 Rizzoli R, Stevenson JC, Bauer JM. et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: A consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas 2014; 79: 122-132
112 Volkert D, Beck AM, Cederholm T. et al. ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41: 958-989
113 Bauer J, Morley JE, Schols A. et al. Sarcopenia: A Time for Action. An SCWD Position Paper. J Cachexia Sarcopenia Muscle 2019; 10: 956-961
114 Calvani R, Picca A, Coelho-Júnior HJ, Tosato M, Marzetti E, Landi F. Diet for the prevention and management of sarcopenia. Metabolism 2023; 146: 155637
115 Ni Lochlainn M, Bowyer R, Welch AA, Whelan K, Steves CJ. Higher dietary protein intake is associated with sarcopenia in older British twins. Age Aging 2023; 52: afad018
116 Cheah KJ, Cheah LJ. Benefits and side effects of protein supplementation and exercise in sarcopenic obesity: A scoping review. Nutr J 2023; 22: 52
117 Hou V, Madden K. Assessing the effects of dietary protein supplementation on sarcopenia in community-dwelling older adults. Can Geriatr J 2022; 25: 390-403
118 Song Z, Pan T, Tong X, Yang Y, Zhang Z. The effects of nutritional supplementation on older sarcopenic individuals who engage in resistance training: A meta-analysis. Front Nutr 2023; 10: 1109789
119 Højfeldt G, Bülow J, Agergaard J. et al. Impact of habituated dietary protein intake on fasting and postprandial whole-body protein turnover and splanchnic amino acid metabolism in elderly men: A randomized, controlled, crossover trial. Am J Clin Nutr 2020; 112: 1468-1484
120 Højfeldt G, Bülow J, Agergaard J. et al. Postprandial muscle protein synthesis rate is unaffected by 20-day habituation to a high protein intake: A randomized controlled, crossover trial. Eur J Nutr 2021; 60: 4307-4319
121 Mai K, Cando P, Trasino SE. mTOR1c Activation with the Leucine “Trigger” for Prevention of Sarcopenia in Older Adults During Lockdown. J Med Food 2022; 25: 117-120
122 Zaromskyte G, Prokopidis K, Ioannidis T, Tipton KD, Witard OC. Evaluating the leucine trigger hypothesis to explain the post-prandial regulation of muscle protein synthesis in young and older adults: A systematic review. Front Nutr 2021; 8: 685165
123 Szwiega S, Pencharz PB, Rafii M. et al. Dietary leucine requirement of older men and women is higher than current recommendations. Am J Clin Nutr 2021; 113: 410-419
124 Costa Riela NA, Alvim Guimarães MM, Oliveira de Almeida D. et al. Effects of beta-hydroxy-beta-methylbutyrate supplementation on elderly body composition and muscle strength: A review of clinical trials. Ann Nutr Metab 2021; 77: 16-22
125 Phillips SM, Lau KJ, D’Souza AC, Nunes EA. An umbrella review of systematic reviews of β-hydroxy-β-methyl butyrate supplementation in ageing and clinical practice. J Cachexia Sarcopenia Muscle 2022; 13: 2265-2275
126 Kreider RB, Kalman DS, Antonio J. et al. International Society of Sports Nutrition position stand: Safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sport Nutr 2017; 14: 18
127 Candow DG, Chilibeck PD, Forbes SC, Fairman CM, Gualano B, Roschel H. Creatine supplementation for older adults: Focus on sarcopenia, osteoporosis, frailty and Cachexia. Bone 2022; 162: 116467
128 Houston DK, Marsh AP, Neiberg RH. et al. Vitamin D Supplementation and Muscle Power, Strength and Physical Performance in Older Adults: A Randomized Controlled Trial. Am J Clin Nutr 2023; 117: 1086-1095
129 Prokopidis K, Giannos P, Katsikas Triantafyllidis K. et al. Effect of vitamin D monotherapy on indices of sarcopenia in community-dwelling older adults: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13: 1642-1652
130 Huang T, Liu C, Cui C, Zhang N, Cheung WH, Wong R. Potential of fatty acids in treating sarcopenia: A systematic review. Nutrients 2023; 15: 3613
131 Bird JK, Troesch B, Warnke I, Calder PC. The effect of long chain omega-3 polyunsaturated fatty acids on muscle mass and function in sarcopenia: A scoping systematic review and meta-analysis. Clin Nutr ESPEN 2021; 46: 73-86
