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Geriatric Frailty and Sarcopenia — Combined Rehabilitation Protocol

Integrated multidisciplinary rehabilitation protocol for older adults (≥65 years) with overlapping frailty (Fried phenotype: weight loss, exhaustion, weakness, slow gait, low activity) and sarcopenia (low muscle mass + low strength/function per EWGSOP2/AWGS criteria), combining progressive resistance training, protein-enriched nutrition (1.2-1.5 g/kg/day), vitamin D supplementation, balance training, and management of polypharmacy/comorbidities to reduce falls, hospitalizations, and disability.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Fizik Tedavi ve Rehabilitasyon department. Book Appointment →

What is Geriatric Frailty and Sarcopenia — Combined Rehabilitation Protocol?

Frailty is a clinical syndrome of decreased physiologic reserve and increased vulnerability to stressors, defined by Fried phenotype (5 criteria: unintentional weight loss ≥10 lbs, exhaustion, weakness via grip strength, slow gait speed <0.8 m/s, low physical activity) where ≥3 criteria = frail, 1-2 = prefrail. Sarcopenia, recognized as ICD-10 disease (M62.84) in 2016, is age-related loss of skeletal muscle mass and function defined by EWGSOP2 (2018) and AWGS (2019) criteria: low muscle strength (handgrip <27 kg men, <16 kg women) + low muscle quantity (DXA, BIA - low ASMI <7.0 kg/m2 men, <5.5 kg/m2 women) and/or low physical performance (gait speed <0.8 m/s, SPPB ≤8, TUG ≥20 sec).

Pathophysiology overlap of frailty and sarcopenia includes: 1) Chronic low-grade inflammation ('inflammaging' - elevated IL-6, TNF-α, CRP); 2) Anabolic resistance — reduced protein synthesis response to dietary amino acids; 3) Hormonal decline — testosterone, growth hormone/IGF-1, vitamin D; 4) Mitochondrial dysfunction and oxidative stress; 5) Neuromuscular junction degeneration; 6) Reduced physical activity and immobilization; 7) Comorbid chronic diseases (heart failure, COPD, CKD, diabetes); 8) Polypharmacy and adverse drug effects. Frailty prevalence rises with age (4% at 65-69, 26% at 85+); sarcopenia affects 5-13% at 60-70, 11-50% at 80+.

Combined rehabilitation protocol per international guidelines (ICFSR, Asian/European Working Groups): 1) PROGRESSIVE RESISTANCE TRAINING (cornerstone) 2-3x/week, 8-10 multi-joint exercises (squat, leg press, chest press, row, deadlift), 60-80% 1RM, 8-12 reps, 2-3 sets, progressive overload over 12 weeks (LIFE Study, SPRINT-T trial); 2) AEROBIC EXERCISE 3-5x/week, 30 min moderate intensity (RPE 12-14, brisk walking, swimming, cycling); 3) BALANCE TRAINING 2-3x/week (tai chi, Otago program - reduces falls 35%, FaME program); 4) PROTEIN INTAKE 1.2-1.5 g/kg/day, 25-30 g per meal, leucine-rich (leucine 2.5-3 g per meal stimulates protein synthesis, post-exercise within 30-60 min); 5) VITAMIN D supplementation 800-2000 IU/day if 25-OH D <30 ng/mL; 6) Combined nutrition + exercise has synergistic effects (LIFE-MoVe, SPRINTT showing reduced disability progression).

Symptoms

Unintentional weight loss (≥4.5 kg or 5% in 1 year)
Self-reported exhaustion ('everything is an effort')
Weakness (low grip strength, difficulty with stairs/groceries)
Slow gait speed (<0.8 m/s)
Low physical activity (energy expenditure <383 kcal/week men, <270 kcal/week women)
Recurrent falls or near-falls
Cognitive decline often accompanying

Risk Factors

Age ≥65 years (especially ≥80)
Female sex (higher prevalence)
Sedentary lifestyle and immobilization
Multiple chronic comorbidities (heart failure, COPD, CKD, diabetes)
Malnutrition and protein deficiency
Polypharmacy (≥5 medications)
Cognitive impairment and dementia

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Functional decline in older adult (mobility, ADLs)
  • Recurrent falls or fear of falling
  • Weight loss with weakness
  • Pre-surgery prehabilitation evaluation
  • Hospitalization with deconditioning
  • Dependency in IADLs (cooking, shopping, finances)
  • Sarcopenia screening (SARC-F questionnaire)

Treatment Methods

01
Progressive resistance training 2-3x/week, 8-12 reps, 2-3 sets, 60-80% 1RM
02
Aerobic exercise 3-5x/week, 30 min moderate intensity
03
Balance training (tai chi, Otago program) 2-3x/week
04
Protein 1.2-1.5 g/kg/day, 25-30 g per meal, leucine-rich
05
Vitamin D 800-2000 IU/day if deficient
06
Comprehensive geriatric assessment and deprescribing
07
Multidisciplinary team: physiatrist, PT, OT, dietitian, geriatrician

Which Department to Visit?

You can visit our Fizik Tedavi ve Rehabilitasyon department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Fizik Tedavi ve Rehabilitasyon Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.