Skip to main content

Exercise Interventions for the Prevention and Treatment of Sarcopenia. A Systematic Umbrella Review

The journal of nutrition, health & aging volume 23, pages 494–502 (2019)Cite this article

Abstract

Objectives

The aim of this systematic review is to provide an overview of the efficacy of different exercise interventions to counter sarcopenia in older adults. This review will allow the Belgian Society of Gerontology and Geriatrics and other scientific societies to formulate specific exercise recommendations in their Clinical Guidelines for Sarcopenia.

Design

We used the method of a systematic umbrella-review. Based on the level of evidence, we formulated specific recommendations for clinical practice.

Methods

Two databases (Pubmed and Web Of Science) were searched systematically and methodological quality of the reviews was assessed. Extracted data was than mapped to an exercise category and an overall synthesis (bottom line statements) was formulated for each of these exercise categories. Subsequently, we assigned a rating of the quality of the evidence supporting each bottom line statement.

Results

We identified 14 systematic reviews or meta-analyses, encompassing four exercise categories: resistance training, resistance training + nutritional supplementation, multimodal exercise programmes and bloodflow restriction training. Importantly, very few systematic reviews or meta-analyses clearly mentioned baseline sarcopenia status. There is high quality evidence for a positive and significant effect of resistance training on muscle mass, muscle strength, and physical performance. The added effect of nutritional supplementation for resistance training on muscle function appears limited. Blood flow restriction training is a novel training method that has a significant impact on muscle strength.

Conclusion

Since sarcopenia is affecting all skeletal muscles in the body, we recommend training the large muscle groups in a total body approach. Although low-intensity resistance training (≤50% 1RM) is sufficient to induce strength gains, we recommend a high-intensity resistance training program (i.e. 80% 1RM) to obtain maximal strength gains. Multimodal exercises and blood flow restriction resistance training may be considered as well.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Figure 1
Figure 2
Figure 3

References

  1. Rosenberg, I.H., Sarcopenia: origins and clinical relevance. J Nutr, 1997;127(5 Suppl): p. 990s–991s.

    Article  CAS  PubMed  Google Scholar 

  2. Cruz-Jentoft, A.J., et al., Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing, 2010;39(4): p. 412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cruz-Jentoft, A.J., et al., Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2018: p. afy169-afy169.

  4. Fielding, R.A., et al., Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc, 2011;12(4): p. 249–56.

    Article  PubMed  Google Scholar 

  5. Dent, E., et al., International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. 2018.

  6. Dam, T.-T., et al., An Evidence-Based Comparison of Operational Criteria for the Presence of Sarcopenia. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2014;69(5): p. 584–590.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Studenski, S.A., et al., The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci, 2014;69(5): p. 547–58.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Anker, S.D., J.E. Morley, and S. von Haehling, Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle, 2016;7(5): p. 512–514.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lauretani, F., et al., Identification and treatment of older persons with sarcopenia. Aging Male, 2014;17(4): p. 199–204.

    Article  PubMed  Google Scholar 

  10. De Spiegeleer, A., et al., Pharmacological Interventions to Improve Muscle Mass, Muscle Strength and Physical Performance in Older People: An Umbrella Review of Systematic Reviews and Meta-analyses. Drugs Aging, 2018.

  11. Liberati, A., et al., The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj, 2009;339: p. b2700.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ouzzani, M., et al., Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016;5(1): p. 210.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Higgins JPT, G.S.e., Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. 2011, The Cochrane Collaboration.

    Google Scholar 

  14. Shea, B.J., et al., Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007;7: p. 10.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Austin, T.M., R.R. Richter, and C.A. Sebelski, Introduction to the GRADE Approach for Guideline Development: Considerations for Physical Therapist Practice. Phys Ther, 2014.

  16. Antoniak, A.E. and C.A. Greig, The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. BMJ Open, 2017;7(7): p. e014619.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Beaudart, C., et al., Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporosis International, 2017;28(6): p. 1817–1833.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bibas, L., et al., Therapeutic interventions for frail elderly patients: part I. Published randomized trials. Prog Cardiovasc Dis, 2014;57(2): p. 134–43.

    Article  PubMed  Google Scholar 

  19. Borst, S.E., Interventions for sarcopenia and muscle weakness in older people. Age and Ageing, 2004;33(6): p. 548–555.

    Article  PubMed  Google Scholar 

  20. Buch, A., et al., Circuit resistance training is an effective means to enhance muscle strength in older and middle aged adults A systematic review and meta-analysis. Ageing Research Reviews, 2017;37: p. 16–27.

    Article  PubMed  Google Scholar 

  21. Csapo, R. and L.M. Alegre, Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: A meta-analysis. Scandinavian Journal of Medicine & Science in Sports, 2016;26(9): p. 995–1006.

    Article  CAS  Google Scholar 

  22. Hughes, L., et al., Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med, 2017;51(13): p. 1003–1011.

    Article  PubMed  Google Scholar 

  23. Duplicate, et al., The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Current Opinion in Clinical Nutrition and Metabolic Care, 2017;20(1): p. 30–53.

    Article  Google Scholar 

  24. Martins, W.R., et al., Elastic resistance training to increase muscle strength in elderly: A systematic review with meta-analysis. Archives of Gerontology and Geriatrics, 2013;57(1): p. 8–15.

    Article  PubMed  Google Scholar 

  25. Papa, E.V., X. Dong, and M. Hassan, Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clinical Interventions in Aging, 2017;12: p. 955–961.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Peterson, M.D., et al., Resistance exercise for muscular strength in older adults: A meta-analysis. Ageing Research Reviews, 2010;9(3): p. 226–237.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Peterson, M.D., A. Sen, and P.M. Gordon, Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc, 2011;43(2): p. 249–58.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Theodorakopoulos, C., et al., Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: A systematic review. Nutrition Research, 2017;43: p. 3–15.

    Article  CAS  PubMed  Google Scholar 

  29. Yoshimura, Y., et al., Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of the American Medical Directors Association, 2017;18(6).

  30. De Spiegeleer, A., et al., Pharmacological Interventions to Improve Muscle Mass, Muscle Strength and Physical Performance in Older People: An Umbrella Review of Systematic Reviews and Meta-analyses. Drugs Aging, 2018;35(8): p. 719–734.

    Article  CAS  PubMed  Google Scholar 

  31. Avenell, A., J.C.S. Mak, and D. O’Connell, Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database of Systematic Reviews, 2014(4).

  32. Liberman, K., et al., The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Curr Opin Clin Nutr Metab Care, 2017;20(1): p. 30–53.

    Article  PubMed  Google Scholar 

  33. WHO. World Health Organisation — Global recommendations on physical activity for health. 2010; Available from: http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/ (last checked: 12/12/2018).

  34. Chen, L.K., et al., Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc, 2014;15(2): p. 95–101.

    Article  PubMed  Google Scholar 

  35. Beaudart, C., et al., Prevalence of sarcopenia: the impact of different diagnostic cut-off limits. J Musculoskelet Neuronal Interact, 2014;14(4): p. 425–31.

    CAS  PubMed  Google Scholar 

  36. Beaudart, C., et al., Estimation of sarcopenia prevalence using various assessment tools. Exp Gerontol, 2015;61: p. 31–7.

    Article  CAS  PubMed  Google Scholar 

  37. Moher, D., et al., Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 2009;6(7): p. e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Buch, A., et al., Circuit resistance training is an effective means to enhance muscle strength in older and middle aged adults A systematic review and meta-analysis. Ageing Research Reviews. 37: p. 16–27.

  39. Csapo, R. and L.M. Alegre, Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: A meta-analysis. Scand J Med Sci Sports. 26(9): p. 995–1006.

  40. Theodorakopoulos, C., et al., Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: A systematic review. Nutrition Research. 43: p. 3–15.

  41. Yoshimura, Y., et al., Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of the American Medical Directors Association. 18(6).

  42. Borst, S.E., Interventions for sarcopenia and muscle weakness in older people. Age Ageing, 2004;33(6): p. 548–55.

    Article  PubMed  Google Scholar 

  43. Peterson, M.D., et al., Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev, 2010;9(3): p. 226–37.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Papa, E.V., X.Y. Dong, and M. Hassan, Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clinical Interventions in Aging, 2017;12: p. 955–961.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Beaudart, C., et al., Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporosis International. 28(6): p. 1817–1833.

  46. Antoniak, A.E. and C.A. Greig, The effect of combined resistance exercise training and vitamin D-3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis. Bmj Open. 7(7).

  47. Liberman, K., et al., The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Current Opinion in Clinical Nutrition and Metabolic Care. 20(1): p. 30–53.

  48. Hughes, L., et al., Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 51(13): p. 1003–1011.

Download references

Author information

Authors and Affiliations

  1. Rehabilitation Research Department, Vrije Universiteit Brussel, Brussels, Belgium

    D. Beckwée

  2. Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium

    D. Beckwée, A. Delaere, S. Aelbrecht, V. Baert & Ivan Bautmans

  3. Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium

    D. Beckwée

  4. Department of Geriatric Physiotherapy, SOMT University of Physiotherapy, Amersfoort, The Netherlands

    D. Beckwée & Ivan Bautmans

  5. Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium

    C. Beaudart & O. Bruyere

  6. CHU UCL Namur, Namur, Belgium

    M. de Saint-Hubert

  7. Institut de Recherche Santé Société, UCLouvain, Louvain-la-Neuve, Belgium

    M. de Saint-Hubert

  8. Gerontology (GERO) & Frailty in Ageing research (FRIA) departments, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium

    Ivan Bautmans

Authors
  1. D. Beckwée
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Delaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Aelbrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Baert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Beaudart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. O. Bruyere
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. de Saint-Hubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ivan Bautmans
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Sarcopenia Guidelines Development Group of the Belgian Society of Gerontology and Geriatrics (BSGG)

Corresponding author

Correspondence to Ivan Bautmans.

Additional information

Members of the Sarcopenia Guideline Development group of the BSGG: Ivan Bautmans; ivan.bautmans@vub.be; Charlotte Beaudart; c.beaudart@ulg.ac.be; David Beckwée; david.beckwee@vub. be; Ingo Beyer; Ingo.Beyer@uzbrussel.be; Olivier Bruyère; olivier.bruyere@ulg.ac.be; Sandra De Breucker; Sandra.De.Breucker@erasme. ulb.ac.be; Anne-Marie De Cock; Annemarie.DeCock@emmaus.be; Andreas Delaere; Andreas.Delaere@vub.be; Marie de Saint-Hubert; marie.desainthubert@uclouvain.be; Anton De Spiegeleer; Anton.DeSpiegeleer@UGent.be; Evelien Gielen; evelien.gielen@ uzleuven.be; Stany Perkisas; stany.perkisas@zna.be; Maurits Vandewoude; Maurits. Vandewoude@zna.be

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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 23, 494–502 (2019). https://doi.org/10.1007/s12603-019-1196-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-019-1196-8

Key words

  • Exercise
  • sarcopenia
  • muscle strength
  • muscle mass
  • physical performance