The “Function vs. Disease Dilemma” in Contemporary Medicine: Physical Frailty & Sarcopenia as a Prototypic Condition of New‐Generation Geriatric Medicine

Abstract

Due to the worldwide demographic transition, healthcare systems are facing new demands. Health services—with their approach of mostly single acute conditions—are indeed confronted with an expanding older population characterized by specific medical needs related to multimorbidity and functional impairment. The European research project “Sarcopenia and Physical fRailty IN older people: multi‐componenT Treatment strategies” (SPRINTT) project is specifically designed to overcome existing barriers for efficient public health interventions against frailty, and promote the implementation of successful aging strategies across Europe. The just‐completed SPRINTT randomized clinical trial (RCT) compared the efficacy of a multicomponent intervention (based on long‐term structured physical activity, nutritional counselling, and an information and communication technology intervention) versus a Healthy Aging Lifestyle Education program for preventing incident mobility disability in community‐dwelling older persons with physical frailty and sarcopenia. For the RCT, we enrolled 1,517 community‐dwellers, aged 70 years and older (750 per treatment arm), non‐disabled older persons exposed to increased vulnerability to stressors. The identification of such population relied on three key elements: low muscle mass measured by DXA (identified using FNIH cutpoints); clinical signs of physical frailty (i.e., weakness, slow walking speed, and poor balance) assessed using SPPB; absence of major mobility disability (able to walk 400 meters within 15 minutes at baseline. The primary outcome was the incidence of mobility disability (i.e., incident inability to walk 400 meters). Secondary outcomes included, among others, changes in physical performance and function; ability of selected biomarkers to predict the rate of change in muscle mass; incidence of falls. The SPRINTT RCT was conducted in 15 study sites located in nine European countries. The mean age of our sample was 79 years (SD ± 5.8), 72% were women, BMI was 28.6 kg/m2 (± 5.9), with 37% of the population showing BMI >30 kg/m2, Handgrip strength was 20.1 kg (SD 8.2), SPPB score was 6.71 (SD 1.4), aLM in men was 21.0 kg (SD 4.06) and 15.0 kg in women (SD 1.98), the aLM/BMI was 0.71 (SD 0.06) in men and 0.51 (SD 0.07) in women. Data analysis is ongoing and final results may be available at the date of the EB meeting.Support or Funding InformationInnovative Medicines Initiative – Joint Undertaking (IMI‐JU 115621)