Monitoring
Once the diagnosis of sarcopenia is established and the treatment has been initiated, it is important to monitor the patient's progress. It is recognised that sarcopenia is difficult to overcome in the older population. There is no consensus on the tests to use for monitoring or at which frequency patients should be monitored. However, an annual review would be reasonable.[54] Tests for monitoring need to be easily applicable, accurate, and sensitive to change. The most practical tests for monitoring are the physical performance tests such as gait speed, chair stand, and hand grip strength assessment. To estimate a change in muscle mass, use the quick and non-invasive anthropometric measurements, especially calf circumference and corrected arm muscle area. The Asian Working Group for Sarcopenia (AWGS) proposes using calf circumference (<34 cm in men, <33 cm in women) to identify people with sarcopenia.[6] For corrected arm muscle area, cut-offs indicating low corrected arm muscle area are ≤21.4 cm² for men and ≤21.6 cm² for women, and would indicate undernutrition.[103]
Imaging tests (i.e., DXA) are superior in sensitivity to anthropometry but have significant limitations. See Diagnosis approach.
Building up muscle mass and strength takes place over weeks; therefore, in the author's opinion, a re-assessment of physical performance should be considered after 8-12 weeks. Where no improvement in muscle strength and function is identified, check the patient's ability to adhere to the exercise programme (particularly if home-based) and consider an unidentified secondary cause for sarcopenia, an intolerance to protein supplements, or poor nutrition. If one or more of these reasons are identified, a comprehensive care plan should be discussed with the patient, their carer(s), and the multidisciplinary team.
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