Ask families why their elderly parent can no longer get out of a chair, and the answer is usually “old age”. Very often, the more precise answer is sarcopenia — and frequently, frailty.
Both conditions are common, measurable and — crucially — treatable. Both respond to the same core intervention: a properly prescribed, progressive exercise programme supported by adequate nutrition. That makes them central to the practice of Physical Medicine & Rehabilitation, yet they remain under-diagnosed in routine clinical care in India.
Sarcopenia is a progressive, generalised skeletal muscle disorder characterised by low muscle strength, low muscle quantity or quality, and — in severe cases — low physical performance. It is now recognised as a disease in its own right, with an ICD-10-CM code (M62.84).
Frailty is a broader clinical state of reduced physiological reserve across multiple systems, leaving the person vulnerable to a sharp decline in health and function after a minor stressor. Two models are widely used:
Sarcopenia is a major physical component of frailty, but frailty also includes nutritional, cognitive, psychological and social dimensions.
Frailty and sarcopenia are fundamentally disorders of function and muscle — the physiatrist’s core territory. The PM&R physician is trained to:
Because body composition and muscle mass differ between populations, Indian clinicians should use the Asian Working Group for Sarcopenia (AWGS) 2019 criteria rather than European or American cut-offs.
In primary care and community settings, AWGS 2019 allows a diagnosis of “possible sarcopenia” on the basis of low grip strength or low performance alone — and recommends starting lifestyle intervention immediately, without waiting for muscle mass measurement.
Before attributing weakness to age, review for: vitamin D deficiency, hypothyroidism, poorly controlled diabetes, chronic kidney disease, chronic inflammatory disease, malignancy, malnutrition, depression, steroid or statin myopathy, and peripheral neuropathy.
The flowchart below brings screening, diagnosis and intervention together.
Exercise is the only intervention with consistent evidence for improving muscle strength, physical performance and frailty status. The International Conference on Frailty and Sarcopenia Research (ICFSR) exercise recommendations (Izquierdo et al., 2021) support a multicomponent programme with resistance training at its core.
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Parameter
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Prescription
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Frequency
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2–3 sessions per week, non-consecutive days
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Exercises
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6–8 major muscle groups, prioritising leg press or sit-to-stand, knee extension, hip abduction/extension, calf raises, seated row, chest press
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Intensity
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Begin at about 30–40% of 1-repetition maximum (1RM), progressing towards 70–80% 1RM over weeks
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Volume
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1–3 sets of 8–12 repetitions
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Progression
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Increase load when the patient can complete 2 extra repetitions in the final set on two consecutive sessions
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Where 1RM testing is impractical, use a rating of perceived exertion: aim for “moderate to somewhat hard” (around 12–14 on the Borg 6–20 scale).
Ageing reduces muscle power faster than strength, and power is closely linked to function — rising from a chair, climbing stairs, recovering from a trip. Once basic strength is established, include exercises performed with a fast concentric (lifting) phase and a slow, controlled lowering phase at light-to-moderate loads.
Incorporate challenging, progressive balance exercises — narrowing the base of support, tandem stance, single-leg stance, weight shifting and stepping — ideally in every session.
Walking, stationary cycling or arm ergometry, building towards moderate intensity. For very frail patients, aerobic training should follow — not precede — a period of resistance training, as it is the muscle weakness that limits endurance.
Practise real-life tasks: sit-to-stand, stair climbing, carrying, and getting up from the floor.
Exercise without adequate protein and energy will not rebuild muscle in an older adult. Many Indian older adults, particularly those on predominantly vegetarian, cereal-based diets, consume less protein than they need.
A complete physiatry-led frailty plan also addresses:
Reassess every 8–12 weeks using the same measures used at baseline: grip strength, gait speed, five-times chair stand or SPPB, Clinical Frailty Scale, and a patient-reported functional goal. Showing patients their own improvement is one of the most effective motivators in rehabilitation.
As the Consultant and Incharge of the NeuroRehabilitation and Musculoskeletal & Sports Rehab Units at Kauvery hospitals Bangalore & Hosur, I lead and empower a diverse team of specialists—including physiotherapists, occupational therapists, speech & swallow therapists, and clinical psychologists, Rehabilitation Nurses—to provide patient-centered care and achieve outstanding results.