132 Cornish SM, Cordingley DM, Shaw KA. et al. Effects of omega-3 supplementation alone and combined with resistance exercise on skeletal muscle in older adults: A systematic review and meta-analysis. Nutrients 2022; 14: 2221
133 Zhang Y, Guo H, Liang J, Xiao W, Li Y. Relationship between dietary omega-3 and omega-6 polyunsaturated fatty acids level and sarcopenia. A meta-analysis of observational studies. Front Nutr 2021; 8: 738083
134 Batista R, de Branco F, Nehme R, de Oliveira EP, Pena G. Association between plasma omega-3 and handgrip strength according to glycohemoglobin levels in older adults: results from NHANES 2011–2012. Nutrients 2022; 14: 4060
135 Xie WQ, Xiao WF, Tang K. et al. Caloric restriction: Implications for sarcopenia and potential mechanisms. Aging (Albany NY) 2020; 12: 24441-24452
136 Boldrin L, Ross JA, Whitmore C. et al. The effect of calorie restriction on mouse skeletal muscle is sex, strain and time-dependent. Sci Rep 2017; 7: 5160
137 Yang L, Licastro D, Cava E. et al. Long-term calorie restriction enhances cellular quality-control processes in human skeletal muscle. Cell Rep 2016; 14: 422-428
138 Rhoads TW, Clark JP, Gustafson GE. et al. Molecular and functional networks linked to sarcopenia prevention by caloric restriction in rhesus monkeys. Cell Syst 2020; 10: 156-168
139 Weir HJ, Yao P, Huynh FK. et al. Dietary restriction and AMPK increase lifespan via mitochondrial network and peroxisome remodeling. Cell Metab 2017; 26: 884-896
140 Almundarij TI, Gavini CK, Novak CM. Suppressed sympathetic outflow to skeletal muscle, muscle thermogenesis, and activity energy expenditure with calorie restriction. Physiol Rep 2017; 5: e13171
141 Ho Y, Hou X, Sun F, Wong S, Zhang X. Synergistic Effects of Time-Restricted Feeding and Resistance Training on Body Composition and Metabolic Health: A Systematic Review and Meta-Analysis. Nutrients 2024; 16: 3066
142 Xie Y, Gu Y, Li Z, He B, Zhang L. Effects of Different Exercises Combined with Different Dietary Interventions on Body Composition: A Systematic Review and Network Meta-Analysis. Nutrients 2024; 16: 3007
143 Deutz NE, Bauer JM, Barazzoni R. et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clin Nutr 2014; 33: 929-936
144 Murphy C, Koehler K. Caloric restriction induces anabolic resistance to resistance exercise. Eur J Appl Physiol 2020; 120: 1155-1164
145 Neeland IJ, Linge J, Birkenfeld AL. Changes in lean body mass with glucagon-like peptide -1-based therapies and mitigation strategies. Diabetes Obes Metab 2024; 26 Suppl 4: 16-27
146 Van Elswyk ME, Teo L, Lau CS, Shanahan CJ. Dietary patterns and the risk of sarcopenia: A systematic review and meta-analysis. Curr Dev Nutr 2022; 6: nzac001
147 Dorrington N, Fallaize R, Hobbs D, Weech M, Lovegrove JA. Diet Quality Index for older adults (DQI-65): Development and use in predicting adherence to dietary recommendations and health markers in the UK National Diet and Nutrition Survey. Br J Nutr 2022; 128: 2193-2207
148 Ghoreishy SM, Koujan SE, Hashemi R, Heshmat R, Motlagh AD, Esmaillzadeh A. Relationship between healthy eating index and sarcopenia in elderly people. BMC Geriatr 2023; 23: 25
149 Andreo-López MC, Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. The influence of the Mediterranean dietary pattern on osteoporosis and sarcopenia. Nutrients 2023; 15: 3224
150 Capurso C, Bellanti F, Lo Buglio A, Vendemiale G. The mediterranean diet slows down the progression of aging and helps to prevent the onset of frailty: A narrative review. Nutrients 2019; 12: 35
151 Koyanagi A, Veronese N, Solmi M. et al. Fruit and vegetable consumption and sarcopenia among older adults in low-and middle-income countries. Nutrients 2020; 12: 706
152 Papadopoulou SK, Detopoulou P, Voulgaridou G. et al. Mediterranean diet and sarcopenia features in apparently healthy adults over 65 years: A systematic review. Nutrients 2023; 15: 1104
