Physiotherapy for sarcopenia · Home visits across Hong Kong
Physiotherapy for sarcopenia,
rebuilding muscle strength with resistance training
Muscle does not have to keep declining with age. Research shows that even frail people aged 80 or 90 can regain muscle strength with the right exercise. Our registered physiotherapists visit the home to design a resistance training programme for the older person, together with enough protein in the daily diet, and help step by step to regain the ability to stand up, walk steadily and fall less.
- Registered physiotherapists in Hong Kong
- Home visits across Hong Kong
- 1 hour $1,000 · 1.5 hours $1,300
- Improving sarcopenia with progressive resistance training
Understanding the problem again
Common misunderstandings about sarcopenia
Sarcopenia is age-related muscle loss. It is a condition that can be formally diagnosed, and it directly raises an older person’s risk of falls, loss of independence and fractures. Early signs are common, such as getting more breathless on stairs than before, finding it hard to twist open a bottle cap, and walking more slowly. It can be spotted early, well before the older person can no longer walk. Sarcopenia is not fixed, however, and with the right training muscle strength can be regained.
- Having no strength is a natural part of getting olderSarcopenia is a condition that can be diagnosed and managed. The earlier training starts, the easier it is to regain strength.
- Walking or aerobic exercise is enoughAerobic exercise mainly trains the heart and lungs. To increase muscle strength, resistance training with progressive load is needed.
- Nutrition milk or protein powder alone is enoughFiatarone’s study showed that without exercise, nutritional supplements alone do not improve muscle strength.
- Progressive resistance trainingThis is the core treatment with the most research support for reversing sarcopenia.
- Enough protein as the raw materialNutrition works only together with exercise. The amount of protein should be advised by a doctor or registered dietitian.
- Balance training to prevent fallsThe World Health Organization recommends balance and coordination training on at least 3 days a week for older people.
How to arrange the daily diet belongs to nutrition and should be left to the treating doctor or a registered dietitian. The physiotherapist is responsible for the exercise training part. After training, the clearest improvement is in muscle “strength” and everyday mobility (such as walking speed and rising from a chair), while the gain in muscle “mass” (muscle volume) is relatively small (Chen 2021). The goal of rehabilitation should therefore be to walk steadily, stand up and fall less, and not just body weight or kilograms of muscle.
Training methods aimed at the root of the problem
Main points of sarcopenia training
Our four service priorities all target the key points in improving sarcopenia. Training is more than moving about casually. It needs resistance training with a suitable dose, gradual progression and guidance from a professional.
Practical tests first, then progressive resistance training
At the home visit we measure the older person’s grip strength, walking speed and sit-to-stand performance (using the AWGS 2019 criteria). We then set a starting dose of about 60–80% load and 8–12 repetitions per set, correct movement posture on the spot, and add training load safely as progress allows.
Muscle strength can be rebuilt at any age
This is not only for younger people: in frail nursing home residents with an average age of 87, 10 weeks of progressive resistance training raised strength by about 113% on average. The weaker the person, the more worthwhile the training.
Nutrition without exercise does not bring muscle strength back by itself
Nutrition is like fuel and exercise is the engine. In Fiatarone’s study, older people who took nutritional supplements without exercising had no improvement in muscle strength at all. The physiotherapist is responsible for the exercise training part, including the starting weight, the repetitions per set and the rate of progression. Advice on diet and nutrition comes from the doctor or a registered dietitian according to the older person’s situation.
Using everyday objects at home as training equipment
We use a chair to practise sit-to-stand, a wall for supported squats, and resistance bands and water bottles for training. Once the older person has learned them, there is no need to buy large machines or go out, and they can practise alone at home every day, which is how the training effect is kept up.
Why come to the home
Home training settings for sarcopenia
Improving sarcopenia does not have to happen in a gym. It can happen at the chair at home, the stairs of the building and the walk to buy groceries. Practising daily movements in the real living environment lets the regained strength be applied in daily life. The four places in the home below are the training settings for our home physiotherapy.
Training map of the home TRIGGER MAP
Clinical evidence
The literature on sarcopenia training
Key figures from the literature EVIDENCE
The clearest improvement from resistance training is in muscle strength and everyday mobility, and the gain in muscle mass is relatively small (Chen 2021). On safety, the Cochrane review pooled 121 trials and found serious adverse events to be very rare, with none caused directly by the training itself. This shows that resistance training is safe for older people with suitable programming and professional guidance.
If a family member can no longer twist a bottle cap firmly and is walking more slowly, you can contact us to describe the situation, and a physiotherapist will answer your questions.
