Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with sarcopenia. The European PRM position (UEMS PRM Section).
Nikolaos Barotsis, Aydan Oral, Carlotte Kiekens and 7 others
Resistance training is the best-supported intervention for sarcopenia.
Pair it with balance and aerobic work for the biggest gains in function and quality of life. Protein helps only alongside exercise. This is a consensus position, not a single trial.
Key findings
1High-quality evidence supports resistance training for improving muscle mass, strength, and physical performance in sarcopenia, and it outperforms non-resistance training for strength and muscle size.
2Combining resistance training with aerobic and balance training is the most effective approach for improving quality of life and physical function in older adults with sarcopenia.
3Nutritional supplements alone show limited and mixed effects. The consensus position is that exercise and adequate protein intake (at least 1.0 g/kg body weight) together form the key intervention for prevention and treatment.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a consensus position, not a primary trial. The 25 recommendations rest on a review of other reviews and trials, and the evidence strength varies widely: some recommendations are backed by systematic reviews of RCTs, others by expert opinion alone (SoE IV or NA). The recommendations are written for PRM physicians specifically. A physiotherapist, OT, or SLP working in a different system may not have the same scope or the same access to the diagnostic tools the paper assumes (DXA, ultrasound, CT). The systematic search was limited to guidelines, meta-analyses, systematic reviews, and RCTs. It did not include observational studies, qualitative work, or implementation research that might inform how these interventions actually get delivered. The paper does not report a single patient population, a single intervention protocol, or a single outcome. It synthesises evidence across many populations (community-dwelling older adults, dialysis patients, breast cancer survivors, long-term care residents) and many interventions, so the recommendations are broad rather than specific to any one clinical scenario. The evidence for nutritional supplements is genuinely mixed across the reviews cited. One review found limited effects of protein, creatine, DHEA, and HMB; another found leucine supported by best evidence; another found HMB improved grip strength but not gait speed. The consensus recommendation to use them sits on top of this inconsistency.
Declared interests
The authors declare no conflict of interest with any financial organisation. The work of two authors (Kiekens and Negrini) was supported by the Italian Ministry of Health under its 'Ricerca Corrente' programme. The authors report no sponsor involvement that could have influenced the outcome.
The easy way to misread this
Do not read the 25 recommendations as the results of a single trial. This is a consensus position built from a review of multiple systematic reviews and meta-analyses, and the evidence strength varies from I to IV across the recommendations. Some rest on no direct evidence at all (SoE IV or NA), so they reflect expert agreement rather than tested effect.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →