Although there are many physiological changes associated with ageing, one of the biggest obstacles to older individuals’ independence is the slow loss of muscle mass and strength. However, in the last 10 years, the definition of sarcopenia has been defined as the progressive loss of skeletal muscle mass and function. It has gained much attention in the areas of geriatric medicine and rehabilitation sciences. It has been recognised as a medical condition that can be identified at early stages and treated effectively through rehabilitation techniques. Sarcopenia has many serious consequences beyond the loss of strength in muscles. For instance, when the muscles begin to degenerate, older people complain of difficulties in executing day-to-day activities such as climbing stairs, standing up from a chair, and walking long distances. Sarcopenia has been recognised as a factor that complicates the health of older people through interactions with other medical conditions such as osteoporosis, diabetes, and cardiovascular disease. To resolve these issues, the need for rehabilitation has been recognised. Physiotherapy has the potential to significantly improve the performance of individuals suffering from sarcopenia. This editorial highlights various rehabilitation approaches used currently for sarcopenia and discusses how evidence-based physiotherapy can help restore strength, mobility, and confidence in ageing populations.

Sarcopenia is a complex pathological state that occurs after a series of complex physiological changes associated with ageing. Muscle loss occurs due to various reasons, including decreased muscle activity, hormonal changes, low-grade inflammation, and inadequate nutrition. Anabolic resistance, a state where muscle shows reduced response to protein and activity stimulus, is one of the most important factors. Compared to younger people, an elderly person may need a higher level of nutrition and activity to maintain muscle mass because of anabolic resistance (Breen and Phillips, 2011). Age-related motor neurone degeneration also results in decreased muscle fibre recruitment and compromised neuromuscular signalling. These alterations eventually result in the shrinkage or disappearance of muscle fibres, which lowers total muscular strength and endurance. The frequent weariness experienced by older persons after regular physical activities can be explained by these physiological changes. Effective rehabilitation requires early detection of sarcopenia. To identify functional decline before the development of severe disability, clinical screening techniques frequently assess measures such as grip strength, walking speed, and muscle mass.

Sarcopenia reacts favourably to rehabilitative therapies, in contrast to many degenerative disorders linked to ageing. The best non-pharmacological method for enhancing muscle strength and physical function in older persons is generally agreed to be exercise therapy (Cruz-Jentoft et al., 2019). Sarcopenia rehabilitation methods seek to accomplish a number of important goals:

• Strengthening of the muscles
• An increase in endurance and mobility
• A decrease in the risk of falls
• Regaining functional autonomy
• Encouragement of active ageing.

Physiotherapists are essential in creating customized rehabilitation plans that take into account the patient’s goals, comorbid conditions, and physical capabilities. Resistance training, cardiovascular exercise, balance training, and functional activity retraining are often included in a well-designed rehabilitation program.

Progressive resistance training is still the most successful therapy for the improvement of muscle strength in patients with sarcopenia. Resistance training helps in the development of structural changes in the tissue of the skeletal muscles and the synthesis of proteins in the muscles. Resistance training programmes have been observed to improve the strength of the muscles in older persons, as indicated in the results of the systematic reviews. More significantly, when the training is monitored and the intensity is gradually increased, the benefits can be enjoyed by persons who are more than 70 years of age. Examples of the training equipment include elastic resistance bands, free weights, weight machines, and body-weight exercises. For the maintenance of the adaptation of the muscles, the training sessions may include 2 or 3 times/week with a corresponding increase in the intensity of the training. Examples of the training exercises are squats, sit-to-stand exercises, and step-up exercises, which are very effective in improving the performance of daily chores.

Although weight training is essential, integrating other forms of exercise frequently yields better functional results. Strength training is combined with aerobic conditioning, flexibility training, and balancing exercises in multicomponent exercise programmes. While balance training improves postural control and lowers the risk of falls, aerobic exercise increases cardiovascular endurance and supports general physical fitness. Exercises for flexibility promote effective movement patterns and preserve joint mobility. Combined exercise programmes appear to enhance gait speed, balance, and functional mobility more than single-modality interventions, according to research on exercise interventions in sarcopenic populations (Chen et al., 2021). Because they treat multiple physical limits at once, these comprehensive programmes are very beneficial in rehabilitation settings.

Activities that mimic practical functioning duties should be incorporated into sarcopenia rehabilitation in addition to isolated muscle strengthening. The goal of functional training is to enhance daily tasks, including walking, lifting goods, climbing stairs, and standing up from a chair. Task-specific training encourages effective muscle recruitment patterns and improves neuromuscular coordination. Patients eventually recover confidence in their capacity to carry out daily tasks safely by practising functional motions in a safe setting. Older persons with sarcopenia frequently experience a fear of falling, which frequently results in less physical activity. This apprehension is lessened, and increased engagement in everyday activities is promoted by rehabilitation programmes that include gradual exposure to functional movements.

Exercise and nutrition must be taken into consideration for effective rehabilitation. Consuming enough protein is crucial for promoting muscle growth and repair after exercise. Research shows that older people’s gains in muscle mass and strength can be greatly increased by combining resistance training with protein supplements (Whaikid and Piaseu, 2024). Through the activation of metabolic pathways involved in muscle growth, protein sources high in critical amino acids, especially leucine, drive the synthesis of muscle proteins. The recommended daily protein intake for older persons undergoing rehabilitation typically falls between 1.0 and 1.5 g/kg of body weight. Patients receive comprehensive therapy that addresses both physical and nutritional issues thanks to interdisciplinary teamwork between physiotherapists, doctors, and dietitians.

Sarcopenia-induced muscle weakness is a major contributor to falls and balance problems. Fall prevention techniques are an integral part of physical therapy programmes, as falls remain a major cause of injury in the elderly. Balance training exercises help to strengthen the balance systems in the human body. Tandem walking, balancing on a single leg, and moving while balancing are a few examples. Tai chi and other mind-body therapies have been found to help the elderly balance better and reduce the chances of falls. These therapies help the elderly to move more safely by improving their postural balance.

New strategies are being developed to help better manage sarcopenia with the progress of rehabilitation science research. Home-based physical fitness programmes are now supported by digital health technology. With these devices, patients are motivated to adhere to their respective physical regimens. Thus, clinicians are able to monitor patient progress. Personalised rehabilitation programmes are also another area that could help better manage sarcopenia. Rehabilitation programmes that are tailored according to the unique characteristics of patients could help produce better and more enduring outcomes. In addition, screening patients for sarcopenia could allow medical practitioners to implement preventive rehabilitation strategies before muscle loss occurs.

Sarcopenia has a significant impact on the quality of life of the patient. Therefore, it has become a serious concern for the ageing population. Fortunately, current scientific data indicate that with appropriate rehabilitative therapy, not only can sarcopenia be controlled, but it can also be reversed to a certain extent. The key to managing sarcopenia effectively lies in appropriate resistance training and multicomponent exercise programmes. Physiotherapists play an important role in facilitating these procedures for the patient, thus helping them to maintain their independence. Finally, the rehabilitation of sarcopenia patients should be focused on helping them to remain active participants in life.