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Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand

ANZSSFR · 2022 · Australia

Source and licence

Authors
Jesse Zanker, Marc Sim, Kate Anderson et al.
Title
Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand
Journal
Journal of Cachexia, Sarcopenia and Muscle, 2022
DOI
10.1002/jcsm.13115
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC9891980

Licence statement of the original publication

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Prevention

  • 1A healthy lifestyle, including balanced diet, adequate protein intake, and regular exercise should be encouraged in adults of all ages.Agreement (%): 100
  • 2Person‐centred physical and dietary interventions, developed with an accredited healthcare professional (or degreed, NZ), are recommended for adults with health conditions known as likely to increase the risk of sarcopenia, such as frailty.Agreement (%): 93.6

Screening

  • 3Provided that adequate resources and training are available, and assessment is acceptable to the individual, adults at risk of sarcopenia should be assessed for sarcopenia annually or after the occurrence of a major health event.Agreement (%): 85.1
  • 4Adults screened as positive for possible sarcopenia should be assessed by an accredited health professional (or degreed, NZ) for further assessment to confirm sarcopenia.Agreement (%): 88.1

Diagnosis and assessment

  • 5The ANZSSFR endorses the use of the revised European Working Group for Sarcopenia in Older People (EWGSOP2) in clinical and research settings, a including its validation in Australia and New Zealand.Agreement (%): 85.1
  • 6Low muscle mass is an important feature of sarcopenia.Agreement (%): 90.9
  • 7In the absence of equipment required for sarcopenia diagnosis, or when physical limitations (e.g., hand arthritis) preclude some active testing, the presence of muscle weakness or slowness (low usual gait speed) makes sarcopenia probable.Agreement (%): 80.0
  • 8Cultural, ethnic and physical ability differences for normal and low muscle strength, physical performance and body composition measures should be considered in the application of diagnostic cut‐points for sarcopenia.Agreement (%): 86.2
  • 9Persons with sarcopenia should be assessed at least annually following diagnosis, with additional assessment following any major health event.Agreement (%): 82.1
  • 10The ANZSSFR recommends clinicians undertake a consultation of 30–60 min duration with persons with or at risk of sarcopenia, which could include assessments described by the BASIC (Basic Assessment Sarcopenia Items for Completion). bAgreement (%): 80.9
  • 11The standardization of a sarcopenia definition and cut‐points for diagnosis and management is recommended across Australia and New Zealand.Agreement (%): 89.6

Management

  • 12Accredited healthcare professionals (or degreed, NZ) should provide an accessible explanation of sarcopenia, including provision of informative material, to those diagnosed with sarcopenia to support engagement in self‐determined health behaviours.Agreement (%): 89.6
  • 13All persons with sarcopenia should be offered resistance‐based training by an accredited healthcare professional (or degreed, NZ), tailored to the individuals' abilities and preferences.Agreement (%): 92.5
  • 14Optimization of energy and protein intake is likely to be beneficial for all persons with sarcopenia, but benefits may be greatest when combined with a physical activity intervention, such as resistance exercise.Agreement (%): 97.9
  • 15Clinicians should consider referring persons with sarcopenia to a dietitian for the development of a dietary and protein optimization plan.Agreement (%): 90.9
  • 16Total protein intake of 1–1.5 g/kg/day should be considered for older adults with sarcopenia, excepting those with significant kidney disease defined by an eGFR of <30 mL/min/1.73 m2.Agreement (%): 86.7

Research

  • 17Local and international collaborations, laboratory‐based studies, registries, randomised controlled trials and translational studies are recommended to improve management of and outcomes for people living with sarcopenia and translation of evidence into clinical practice.Agreement (%): 95.5

Prevention

  • Statement 1promotes encouraging healthy diet and physical activity across the lifespan. This statement reflects epidemiological associations between healthy behaviours and improved health across the lifespan. 37 Statement 1 was the only statement which achieved 100% agreement among respondents, suggesting topic experts uniformly view prevention and health promotion as important aspects of care. Reducing sedentary behaviour, 37 and achieving a balanced diet 38 are reflected in this statement.
  • Statement 2recognizes that those living with comorbidities, such as frailty, have higher risk of having or developing sarcopenia 4 and that physical and dietary interventions aligned with individuals' values and preferences should be considered by interdisciplinary health professionals to reduce this risk. 39 In the Consumer Expert Delphi, respondents highlighted a range of activities that would be acceptable to them to prevent sarcopenia, from resistance exercise to tai chi, and dietary modification. 30

Diagnosis (probable and confirmed sarcopenia)

  • Statement 11highlights the importance of standardization of measures of muscle strength and physical performance. Operationally, this means that within institutions and when following up individual patients, the same measures should be used over time to track progress and identify meaningful change. In the context of sarcopenia, clinically meaningful change is represented by a change in muscle strength or physical performance over time that may have clinical implications [S14]. While the Topic Expert Delphi did not address this, a change in normal gait speed of ≥0.1 m/s or an SPPB improvement of 0.5–1.0 points may represent clinically meaningful change [S14,15]. Health professionals should be aware that change in handgrip strength after an exercise intervention is not a reliable indicator of clinically meaningful change [S16] and so other measures (e.g., gait speed, SPPB) should be used for longitudinal monitoring.

Management

  • Statement 14recognizes that the effect of adequate protein and energy intake may be optimized by resistance exercise, particularly in those with low habitual protein (energy) intake [S19]. Given the specific skill set required to comprehensively assess and optimize dietary intake, and intervene where indicated, we recommend health professionals consider referring patients with sarcopenia to a dietitian (e.g., Accredited Practising Dietitian in Australia and New Zealand) (Statement 15). The specific amount of protein recommended for older adults with sarcopenia remains contested, with conflicting evidence [S20]. As such, we recommend (Statement 16) clinicians consider targeting a total protein intake of 1.0–1.5 g/kg/day in persons with sarcopenia, ideally ≥1.2 g/kg spread evenly throughout the day, with or without supplementation. The exception to this is in those with stage IV chronic kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2) [S21], in whom clinical judgement should be applied.

Abstract

Background: Sarcopenia is an age‐associated skeletal muscle condition characterized by low muscle mass, strength, and physical performance. There is no international consensus on a sarcopenia definition and no contemporaneous clinical and research guidelines specific to Australia and New Zealand. The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force aimed to develop consensus guidelines for sarcopenia prevention, assessment, management and research, informed by evidence, consumer opinion, and expert consensus, for use by health professionals and researchers in Australia and New Zealand.

Methods: A four‐phase modified Delphi process involving topic experts and informed by consumers, was undertaken between July 2020 and August 2021. Phase 1 involved a structured meeting of 29 Task Force members and a systematic literature search from which the Phase 2 online survey was developed (Qualtrics). Topic experts responded to 18 statements, using 11‐point Likert scales with agreement threshold set a priori at >80%, and five multiple‐choice questions. Statements with moderate agreement (70%–80%) were revised and re‐introduced in Phase 3, and statements with low agreement (<70%) were rejected. In Phase 3, topic experts responded to six revised statements and three additional questions, incorporating results from a parallel Consumer Expert Delphi study. Phase 4 involved finalization of consensus statements.

Results: Topic experts from Australia (n = 62, 92.5%) and New Zealand (n = 5, 7.5%) with a mean ± SD age of 45.7 ± 11.8 years participated in Phase 2; 38 (56.7%) were women, 38 (56.7%) were health professionals and 27 (40.3%) were researchers/academics. In Phase 2, 15 of 18 (83.3%) statements on sarcopenia prevention, screening, assessment, management and future research were accepted with strong agreement. The strongest agreement related to encouraging a healthy lifestyle (100%) and offering tailored resistance training to people with sarcopenia (92.5%). Forty‐seven experts participated in Phase 3; 5/6 (83.3%) revised statements on prevention, assessment and management were accepted with strong agreement. A majority of experts (87.9%) preferred the revised European Working Group for Sarcopenia in Older Persons (EWGSOP2) definition. Seventeen statements with strong agreement (>80%) were confirmed by the Task Force in Phase 4.

Conclusions: The ANZSSFR Task Force present 17 sarcopenia management and research recommendations for use by health professionals and researchers which includes the recommendation to adopt the EWGSOP2 sarcopenia definition in Australia and New Zealand. This rigorous Delphi process that combined evidence, consumer expert opinion and topic expert consensus can inform similar initiatives in countries/regions lacking consensus on sarcopenia.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Methods
  • Task Force, Panel and Topic Expert participants
  • The modified Delphi method
  • Results
  • Phase 1: Video‐teleconference of task force
  • Phase 2: Online survey
  • Phase 2 statements
  • Consumer Expert Delphi results and impact on Phase 3 statements
  • Phase 3: Online survey
  • Phase 4: Confirmation of recommendations
  • Discussion
  • Prevention
  • Screening, diagnosis and assessment
  • Management
  • Research
  • Strengths and limitations
  • Conclusion
  • Supporting information

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