Sarcopenia is the progressive loss of skeletal muscle mass, strength, and physical performance with age — now recognised by the EWGSOP2 consensus as a muscle disease with its own ICD-10 code (M62.84) since 2016. Roughly 10-27% of community-dwelling adults over 60 meet diagnostic criteria, with prevalence rising sharply after age 80.
Sarcopenia (ICD-10: M62.84) is a generalised, progressive skeletal muscle disorder characterised by low muscle strength, low muscle quantity or quality, and reduced physical performance, as defined by the 2019 revised European Working Group on Sarcopenia in Older People (EWGSOP2) consensus. The 2019 Asian Working Group for Sarcopenia (AWGS) consensus uses lower regional cut-offs but the same conceptual framework. EWGSOP2 places low muscle strength at the centre of the diagnosis — measured by hand-grip dynamometry or the five-times sit-to-stand test — because strength loss precedes mass loss and predicts adverse outcomes better than mass alone. The disease is staged as probable sarcopenia (low strength only), confirmed sarcopenia (low strength plus low muscle mass on DXA, BIA, CT, or MRI), and severe sarcopenia (all three criteria met including low physical performance).
The key symptoms of Sarcopenia are: Progressive weakness in everyday tasks such as opening jars, carrying groceries, rising from a low chair, or climbing stairs — usually the first symptom and often misattributed to general ageing., Slowed walking speed, with patients taking longer to cross the street or keep up with a companion; gait speed under 0.8 m/s is the standard threshold for low physical performance., Repeated falls or near-falls, especially on uneven ground or stairs, related to weak quadriceps and hip abductors and slower postural reflexes., Visible thinning of the thigh, calf, or upper arm muscles, sometimes with prominent tendons or sunken temples, though body weight may stay stable due to fat replacing muscle., Difficulty rising from a chair without using the arms — the five-times sit-to-stand test taking longer than 15 seconds is a validated bedside indicator., Reduced grip strength noticed when carrying shopping bags, twisting taps, or holding handrails — grip under 27 kg in men or 16 kg in women meets the EWGSOP2 cut-off., Increased fatigue with low-level activity and longer recovery from minor exertion, even without other illness..
The EWGSOP2 algorithm — Find-Assess-Confirm-Severity — is the most widely used diagnostic pathway and is mirrored, with regional cut-offs, by AWGS 2019. Screening begins with the SARC-F questionnaire (a five-item self-report covering Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls; a score of 4 or more is positive) or clinical suspicion in any older adult reporting falls, weakness, slow walking, weight loss, or recent hospitalisation. The next step is to Assess muscle strength: hand-grip dynamometry is the standard, with cut-offs of under 27 kg in men and under 16 kg in women in EWGSOP2 (28 kg and 18 kg in AWGS 2019). The five-times sit-to-stand test taking longer than 15 seconds is an acceptable alternative. Low strength alone confirms probable sarcopenia and is sufficient to start treatment in primary care. Confirmation requires demonstrating low muscle quantity or quality using DXA (appendicular skeletal muscle mass index below 7.0 kg/m² in men, 5.5 kg/m² in women), bioelectrical impedance analysis, lumbar CT at L3, or MRI. Severity is graded by physical performance — gait speed under 0.8 m/s, Short Physical Performance Battery score under 8, or Timed Up and Go over 20 seconds. Serum creatinine, vitamin D, thyroid function, fasting glucose, and a full blood count are reasonable baseline tests to identify treatable secondary causes. Imaging or biopsy is rarely needed unless an alternative diagnosis is suspected.
With consistent resistance training and adequate protein, measurable strength gains appear within 8-12 weeks in roughly 60-70% of older adults, gait speed improves by 0.1-0.2 m/s, and falls risk drops by 20-30%. Lean mass changes lag strength — DXA-measured gains of 0.5-1.5 kg are typical over 6-12 months. Outcomes are best when training is supervised, progressive, and combined with protein optimisation. Untreated sarcopenia approximately doubles the 10-year risk of disability and falls, increases hospitalisation by 50-100%, and is associated with a 1.5-2 fold increase in all-cause mortality independent of comorbidity. Severe sarcopenia (low strength, mass, and performance combined) carries the highest risk: median survival drops by several years compared to non-sarcopenic peers of the same age. Reversibility is real but partial — older adults rarely regain the peak muscle of their 40s, but functional capacity and independence can be substantially preserved. The strongest prognostic factors are baseline strength, adherence to resistance training, and the presence or absence of severe secondary disease.
Geriatric medicine, rehabilitation medicine, or a specialist sarcopenia/falls clinic should be involved when SARC-F is positive and primary-care assessment confirms probable sarcopenia, when patients have recurrent falls, weight loss, or recurrent hospitalisations, when secondary causes such as cancer or chronic organ failure are suspected, or when initial exercise and nutrition fail to produce measurable strength gains at 12 weeks. Endocrinology referral is useful for suspected hypogonadism, hyperthyroidism, or vitamin D-resistant osteomalacia.
Find specialists →Strength gains begin within 2-4 weeks of starting supervised resistance training, driven first by neural adaptation, then by muscle hypertrophy from week 6-8. Most patients show clinically meaningful improvements in chair-stand and gait speed by 12 weeks. Lean mass gains on DXA follow at 3-6 months. Without continued training, strength gains regress within 8-12 weeks of stopping — sarcopenia management is lifelong, not a finite course. After hospitalisation, an intensive 4-6 week supervised rehabilitation programme typically restores most of the strength lost during admission.
All adults over 50 with or at risk of sarcopenia should do progressive resistance training 2-3 times weekly, targeting major muscle groups with 8-12 repetitions at 60-80% of one-repetition maximum. Add 150 minutes of moderate aerobic activity weekly (brisk walking, cycling, swimming) and 2-3 sessions of balance work (tai chi, standing on one leg, heel-to-toe walking) to reduce falls. Supervised programmes outperform unsupervised, especially in the first 12 weeks while technique and dose are being established. Mild muscle soreness 24-48 hours after a session is expected and is not a reason to stop; sharp joint pain is. Resistance training is safe in stable heart failure, COPD, CKD, and after myocardial infarction with cardiologist clearance.
Look for a geriatrician or rehabilitation physician with access to a multidisciplinary team — dietitian, physiotherapist, and occupational therapist — rather than a single-specialty clinic. Ask whether the practice routinely measures grip strength and gait speed at each visit, uses DXA or BIA for body composition, and has a supervised resistance exercise pathway rather than only generic advice to be more active. Continuity matters: sarcopenia is a multi-year condition and gains evaporate within weeks of stopping training.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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