Sarcopenia, the age-related loss of muscle strength and size, is common and often accompanies other long-term conditions but is underdiagnosed in clinical practice. Sarcopenia affects up to 10% of people aged 65 and over. It leads to reduced mobility, falls, longer hospital stays and loss of independence, costing the NHS an estimated £2 billion each year.

Despite its impact, our national survey found that only 9% of hospital services caring for older people in the UK were measuring and diagnosing sarcopenia. Without a diagnosis, people cannot access effective treatments such as resistance exercise training. Poor identification also makes it difficult for researchers and industry partners to find and recruit participants for clinical studies of new treatments.

NIHR BRC: Newcastle supported the research from 2017 onwards.

Impact on diagnosis, care and policy

The research conducted by NIHR BRC-supported researchers has helped transform how sarcopenia is defined, diagnosed and managed, leading to improvements in healthcare services, workforce development and national and international guidance.

The Benchmarking Exercise Programme for Older People (BEPOP) has supported services across the UK to improve the quality of resistance exercise programmes for people living with sarcopenia. By providing site-specific feedback and sharing national best-practice recommendations, the programme helps healthcare professionals improve local exercise services.

The team created the first set of reference values for handgrip strength across the life course, one of the key measures used to diagnose sarcopenia. The thresholds derived from this work were adopted by the European Working Group revised diagnostic criteria, among the most widely used sarcopenia criteria internationally. The research also informed the World Health Organization's Decade of Healthy Ageing report and is contributing to the Global Leadership in Sarcopenia (GLIS) world-wide sarcopenia guideline initiative.

Alongside this, BEPOP has delivered training webinars and conferences in collaboration with the Chartered Society of Physiotherapy. The team established the British Geriatrics Society Sarcopenia Special Interest Group, which now has more than 1,300 members and supports conference symposia, surveys and continuing professional development activities. Collaborating with NIHR Wessex ARC, they also developed and implemented guidance and training materials to embed sarcopenia measurement into orthopaedic practice.

To support routine diagnosis in clinical care, they introduced sarcopenia measurement into local geriatric medicine, vascular surgery and lung cancer services through SarcScreen, a pioneering electronic health record system. The NIHR BRC: Newcastle supported the BEPOP project lead and a NIHR BRC intern for the rollout of the SarcScreen system. The research team also developed and published the Newcastle Protocol, which provides guidance on assessing chair rise time, that is another important component of sarcopenia diagnosis.

Increased diagnosis, more participants, effective treatments

Patients and carers benefit from greater awareness, measurement and diagnosis of sarcopenia. As more people are identified, more can access effective treatments such as resistance exercise training. Improvements in exercise services also help patients achieve better outcomes.

Clinicians and healthcare services benefit from improved awareness, training and guidance, leading to more widespread diagnosis and higher-quality interventions. Better patient outcomes have the potential to reduce demand on health and social care services and lower associated costs.

Industry benefits from improved diagnosis and recording of sarcopenia, making it easier to identify eligible participants for clinical studies and support the development of new treatments.

Expanding the impact

The team are now focused on extending the reach of this work across the North East, nationally and internationally.

Through the newly established Newcastle Sarcopenia Improvement Initiative, they are building a network of practitioners to support wider adoption of sarcopenia measurement, diagnosis and management across Newcastle Hospitals NHS Foundation Trust and regional partners. They continue to contribute to the Global Leadership in Sarcopenia (GLIS) initiative, helping develop global guidance for diagnosis and management.

The BEPOP programme is also continuing to grow, building on the success of its first wave with 20-25 sites participating in Wave 2 and plans for 40-50 sites in Wave 3. In addition, they will repeat the national survey of sarcopenia diagnosis and management to assess progress since 2018 and identify opportunities for further improvement across the UK.