Advances in Clinical Management Strategies for Sarcopenia: From Exercise and Nutrition to Pharmacotherapy and Comprehensive Interventions.

Sarcopenia is an aging-related syndrome characterized by the progressive decline of skeletal muscle mass, strength, and function. With the accelerating global aging population, sarcopenia has emerged as a serious public health issue. It significantly impairs the quality of life in older adults and elevates the risks of falls, fractures, adverse comorbidity outcomes, and mortality. This review aims to systematically summarize recent advances in the clinical management of sarcopenia, focusing on evaluating evidence-based support for various intervention strategies. Exercise intervention remains the cornerstone of treatment, and multiple modalities-such as high-intensity resistance training, low-load blood flow restriction training, multicomponent training, neuromuscular electrical stimulation, and telerehabilitation-have been proven effective in improving muscle mass and function. Nutritional support serves as a core strategy, wherein adequate protein intake (1.2-1.5 g/kg daily) and essential amino acids are critical. Specific nutrients, including β-hydroxy-β-methylbutyrate, leucine-rich whey protein, vitamin D, and composite formulations targeting the "gut-muscle axis," demonstrate synergistic or independent muscle-protective effects in both preclinical and clinical studies. Although no pharmacotherapy is yet globally approved, several targeted drugs show potential for increasing muscle mass in clinical trials. These include agents acting on the myostatin/activin signaling pathway (e.g., Bimagrumab), androgen receptors (e.g., LPCN 1148), metabolic and endocrine pathways (e.g., active vitamin D, metformin), as well as anti-inflammatory and immunomodulatory approaches (e.g., probiotics, anti-TNF-α agents). However, their functional benefits and long-term safety require further validation. Furthermore, comprehensive intervention and management strategies-particularly combined exercise and nutrition, multi-domain lifestyle interventions, individualized treatment based on screening and stratification, and prehabilitation programs for specific clinical populations such as those with chronic kidney disease, heart failure, or cancer-have been established as effective pathways to achieve optimal clinical outcomes. Despite notable progress, the field continues to face challenges including disease heterogeneity, inconsistent diagnostic criteria, poor long-term adherence to interventions, and inadequate functional translation of drug therapies. Future research should prioritize advancing precision medicine, optimizing personalized regimens, exploring novel biomarkers, and integrating and disseminating effective interventions into community and clinical practice to comprehensively improve the clinical management of sarcopenia.