153 Bian D, Xuan C, Li X. et al. The association of dietary inflammatory potential with sarcopenia in Chinese community-dwelling older adults. BMC Geriatr 2023; 23: 281
154 Jin M, Bok M, Rho H, Chon J, Lim H. A pro-inflammatory diet increases the risk of sarcopenia components and inflammatory biomarkers in postmenopausal women. Nutr Res 2022; 107: 195-205
155 Kushkestani M, Nosrani SE, Moradi K, Lira FS. Poor sleep quality correlated negatively with physical activity level and nutritional status in older adults living in nursing homes. Aging Med Healthc 2021; 12: 46-52
156 Kushkestani M, Parvani M, Ghafari M, Avazpoor Z. The role of exercise and physical activity on aging-related diseases and geriatric syndromes. SPORT TK 2022; 11: 6-6
157 Kushkestani M, Moghadassi M, Parvani M. et al. Physical activity as a preventive factor to aging-related physical dysfunction in Iranian community-dwelling elderly. J Aging Sci 2020; 8: 1-7
158 Kushkestani M, Parvani M, Bathaeezadeh SY. et al. The evaluation of differences on geriatric syndromes between active and sedentary elderly. J Sports Sci 2020; 8: 56-66
159 Kushkestani M, Parvani M, Nosrani SE, Rezaei S. The physical activity and fall risk among Iranian older male adults. Open Nurs J 2020; 14: 159-167
160 Kushkestani M, Parvani M, Rezaei S. The relationship between the level of physical activity and dementia in elderly residents of nursing homes in Tehran. Biomed J Sci Tech Res 2020; 29: 7327
161 TARTIBIAN B, Kushkestani M, Ebrahimpour NS. et al. Relationship between the level of physical activity and nutritional status with fatigue in elderly residents of rest homes in Tehran. Aging Med Healthc 2019; 12: 46-52
162 Santos AC, Willumsen J, Meheus F, Ilbawi A, Bull FC. The cost of inaction on physical inactivity to public health-care systems: A population-attributable fraction analysis. Lancet Glob Health 2023; 11: e32-e39
163 Steffl M, Bohannon RW, Sontakova L, Tufano JJ, Shiells K, Holmerova I. Relationship between sarcopenia and physical activity in older people: A systematic review and meta-analysis. ClInterventions Aging 2017; 12: 835-845
164 Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA 2007; 297: 1769-1774
165 Perkin O, McGuigan P, Thompson D, Stokes K. A reduced activity model: A relevant tool for the study of ageing muscle. Biogerontology 2016; 17: 435-447
166 Tudor-Locke C, Craig CL, Aoyagi Y. et al. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011; 8: 80
167 Breen L, Stokes KA, Churchward-Venne TA. et al. Two weeks of reduced activity decreases leg lean mass and induces “anabolic resistance” of myofibrillar protein synthesis in healthy elderly. J Clin Endocrin Metab 2013; 98: 2604-2612
168 Phillips SM, Glover EI, Rennie MJ. Alterations of protein turnover underlying disuse atrophy in human skeletal muscle. J Appl Physiol 2009; 107: 645-654
169 McGlory C, von Allmen MT, Stokes T. et al. Failed recovery of glycemic control and myofibrillar protein synthesis with 2 wk of physical inactivity in overweight, prediabetic older adults. J Gerontol A Biol Sci Med Sci 2018; 73: 1070-1077
170 Pahor M, Guralnik JM, Ambrosius WT. et al. Effect of structured physical activity on prevention of major mobility disability in older adults: The LIFE study randomized clinical trial. JAMA 2014; 311: 2387-2396
171 Bernabei R, Landi F, Calvani R. et al. Multicomponent intervention to prevent mobility disability in frail older adults: Randomised controlled trial (SPRINTT project). BMJ 2022; 377: e068788
172 Rezaei S, Eslami R, Tartibian B. The effects of TRX suspension training on sarcopenic biomarkers and functional abilities in elderlies with sarcopenia: A controlled clinical trial. BMC Sports Sci Med Rehabil 2024; 16: 58
173 Liang J, Zhang H, Zeng Z. et al. MicroRNA profiling of different exercise interventions for alleviating skeletal muscle atrophy in naturally aging rats. J Cachexia Sarcopenia Muscle 2023; 14: 356-368
