**7. Management of sarcopenia**

*Background and Management of Muscular Atrophy*

stair climb power test is only used for research [7].

as shown in **Table 3** [34].

in **Table 5**.

**Table 4.**

**Primary sarcopenia** • **Age-related sarcopenia**

**Secondary sarcopenia** • **Activity-related sarcopenia**

*Category of sarcopenia by cause [7].*

Presarcopenia Decreased

**6. Category and stage sarcopenia**

needed to get up from a seat and get back to sitting for as much as five cycles [30]. Based on AWGS recommendations, physical performance can be measured by a test of running as far as 5 m. Walking speed provides predictive value for the condition of disability and predicts the course of the disease [31, 32]. Time to get up and go test is a method of measuring physical performance in the elderly by using subjects rising from a chair, walking at a close range, returning, and sitting as before [33]. Stair climb power test is used as a method for assessing foot impairment. But the

Currently, there is a questionnaire for Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F), which can be used to detect early sarcopenia quickly and it has high specifications. This is because the diagnosis of sarcopenia using the SARC-F questionnaire does not require certain other measurement tools. This criterion is subjective only by conducting careful and thorough interviews. The SARC-F questionnaire has a good specificity and sensitivity in identifying the presence of sarcopenia. The sarcopenia category is defined if the SARCF score > 4,

Sarcopenia is a condition with many different causes and outcomes. In some individuals, a single cause of sarcopenia can be identified, but in other cases, clinicians can fail to identify the cause of sarcopenia. To facilitate clinical practice, sarcopenia is categorized into primary and secondary sarcopenia (**Table 4**). The etiology of sarcopenia can be multifactorial in the elderly, so there is a possibility that a person belongs to the primary, secondary, or both types of sarcopenia [7]. Sarcopenia stage is divided into three types based on the condition of muscle mass, muscle strength, and physical performance. The division of sarcopenia is seen

No other cause evident except aging

or zero-gravity conditions • **Disease-related sarcopenia** Associated with advanced organ failure (heart, lung, liver, kidney,

• **Nutrition-related sarcopenia** Results from inadequate dietary intake of energy and/or protein, as

that cause anorexia

**Stage Muscle mass Muscle strength Performance**

Severe sarcopenia Decreased Decreased Decreased

Sarcopenia Decreased Decreased or normal Decreased or normal

Can result from bed rest, sedentary lifestyle, deconditioning,

and brain), inflammatory disease, malignancy, or endocrine disease

with malabsorption, gastrointestinal disorders, or use of medications

**74**

**Table 5.**

*Stage of sarcopenia [7].*

Sarcopenia is a condition caused by a variety of complex factors. Therefore, a Geriatric Patient Full Assessment (P3G) for the management of sarcopenia should be carried out interdisciplinary with a focused and comprehensive intervention. P3G aims to improve physical and psychological patients, optimize drug administration to reduce the incidence of hospitalization and the risk of mortality, and increase patient satisfaction. P3G is carried out with an interdisciplinary team consisting of geriatric doctors, nurses, social workers, pharmacists, and physiotherapists who make plans for integrated care [17].

Diet control and physical training such as resistance training and stretching have a positive impact on sarcopenia associated with chronic diseases such as diabetes mellitus, hypertension, and coronary heart disease. Besides, psychological supportive therapy is needed for the management of sarcopenia because psychological factors of patients with sarcopenia are important in both prevention and recovery. Here are some recommendations for the management of sarcopenia [35]:


A protein diet is an important key needed to prevent a progressive reduction in muscle mass. Its mechanism of action is by preventing a negative nitrogen balance. The recommended diet for healthy people is 0.8 g/kg/day (RDA = recommended diet allowance). In the elderly >70 years, 40% of the protein diet is less than the RDA. In elderly patients with sarcopenia, the minimum recommended diet is according to the RDA (0.8) and will be increased to 1–1.5 g/kg/day by the increase in physical activity and comorbidities. Adequate protein intake in the elderly over 70 years has a positive effect on the ability to maintain muscle reserves and prevent sarcopenia. The positive effect is because the protein diet stimulates insulin-like growth factor 1 (IGF-1). Increased levels of IGF-1 as a result of this diet have an impact on preventing decreased protein synthesis and decreased muscle mass [36].

The use of creatine as a treatment for sarcopenia is still controversial because several studies have different results. In one study, the results showed that the elderly who took creatine supplements followed by endurance training experienced an increased muscle mass and strength. However, other studies show conflicting results, where creatine supplementation does not affect the muscle mass and strength [37].

Vitamin D levels can affect the incidence of sarcopenia. Some data show that inadequate levels of vitamin D can reduce muscle function and are associated with sarcopenia. Low levels of 25 (OH) D are associated with lower muscle mass, lower functional test results and can be used to predict muscle mass loss which will be one of the causes of disability. Lack of vitamin D is associated with poorer muscle function and loss of muscle mass [17].

Important physical activity becomes a pillar of conventional management that is very profitable. Large observational studies such as the British Regional Heart Study (BRHS), the Third National Health and Nutrition Examination Survey (NHANES III), and the Cardiovascular Health Study (CHS) show an inverse relationship between CRP concentration and physical activity in the elderly. The Health Aging and Body Composition (Health ABC) Study also found a linear tendency to decrease TNF with increased physical activity [9]. Therefore, physical activity is very necessary for the management of sarcopenia. The management of sarcopenia through physical activity must be designed with specific guidelines so that it gradually burdens muscles and makes positive adaptations. This should also be noted in physiology related to age and aging to avoid injury. Physical exercise in sarcopenia patients is focused on dynamic movements that target the major or major muscle groups such as knee and hip extensors through intrinsic and eccentric movements. The period of heating and cooling in the elderly is sought to last 15–20 min when heating and 10–15 min when cooling [38].

Management of other sarcopenia is still under studies, such as the therapeutic approach of using testosterone, estrogen, dehydroepiandrosterone (DHEA), and angiotensin-converting enzyme inhibitors (ACE inhibitors) [17].

#### **8. Conclusions**

Sarcopenia is more prevalent in older patients, especially men, and is defined by decreased muscle mass with decreased muscle strength and/or performance. Sarcopenia can cause multiple morbidities in the elderly, including frailty, fractures, falls, and even death. There are multifactorial factors (divided into intrinsic and extrinsic factors) that trigger sarcopenia, but the inflammatory process is recognized as a basic mechanism. Constitutional factors, aging, lifestyle, changes in body condition, and chronic diseases are considered as risk factors for sarcopenia in the elderly. Diagnostic criteria for sarcopenia are still under controversy since there is a variety of the component because it differs based on race and gender. Criteria from EWGSOP and AWGS are the most widely used. Currently, SARC-F questionnaires can detect early sarcopenia and have high specifications. In clinical practice, sarcopenia is categorized into primary and secondary sarcopenia and is divided into three stadiums, which are pre-sarcopenia, sarcopenia, and severe sarcopenia. Management of sarcopenia should be interdisciplinary with a focused and comprehensive intervention. Nutrition and physical training are the most important therapies for sarcopenia in the elderly.

**77**

**Author details**

IGP Suka Aryana

Geriatric Division, Internal Medicine Department, Medical Faculty of Udayana

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

University, Sanglah Teaching Hospital, Bali, Indonesia

provided the original work is properly cited.

\*Address all correspondence to: ptsuka\_aryana@unud.ac.id

*Clinical Relations of Sarcopenia*

*DOI: http://dx.doi.org/10.5772/intechopen.93408*

#### **Conflict of interest**

The authors declare no conflict of interest.

*Clinical Relations of Sarcopenia DOI: http://dx.doi.org/10.5772/intechopen.93408*

*Background and Management of Muscular Atrophy*

function and loss of muscle mass [17].

heating and 10–15 min when cooling [38].

therapies for sarcopenia in the elderly.

The authors declare no conflict of interest.

**Conflict of interest**

**8. Conclusions**

sarcopenia. Low levels of 25 (OH) D are associated with lower muscle mass, lower functional test results and can be used to predict muscle mass loss which will be one of the causes of disability. Lack of vitamin D is associated with poorer muscle

Important physical activity becomes a pillar of conventional management that is very profitable. Large observational studies such as the British Regional Heart Study (BRHS), the Third National Health and Nutrition Examination Survey (NHANES III), and the Cardiovascular Health Study (CHS) show an inverse relationship between CRP concentration and physical activity in the elderly. The Health Aging and Body Composition (Health ABC) Study also found a linear tendency to decrease TNF with increased physical activity [9]. Therefore, physical activity is very necessary for the management of sarcopenia. The management of sarcopenia through physical activity must be designed with specific guidelines so that it gradually burdens muscles and makes positive adaptations. This should also be noted in physiology related to age and aging to avoid injury. Physical exercise in sarcopenia patients is focused on dynamic movements that target the major or major muscle groups such as knee and hip extensors through intrinsic and eccentric movements. The period of heating and cooling in the elderly is sought to last 15–20 min when

Management of other sarcopenia is still under studies, such as the therapeutic approach of using testosterone, estrogen, dehydroepiandrosterone (DHEA), and

Sarcopenia is more prevalent in older patients, especially men, and is defined by decreased muscle mass with decreased muscle strength and/or performance. Sarcopenia can cause multiple morbidities in the elderly, including frailty, fractures, falls, and even death. There are multifactorial factors (divided into intrinsic and extrinsic factors) that trigger sarcopenia, but the inflammatory process is recognized as a basic mechanism. Constitutional factors, aging, lifestyle, changes in body condition, and chronic diseases are considered as risk factors for sarcopenia in the elderly. Diagnostic criteria for sarcopenia are still under controversy since there is a variety of the component because it differs based on race and gender. Criteria from EWGSOP and AWGS are the most widely used. Currently, SARC-F questionnaires can detect early sarcopenia and have high specifications. In clinical practice, sarcopenia is categorized into primary and secondary sarcopenia and is divided into three stadiums, which are pre-sarcopenia, sarcopenia, and severe sarcopenia. Management of sarcopenia should be interdisciplinary with a focused and comprehensive intervention. Nutrition and physical training are the most important

angiotensin-converting enzyme inhibitors (ACE inhibitors) [17].

**76**
