Sarcopenia (Muscle Wasting) and Frailty

What is It?

As we age, almost everyone will experience a loss of skeletal muscle mass (the muscle that you can grow and develop through proper exercise and nutrition) and function (a person’s ability to perform normal activities of daily living)—this is known as sarcopenia.


Normal muscle mass on left, muscle wasting on right; Figure from the International Osteoporosis Foundation (2017)

Sarcopenia is linked to a number of adverse health outcomes. For example, it increases the risk of falls, fractures, and functional dependence (relying on another to assist with activities of daily living, such as using the washroom or preparing meals). It can also lead to longer hospital stays, a need for home care, and/or assisted living situations. Research also shows that sarcopenia can be linked to an earlier death.

Sarcopenia is diagnosed by the presence of low muscle mass as well as low muscle strength and/or low physical performance. A variety of tools are used to test these individual components that make up sarcopenia. Measures of muscle mass (e.g., MRI), strength (e.g., handgrip strength), and function (e.g., usual gait speed) are taken separately, and used to determine a formal diagnosis of sarcopenia.

Table 1. Criteria for the diagnosis of sarcopenia
Diagnosis is based on documentation of criterion 1 plus (criterion 2 or criterion 3)
1. Low muscle mass

2. Low muscle strength

3. Low physical performance

Chart recreated from Cruz-Jentoft et al. (2010)

Exercise and nutrition are key elements in treatment plans, but research must continue to explore treatment options. Exercise routines that consist of a variety of types of exercise (e.g., resistance, aerobic) may be better than exercise routines that consist of only one type of exercise. Dietary plans that promote proper nutritional intake as well as protein intake are important. Currently, there are no known medication options for treatment.

As with treatment of sarcopenia, nutrition and exercise may be important in the prevention of sarcopenia. Risk factors for developing sarcopenia include being age 40 or older, leading a sedentary (inactive) lifestyle, and an unbalanced diet and malnutrition. Addressing these factors may help prevent the onset or the severity of sarcopenia.

Research shows that resistance (or strength) training combined with aerobic exercise helps build and maintain muscle mass. Researchers are looking at the types of exercise that work best for older adults and if there are non-traditional exercise programs that might work for older adults with limited physical function. However, leading an active lifestyle does not guarantee that you will not get sarcopenia.

For nutrition, researchers are looking into the roles of protein, specific amino acids, and micronutrients (such as vitamin D).

A key question researchers are trying to answer is: how can exercise and nutrition be combined to prevent sarcopenia?

What is Its Connection to Frailty?

Frailty and sarcopenia overlap. Sarcopenia and frailty are both causes of physical function impairment and share similar characteristics. Although frailty includes elements beyond impaired physical function (such as cognitive impairment, psychological and social dimensions), sarcopenia contributes to the psychical aspect of frailty and may lead to greater vulnerability for other aspects of frailty.

The message: “sarcopenia may be a precursor to the development of frailty and its [frailty’s] adverse health outcomes” (Kobashigawa et al., 2019). What does this mean? Identifying and diagnosing sarcopenia early may help in the prevention or management of frailty. Frailty and sarcopenia do not always co-occur (e.g., most but not all older adults living with frailty will exhibit sarcopenia, and older adults living with sarcopenia may or may not exhibit frailty), but it’s still important to be aware of the connection between the two conditions.


Sarcopenia & Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT Trial) (Resources for the public, researchers, and healthcare providers)

SPRINTT’s Poster on Aerobic Exercise

SPRINTT’s Poster on Protein

SPRINTT’s Poster on Frailty

SPRINTT’s Poster on Sarcopenia

Detailed Presentation on SPRINTT Trial

Summary Presentation on SPRINTT Trail

International Osteoporosis Foundation (IFO)

International Conference on Frailty & Sarcopenia Research

British Geriatrics Society

Age and Ageing. (03 May 2019). Age and Ageing collection: Sarcopenia research and practice. [Website].Retrieved from

McGlory, C., van Vliet, S., Stokes, T., Mittendorfer, B., & Phillips, S.M. (2019). The impact of exercise and nutrition on the regulation of skeletal muscle mass. Journal of Physiology, 597(5), 1251-1258. doi: 10.1113/JP275443

Ali, T.F., Warkentin, L.M., Gazala, S., Wagg, A.S., Padwal, R.S., Khadaroo, R.G. (2015). Self-reported outcomes in individuals aged 65 and older admitted for treatment to an acute care surgical service: A 6-month prospective cohort study. Journal of the American Geriatrics Society, 63(11), 2388-2394. doi: 10.1111/jgs.13783

Cruz-Jentoft, A.J., Baeyens, J.P., Bauer, J.M., Boirie, Y., Cederholm, T., Landi, F., Martin, F.C., Michel, J.P., Rolland, Y., Schneider, S.M., Topinková, E., Vandewoude, M., & Zamboni, M. (2010). Sarcopenia: European consensus on definition and diagnosis. Age and Ageing, 39, 412-423. doi: 10.1093/ageing/afq034

Kobashigawa, J., Dadhania, D., Bhorade, S., Adey D., Berger, J., Bhat, G., Budev, M., Duarte‐Rojo, A., Dunn, M., Hall, S., Harhay, M.N., Johansen, K.L., Joseph, S., Kennedy, C.C., Kransdorf, E., Lentine, K.L., Lynch, R.J., McAdams‐DeMarco, M., Nagai, S., Olymbios, M., Patel, J., Pinney, S., Schaenman, J., Segev, D.L., Shah, P., Singer, L.G., Singer, J.P., Sonnenday, C., Tandon, P., Tapper, E., Tullius, S.G., Wilson, M., Zamora, M., & Lai, J.C. (2019). Report from the American Society of Transplantation on frailty in solid organ transplantation. American Journal of Transplantation, 19, 984-994. doi: 10.1111/ajt.15198

Maltais, M., Aubertin-Leheudre, M., Dray, C., Fielding, R.A., Rolland, Y., Cesari, M., Vellas, B. (2019). The Journal of Frailty & Aging, 8(3), 117-119. doi:

Marzetti, E., Calvani, R., Tosato, M., Cesari, M., Di Bari, M., Cherubini, A., Collamati, A., D’Angelo, E., Pahor, M., Bernabei, R., & Landi, F. (2017). Sarcopenia: An overview. Aging Clinical and Experimental Research, 29, 11-17. doi: 10.1007/s40520-016-0704-5

Rozenberg, D., Wickerson, L., Singer, L.G., & Mathur, S. (2014). Sarcopenia in lung transplantation: A systematic review. The Journal of Heart and Lung Transplantation, 33(12), 1203-1212. doi: