ABSTRACT

Background: Sarcopenia is the age-related, generalised and progressive loss of skeletal muscle mass, strength and physical function, and is one of the most clinically relevant age-related musculoskeletal conditions of the 21st century. Sarcopenia is a problem in the general community, with prevalence rates ranging from 10-40% of older people worldwide, and it is a major risk factor for falls, functional dependency, hospitalisation and all-cause mortality. Physiotherapy-informed exercise programs are known to be the basis of non-medication treatment, although there is an ongoing research interest in developing best practice exercise programs and for the additional benefit of nutritional co-interventions.

Objective: To systematically review the effectiveness of physiotherapy-based interventions alone or in combination with nutrition on muscle mass, muscle strength, physical performance and functional independence in older adults (aged ≥60 years) with sarcopenia in the community setting.

Methods: This systematic review was performed in line with the PRISMA 2020 guidelines. Studies were retrieved from six electronic databases (PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library and CINAHL) from January 2020 to December 2025. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) including community-dwelling adults ≥60 years with sarcopenia that was diagnosed using either the EWGSOP2 or AWGS 2019 criteria and reported at least one physiotherapy intervention were included. For RCTs, the risk of bias was evaluated with the Cochrane RoB 2 tool and for non-randomised studies ROBINS-I.

Results: A systematic search of 4,218 records led to 47 studies being eligible for inclusion, with 5,632 participants (mean age 73.4 ± 6.2 years; 68.3% female). Resistance training (RT) was the most widely studied modality, and visual evidence of clinically significant improvements in handgrip strength (+2.1-4.8 kg), appendicular skeletal muscle mass (+0.3-0.8 kg/m²), and gait speed (+0.08-0.14 m/s). Multicomponent programmes (resistance, balance, aerobic and functional exercise) were associated with better improvements in Short Physical Performance Battery (SPPB) scores and Timed Up and Go (TUG) performance. Whey/leucine-enriched protein supplementation (≥1.2 g/kg/day) plus RT was the most effective combination of physiotherapy and nutritional interventions for increasing lean mass, and muscle protein synthesis. The findings of supplementation with vitamin D alone were inconclusive in terms of improving the indices of sarcopenia.

Conclusion: Progressive resistance training, with a 60-80% of 1 repetition maximum (1RM), 2-3 sessions per week for at least 12 weeks, is the most supported physiotherapy intervention for older adults in the community who present with sarcopenia. Multicomponent programmes, when used in conjunction with sufficient levels of protein supplementation (1.2-1.6 g/kg/day) and sufficient vitamin D levels, result in the most clinically meaningful improvements in all domains of sarcopenia. The findings have important implications for physiotherapy practices, especially in the community-based rehabilitation setting in resource-poor countries like India where community-based rehabilitation needs to be effective and cost-effective.

Keywords: sarcopenia; physiotherapy; resistance training; multicomponent exercise; nutritional supplementation; muscle strength; functional outcomes; community-dwelling; older adults; geriatric rehabilitation