Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview - the SENATOR Project ONTOP Series

I. Lozano-Montoya, A. Correa-Pérez, I. Abraha,  R.L. Soiza, A. Cherubini, D. O'Mahony, A.J. Cruz-Jentoft 

Clin Interv Aging. 2017;12:721-740

Physical frailty (PF) and sarcopenia are predictors of negative health outcomes such as falls, disability, hospitalization, and death. Some systematic reviews (SRs) have been published on different nonpharmacological treatments of frailty and sarcopenia using heterogeneous definitions of them.
The objective was to critically appraise the evidence from systematic reviews of the primary studies on nonpharmacological interventions to treat PF (defined by Fried’s frailty phenotype) and sarcopenia (defined by the EWGSOP) in older patients. 
At this purpose PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched in October 2015. Any primary study described in these SRs with experimental design was included.
Ten SRs with 5 primary studies satisfied the inclusion criteria. The most frequent interventions in the included studies were physical exercise (4) and nutritional supplementation (2). Muscle strength (MS; except for one study in a frail population) and physical performance (PP; except for another study in a frail population) improved with exercise and amino acid supplementation in frail and sarcopenic old adults. Falls and activities of daily living were assessed in two studies with opposite results. The overall quality of the evidence was low. This overview of SRs highlights the importance of exercise interventions with or without nutritional supplementation to improve the PP in community-dwelling patients aged >65 years with PF and sarcopenia. MS improved with multidisciplinary treatment and exercise interventions in this population.

Comment: This overview suggests that resistance and balance exercise may be the first treatment step, with a possible effect of nutritional supplementation added to exercise to improve outcomes. Exercise and nutritional interventions seem to be safe and are recommended from a public health point of view in older populations, both healthy or with a wide range of co-morbid problems. Therefore, there seem to be no clear reasons to avoid these interventions in frail or sarcopenic patients. However, expected impact on outcomes needs to be interpreted with caution due to methodological limitations in the small number of trials available and the risk of bias in several domains.