Table 6.

Advantages and disadvantages of different management strategies for sarcopenia.

Treatment strategy	Intervention	Advantages	Disadvantages
Nutritional supplementation or medical nutrition therapy (MNT) [48,70]	Protein supplements including whey protein [145,210]	-Improves muscle mass, upper and lower limb strength and walking capacity	Does not improve the muscle strength and physical performance
		-Beneficial effect seen when added to resistance training
	Essential amino acid (EAA) supplementation [211]	Improves muscle mass and basal muscle protein synthesis	No improvement in muscle strength and physical performance
	β-hydroxy β-methylbutyric acid (HMB) supplementation [[212], [213], [214]]	No consistent results across studies regarding muscle mass, strength and physical performance.
	Fatty acid supplementation (omega-3 fatty acids) [215,216]	-Improved both muscle volume and physical performance	Need further investigation on the dosage and frequency use
		-Can be added to exercise and/or protein supplementation for added benefit
	Creatine [217,218]	-Improves muscle mass, muscle strength and physical performance -Beneficial effect seen when added to resistance training as increases energy availability during exercise -May have beneficial effect on bone density	-Supplementation responds better with low dietary creatine intake (eg, vegetarians) -Effect not seen if resistance training is not performed correctly (eg, unsupervised)
Exercise and physical activity [133,139,140,147]	Resistance training (weightlifting, pulling against resistance bands, or moving body parts against gravity)	Increased muscle mass and strength, skeletal muscle protein synthesis and muscle fiber size and improvement in physical performance	-Motivation to exercise in older adults is low -Highly dependent on patients' mobility
	Aerobic exercise (jogging, cycling, brisk walking, dancing, climbing stairs, and treadmill)	Increase mitochondrial volume and activity
	Balance (standing on heels or toes, tandem walking, walking on different types of surfaces) and flexibility (stretches, Tai Chi, yoga)	Stabilizes osteo-arthro-muscular triad
Environmental optimization [138,152]	Physical- Ramps, grab rails, types of toilets, other assistive devices	Aids in easing activities of daily living and prevents falls	May not be possible to use these across region, especially in rural areas
	Psychological-support	-Helps combat loneliness, depression etc	-Not available at all centers -The effect builds slowly over time and needs consistent approach
		-Improves adherence to rehabilitation program
		-Keeps individual motivated to follow non-pharmacological treatment like exercise, nutrition changes etc
	Social or peer group support	Has not been explored in sarcopenia
	Prevention of sarcopenia	Walking to work, climbing stairs, use of less technology
Medical optimization of comorbidities	Optimal medical management of causes of secondary sarcopenia through pharmacological and non-pharmacological methods (MNT, psychotherapy, exercise, etc.)
Pharmacotherapy	Vitamin D [25,83]	Increase muscle strength	No consistent results across studies
	Testosterone [219]	-Lean muscle mass is enhanced-increased protein synthesis -Reduced muscle fat mass	-Troublesome side effect, such as fluid retention, gynecomastia, cardiovascular effects etc -Effect lasts only as long as therapy is provided -Inconclusive evidence that enhanced muscle mass correlates with improved muscular strength and physical performance
	Calcium supplementation [220,221]	-Positive regulation of muscle health in calcium deficient	-Hypercalcemia can cause muscle weakness and arrhythmia
	Myostatin inhibitors [219]	Lean muscle mass is enhanced	Inconclusive evidence that enhanced muscle mass correlates with improved muscular strength and physical performance
	Growth hormone [19,222]	-Lean muscle mass is enhanced -Reduced muscle fat mass	-High incidence of adverse reactions like fluid retention, orthostatic hypotension -High cost
	Alendronate [223,224]	Improves lumbar bone mineral density, muscle mass and handgrip strength	Not used in routine clinical practice Results mainly from clinical trials on osteoporosis patients
	Hormone replacement therapy [225].	-Lean muscle mass is enhanced -Effect seen in younger women too	Effect not seen in women >65 years and in obese women
	Anabolic steroids [226,227]	-Increase in fat-free mass, handgrip strength, and muscle mRNA levels for several growth factors -Decrease in fat mass	-Liver injury -Steroid induced myopathy
	ACE inhibitors [181,228]	Some evidence for increased exercise capacity	-Renal function needs monitoring -Not a routine treatment for sarcopenia