Increasing sarcopenia burden calls for better Filipino-specific management
02 Aug 2025
In
a recent review by Ji et al. on sarcopenia management in the country, they noted
a local prevalence of 27.7 percent based on the Asian Working Group for
Sarcopenia. And yet, sarcopenia is poorly diagnosed and inadequately integrated
into routine healthcare. To address this, the Philippines has incorporated
sarcopenia screening into the Comprehensive Geriatric Assessment (CGA) and
initiated the Longitudinal Study on Health and Aging in the Philippines (LSHAP)
in 2018. A multinational panel at the Asia-Pacific conference on muscle health
and sarcopenia also reportedly proposed five core pillars to enhance awareness,
education, initiatives, engagement, and research. [Front Med (Lausanne) 2025 Jan 7:11:1501501.
doi: 10.3389/fmed.2024.1501501]
Li et al. noted in their review that the condition involves a decline in fast-twitch type II muscle fibers, reduced muscle protein synthesis due to impaired mTOR signaling, increased protein breakdown via the ubiquitin-proteasome system, and hormonal imbalances. Chronic inflammation, oxidative stress, and physical inactivity are said to worsen muscle degeneration, with pro-inflammatory cytokines contributing to muscle wasting, while reduced levels of testosterone, growth hormone, and IGF-1 impairing muscle regeneration. Physical inactivity remains one of the most significant contributors to sarcopenia progression, leading to muscle atrophy and functional decline. Reported risk factors for sarcopenia are related to genetics and the environmental, and include smoking, age, alcohol consumption, and waist circumference.
Various diagnostic criteria across regions, Li et al. observed, are widely used in the country. They mentioned the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) use different algorithms to assess muscle mass, strength, and physical performance. EWGSOP1 prioritizes muscle mass, while EWGSOP2 and AWGS2 emphasize muscle mass and strength, with the latter two resulting in lower prevalence rates. Since studies suggest that prevalence rates differ depending on the diagnostic framework used, Li et al. asked “whether these criteria are appropriate for Filipino populations, considering potential ethnic and environmental differences”.
The laboratory diagnostic tools are just as important as the diagnostic tools. Diagnostic methods reviewed by Li et al. include dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) for muscle mass assessment, handgrip strength measurement, and gait speed tests. However, according to the authors, normative reference values for the Filipino population remain underdeveloped. Recent research has proposed localized cut-off values: lean tissue index <12.50 kg/m2 for males and <8.33 kg/m2 for females; grip strength <24.54 kg for males and <16.10 kg for females; and gait speed <0.55 m/s for males and <0.65 m/s for females. However, the authors qualified these criteria require further validation for Filipino patients.
Li et al. summarized current global treatment approaches for managing sarcopenia in the Philippines to help address the gap in research on the treatment of sarcopenia among Filipinos. Among the interventions they mentioned include exercise, nutrition and a host of others, including vitamin D supplementation, and pharmacologic and hormonal treatment. Exercise is a key intervention for sarcopenia, with resistance training demonstrating the most significant benefits. A structured resistance program, beginning with low intensity (40–60 percent of 1RM) and progressing to higher intensities (60–80 percent of 1RM), improves muscle mass and strength. Aerobic exercises, such as walking and cycling, enhance endurance and physical function. A combination of aerobic and resistance training is most effective in reducing body fat and improving mobility. Balance training, including static (single-leg stance) and dynamic (walking exercises), helps prevent falls. Family-based training programs support patient adherence, integrating rehabilitation exercises into daily life. A personalized exercise prescription following the FITT principle (Frequency, Intensity, Time, Type) ensures safety and effectiveness, recommending at least three sessions per week with moderate-intensity resistance and aerobic training.
Nutritional support, another intervention tackled by the authors, is critical role in the management, and must be tailored to Filipino dietary habits and healthcare accessibility. Protein supplementation has reportedly shown benefits, particularly when combined with resistance training. Whey protein enhances muscle synthesis, while essential amino acids improve energy metabolism. Creatine supplementation supports muscle strength and mass, particularly in combination with exercise. β-Hydroxy-β-methylbutyric acid (HMB), a protein metabolite, has been shown to be linked to sarcopenia prevention and treatment.
