**5.3 Physical performance**

An examination of physical performance is an examination of muscle function by performing physical activity. There are several ways of checking physical performance, such as the Short Physical Performance Battery (SPPB), walking speed, a 6-min walk test, time up and go test, and the strength of climbing stairs. Inspection with Short Physical Performance Battery (SPPB) is a standard inspection for physical performance. This check is carried out to evaluate balance, path, strength, and endurance. SPPB is done by assessing the ability to stand on both legs, in semi-tandem and tandem positions, the time needed to walk 8 ft, and the time


#### **Table 3.**

*Strength, assistance walking, rise from a chair, climb stairs, and falls [34].*

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

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

#### **6. Category and stage sarcopenia**

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 in **Table 5**.


#### **Table 4.**

*Category of sarcopenia by cause [7].*


**75**

*Clinical Relations of Sarcopenia*

acid leucine.

nia patients.

muscle mass [36].

strength [37].

**7. Management of sarcopenia**

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

therapists who make plans for integrated care [17].

mended total protein intake is 1–1.5 g/kg/day.

is given up to 50,000 IU per week.

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 physio-

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.Multimodal therapy can be carried out with balanced energy and protein supplementation for the prevention and recovery of sarcopenia. The recom-

b.The recommended protein consumption is of good quality such as the amino

c.Creatine supplementation to enhance the physical exercise effects of sarcope-

d.Vitamin D supplementation with doses above 100 nmol/L. A dose of vitamin D

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

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

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

e.Resistance and aerobic exercise are done for 20–30 min, 3 times a week.

**Table 5.** *Stage of sarcopenia [7].*