174 Long Y-F, Chow SK, Cui C. et al. Does exercise influence skeletal muscle by modulating mitochondrial functions via regulating MicroRNAs? A systematic review. Ageing Res Rev 2023; 91: 102048
175 Anton SD, Hida A, Mankowski R. et al. Nutrition and exercise in sarcopenia. Curr Prot Pept Sci 2018; 19: 649-667
176 Kushkestani M, Parvani M, Moghadassi M, Kazemzadeh Y, Moradi K. Impact of hypertension and physical fitness on SARS-COV-2 and related consequences.(Possible mechanisms with focusing on ACE2). Casp J Intern Med 2022; 13: 148-154
177 Kushkestani M, Parvani M, Teixeira AM. Physical activity is a preventive factor against SARS-CoV-2 in healthy subjects (possible cellular and molecular mechanisms). Biomed J Sci Tech Res 2020; 29: 22429-22436
178 Tartibian B, Kushkestani M, Ebrahimpour Nosrani S. The effect of 12-week endurance training on lipid profiles and fat percentage of overweight girls. New Approaches Sport Sci 2019; 1: 189-200
179 Min L, Ablitip A, Wang R, Luciana T, Wei M, Ma X. Effects of Exercise on Gut Microbiota of Adults: A Systematic Review and Meta-Analysis. Nutrients 2024; 16: 1070
180 Sales KM, Reimer RA. Unlocking a novel determinant of athletic performance: The role of the gut microbiota, short-chain fatty acids, and “biotics” in exercise. J Sport Health Sci 2023; 12: 36-44
181 Li T, Yin D, Shi R. Gut-muscle axis mechanism of exercise prevention of sarcopenia. Front Nutr 2024; 11: 1418778
182 Morton RW, Murphy KT, McKellar SR. et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Brit J Sport Med 2018; 52: 376-384
183 Gonzalez AM, Hoffman JR, Stout JR, Fukuda DH, Willoughby DS. Intramuscular Anabolic Signaling and Endocrine Response Following Resistance Exercise: Implications for Muscle Hypertrophy. Sports Med 2016; 46: 671-685
184 Ato S, Tsushima D, Isono Y, Suginohara T. et al. The effect of changing the contraction mode during resistance training on mTORC1 signaling and muscle protein synthesis. Front Physiol 2019; 10: 406
185 Ziaaldini MM, Marzetti E, Picca A, Murlasits Z. Biochemical pathways of sarcopenia and their modulation by physical exercise: A narrative review. Front Med 2017; 4: 167
186 White TA, LeBrasseur NK. Myostatin and sarcopenia: Opportunities and challenges-a mini-review. Gerontology 2014; 60: 289-293
187 Negaresh R, Ranjbar R, Baker JS. et al. Skeletal muscle hypertrophy, insulin-like growth factor 1, myostatin and follistatin in healthy and sarcopenic elderly men: The effect of whole-body resistance training. Int J Prev Med 2019; 10: 29
188 Beckwée D, Delaere A, Aelbrecht S. et al. Exercise interventions for the prevention and treatment of sarcopenia. A systematic umbrella review. J Nutr Health Aging 2019; 23: 494-502
189 Coen PM, Musci RV, Hinkley JM, Miller BF. Mitochondria as a target for mitigating sarcopenia. Front Physiol 2018; 9: 1883
190 Verdijk LB, Snijders T, Drost M, Delhaas T, Kadi F, van Loon LJ. Satellite cells in human skeletal muscle; from birth to old age. Age (Dordrecht, Neth) 2014; 36: 545-7
191 Carnio S, LoVerso F, Baraibar MA. et al. Autophagy impairment in muscle induces neuromuscular junction degeneration and precocious aging. Cell Rep 2014; 8: 1509-1521
192 Kwon I, Jang Y, Cho J-Y, Jang YC, Lee Y. Long-term resistance exercise-induced muscular hypertrophy is associated with autophagy modulation in rats. J Physiol Sci 2018; 68: 269-280
193 Mejías-Peña Y, Estébanez B, Rodriguez-Miguelez P. et al. Impact of resistance training on the autophagy-inflammation-apoptosis crosstalk in elderly subjects. Aging (Albany NY) 2017; 9: 408-418
194 Long Y-F, Chow SK, Cui C. et al. Regulation of mitochondrial dynamic equilibrium by physical exercise in Sarcopenia: A systematic review. J Orthopaedic Translation 2022; 35: 37-52
195 Tryon LD, Crilly MJ, Hood DA. Effect of denervation on the regulation of mitochondrial transcription factor A expression in skeletal muscle. Am J Physiol Cell Physiol 2015; 309: C228-C238
196 Erlich AT, Tryon LD, Crilly MJ. et al. Function of specialized regulatory proteins and signaling pathways in exercise-induced muscle mitochondrial biogenesis. Integr Med Res 2016; 5: 187-197
197 Konopka AR, Suer MK, Wolff CA, Harber MP. Markers of human skeletal muscle mitochondrial biogenesis and quality control: Effects of age and aerobic exercise training. J Gerontol A Biol Sci Med Sci 2014; 69: 371-378
198 Heo JW, No MH, Cho J. et al. Moderate aerobic exercise training ameliorates impairment of mitochondrial function and dynamics in skeletal muscle of high-fat diet-induced obese mice. FASEB J 2021; 35: 21340
199 Bao W, Sun Y, Zhang T. et al. Exercise programs for muscle mass, muscle strength and physical performance in older adults with sarcopenia: A systematic review and meta-analysis. Aging Dis 2020; 11: 863-873
200 Park SS, Seo Y-K, Kwon K-S. Sarcopenia targeting with autophagy mechanism by exercise. BMB Rep 2019; 52: 64-69
201 Pagano AF, Py G, Bernardi H, Candau RB, Sanchez AM. Autophagy and protein turnover signaling in slow-twitch muscle during exercise. Med Sci Sport Exerc 2014; 46: 1314-1325
202 Abreu P, Mendes SV, Ceccatto VM, Hirabara SM. Satellite cell activation induced by aerobic muscle adaptation in response to endurance exercise in humans and rodents. Life Sci 2017; 170: 33-40
203 Ferreira CB, Teixeira PDS, Alves Dos Santos G. et al. Effects of a 12-Week Exercise Training Program on Physical Function in Institutionalized Frail Elderly. J Aging Res 2018; 2018: 7218102
204 Shen Y, Shi Q, Nong K. et al. Exercise for sarcopenia in older people: A systematic review and network meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14: 1199-1211
205 Moghadam BH, Bagheri R, Ashtary-Larky D. et al. The effects of concurrent training order on satellite cell-related markers, body composition, muscular and cardiorespiratory fitness in older men with sarcopenia. J Nutr Health Aging 2020; 24: 796-804
206 Zhu L-Y, Chan R, Kwok T, Cheng KC, Ha A, Woo J. Effects of exercise and nutrition supplementation in community-dwelling older Chinese people with sarcopenia: A randomized controlled trial. Age Aging 2019; 48: 220-228
207 Sherrington C, Fairhall N, Kwok W. et al. Evidence on physical activity and falls prevention for people aged 65+ years: Systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act 2020; 17: 144
208 Liang Y, Wang R, Jiang J, Tan L, Yang M. A randomized controlled trial of resistance and balance exercise for sarcopenic patients aged 80–99 years. Sci Rep 2020; 10: 18756
209 Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?. Age Aging 2006; 35 (Suppl. 02) ii7-ii11
210 Kumar P, Umakanth S, Girish N. A review of the components of exercise prescription for sarcopenic older adults. Eur Geriatr Med 2022; 13: 1245-1280
211 Makizako H, Nakai Y, Tomioka K. et al. Effects of a multicomponent exercise program in physical function and muscle mass in sarcopenic/pre-sarcopenic adults. J Clin Med 2020; 9: 1386
212 Rios-Escalante V, Perez-Barba JC, Espinel-Bermudez MC. et al. Effects of a Multicomponent Preventive Intervention in Women at Risk of Sarcopenia: A Pilot Study. Healthcare 2024; 12: 1191
213 Zeng Y, He X, Peng X, Zhao L, Yin C, Mao S. Combined Nutrition with Exercise: Fueling the Fight Against Sarcopenia Through a Bibliometric Analysis and Review. Int J Gen Med 2024; 17: 1861-1876
214 Beaudart C, Dawson A, Shaw SC. et al. Nutrition and physical activity in the prevention and treatment of sarcopenia: Systematic review. Osteoporos Int 2017; 28: 1817-1833
215 Damanti S, Azzolino D, Roncaglione C, Arosio B, Rossi P, Cesari M. Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia. Nutrients 2019; 11: 1991
216 Barajas-Galindo DE, González Arnáiz E, Ferrero Vicente P, Ballesteros-Pomar MD. Effects of physical exercise in sarcopenia. A systematic review. Endocrinol Diabetes Nutr (Engl Ed) 2021; 68: 159-169