WhatsApp for a free enquiry and instant quoteFrom the basics onward
Physiotherapy for sarcopenia: guide
To learn about the causes and diagnosis of sarcopenia, how resistance training is done, how diet and nutrition fit in, and the common myths, read the articles below.
Related physiotherapy topics 03
Rehabilitation and regular exerciseIndividual exercise plans designed by a physiotherapistKnee osteoarthritisEight topics on muscle strengthening, injections, knee braces and joint replacement surgery for knee osteoarthritisRehabilitation after a long hospital stayHow to rebuild muscle strength after long bed rest or hospitalisationFAQ · Cost and results
Physiotherapy for sarcopenia: common questions
Can sarcopenia be reversed or cured?
It can be improved, and the evidence is solid. Progressive resistance training can rebuild muscle strength. Even in frail older people with an average age of 87, 10 weeks of training raised muscle strength by about 113% on average (Fiatarone 1994), and a Cochrane review pooling 121 randomised controlled trials also confirmed a significant increase in strength. Note that muscle strength and physical function (walking speed, rising from a chair, climbing stairs) usually improve the most, while the gain in muscle mass is relatively small (Chen 2021). The goal should therefore be to walk steadily, stand up and fall less, and not simply to chase kilograms.
How is sarcopenia diagnosed?
Screening is usually done first with a simple tool (the SARC-F questionnaire or calf circumference), followed by confirmation by a professional. The Asian AWGS 2019 criteria are: grip strength <28kg in men and <18kg in women, 6-metre walking speed <1.0 m/s, and muscle mass measured by DXA or BIA. The European EWGSOP2 uses muscle strength as the primary indicator, with a grip strength threshold of <27kg in men and <16kg in women. A home assessment measures grip strength, walking speed and sit-to-stand performance, to quantify the level of strength and mobility. Whether sarcopenia is diagnosed (which needs a muscle mass measurement) is for the doctor to decide, and the physiotherapist is responsible for the exercise prescription and the adjustment of progress afterward.
What exercises should be done? How long before results show?
The core is progressive resistance (weight-bearing) training. The World Health Organization recommends muscle-strengthening activity at least 2 days a week for older adults, covering the major muscle groups, at an intensity of about 60–80% of maximum load and 8–12 repetitions per set. Clear progress is usually seen after 8–12 weeks of continued training. To prevent falls, the WHO also recommends adding balance and coordination training on at least 3 days a week.
If only protein powder is taken and no exercise is done, can strength be regained?
No. In Fiatarone’s study, nutritional supplementation alone with no exercise brought no improvement in strength at all. Exercise is the active ingredient, and regaining strength needs a progressive resistance load. The diet half belongs to nutrition, and should be advised by the treating doctor or a registered dietitian according to the individual’s health. The physiotherapist is responsible for the training half: starting load, repetitions per set, rate of progression and posture.
Is resistance training safe for older people?
With proper programming and supervision it is safe. The Cochrane review of 121 trials found that serious adverse events were rare, and none was attributed to the training itself. For older people the difficulty lies in the starting intensity, rate of progression and movement posture. This is where a home-visiting physiotherapist adds value: adjusting the weights in real time, making sure posture is correct and adding load safely as progress allows.
How are sarcopenia and falls related?
A decline in muscle strength and muscle mass directly raises the risk of falls and fractures. Resistance training combined with balance training improves walking speed and Timed-Up-and-Go performance (Chen 2021; Liu & Latham), and the WHO also lists strength plus balance training as the core recommendation for fall prevention in older people. Home training can also modify high-risk spots in the real home environment at the same time.
If you have questions about declining muscle strength, message us at any time to ask.
WhatsApp for a free enquiry and instant quote1 hour $1,000 · 1.5 hours $1,300 · no minimum charge · All service fees
Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.
References
- Chen, L. K., Woo, J., Assantachai, P., et al. (2020). Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. Journal of the American Medical Directors Association, 21(3), 300–307.e2. DOI
- Cruz-Jentoft, A. J., Bahat, G., Bauer, J., et al. (2019). Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16–31. DOI
- Liu, C. J., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, (3), CD002759. DOI
- Chen, N., He, X., Feng, Y., Ainsworth, B. E., & Liu, Y. (2021). Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. European Review of Aging and Physical Activity, 18, 23. DOI
- Peterson, M. D., Sen, A., & Gordon, P. M. (2011). Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Medicine and Science in Sports and Exercise, 43(2), 249–258. DOI
- Fiatarone, M. A., O'Neill, E. F., Ryan, N. D., et al. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. New England Journal of Medicine, 330(25), 1769–1775. DOI
- Bull, F. C., Al-Ansari, S. S., Biddle, S., et al. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. DOI