Sarcopenia is a pressing health issue in the Philippines, with high prevalence rates among older adults. While research efforts have advanced, there remains a need for nationally standardized diagnostic criteria, improved integration of sarcopenia management into clinical practice, and further exploration of treatment approaches. Addressing these gaps through policy development, awareness campaigns, and local research initiatives will help mitigate the impact of sarcopenia and improve quality of life for aging Filipinos.
Li et al. noted in their review that the condition involves a decline in fast-twitch type II muscle fibers, reduced muscle protein synthesis due to impaired mTOR signaling, increased protein breakdown via the ubiquitin-proteasome system, and hormonal imbalances. Chronic inflammation, oxidative stress, and physical inactivity are said to worsen muscle degeneration, with pro-inflammatory cytokines contributing to muscle wasting, while reduced levels of testosterone, growth hormone, and IGF-1 impairing muscle regeneration. Physical inactivity remains one of the most significant contributors to sarcopenia progression, leading to muscle atrophy and functional decline. Reported risk factors for sarcopenia are related to genetics and the environmental, and include smoking, age, alcohol consumption, and waist circumference.
Various diagnostic criteria across regions, Li et al. observed, are widely used in the country. They mentioned the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) use different algorithms to assess muscle mass, strength, and physical performance. EWGSOP1 prioritizes muscle mass, while EWGSOP2 and AWGS2 emphasize muscle mass and strength, with the latter two resulting in lower prevalence rates. Since studies suggest that prevalence rates differ depending on the diagnostic framework used, Li et al. asked “whether these criteria are appropriate for Filipino populations, considering potential ethnic and environmental differences”.
The laboratory diagnostic tools are just as important as the diagnostic tools. Diagnostic methods reviewed by Li et al. include dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) for muscle mass assessment, handgrip strength measurement, and gait speed tests. However, according to the authors, normative reference values for the Filipino population remain underdeveloped. Recent research has proposed localized cut-off values: lean tissue index <12.50 kg/m2 for males and <8.33 kg/m2 for females; grip strength <24.54 kg for males and <16.10 kg for females; and gait speed <0.55 m/s for males and <0.65 m/s for females. However, the authors qualified these criteria require further validation for Filipino patients.
Li et al. summarized current global treatment approaches for managing sarcopenia in the Philippines to help address the gap in research on the treatment of sarcopenia among Filipinos. Among the interventions they mentioned include exercise, nutrition and a host of others, including vitamin D supplementation, and pharmacologic and hormonal treatment. Exercise is a key intervention for sarcopenia, with resistance training demonstrating the most significant benefits. A structured resistance program, beginning with low intensity (40–60 percent of 1RM) and progressing to higher intensities (60–80 percent of 1RM), improves muscle mass and strength. Aerobic exercises, such as walking and cycling, enhance endurance and physical function. A combination of aerobic and resistance training is most effective in reducing body fat and improving mobility. Balance training, including static (single-leg stance) and dynamic (walking exercises), helps prevent falls. Family-based training programs support patient adherence, integrating rehabilitation exercises into daily life. A personalized exercise prescription following the FITT principle (Frequency, Intensity, Time, Type) ensures safety and effectiveness, recommending at least three sessions per week with moderate-intensity resistance and aerobic training.
Nutritional support, another intervention tackled by the authors, is critical role in the management, and must be tailored to Filipino dietary habits and healthcare accessibility. Protein supplementation has reportedly shown benefits, particularly when combined with resistance training. Whey protein enhances muscle synthesis, while essential amino acids improve energy metabolism. Creatine supplementation supports muscle strength and mass, particularly in combination with exercise. β-Hydroxy-β-methylbutyric acid (HMB), a protein metabolite, has been shown to be linked to sarcopenia prevention and treatment.
Sarcopenia is a pressing health issue in the Philippines, with high prevalence rates among older adults. While research efforts have advanced, there remains a need for nationally standardized diagnostic criteria, improved integration of sarcopenia management into clinical practice, and further exploration of treatment approaches. Addressing these gaps through policy development, awareness campaigns, and local research initiatives will help mitigate the impact of sarcopenia and improve quality of life for aging Filipinos.