What is the reason for and aim of the publication?
Many people with cardiovascular disease (CVD) are at high risk of developing sarcopenia – a clinical condition diagnosed by the loss of muscle mass, strength, and function, especially during ageing. Sarcopenia is associated with disability and worse outcomes in patients with CVD. While exercise and nutrition are regarded as effective strategies to combat sarcopenia, there is a lack of specific, evidence-based guidance for how to apply these interventions in CVD patients. The aim of the publication was to provide expert consensus and scientific guidance on how exercise and nutritional interventions can be used to prevent and manage sarcopenia in people with CVD, as commissioned by the European Association of Preventive Cardiology (EAPC).
What are the most important take-home messages?
- Sarcopenia remains a critical and under-recognised problem in people with CVD, which remains poorly accounted for in many studies to date.
- Regular multicomponent exercise, including resistance and endurance training, is likely the most effective intervention to manage sarcopenia in CVD.
- Alongside exercise, adequate nutrition that includes meeting daily protein intake and avoiding malnutrition, is important for reducing sarcopenia in CVD.
- Various medications prescribed for CVD may promote sarcopenia and negatively effect exercise and nutritional interventions, which should be considered.
- More high-quality evidence is urgently required in CVD patients with diagnosed sarcopenia to better identify the optimal exercise and nutritional approaches.
Fig.: A reciprocal relationship exists between cardiovascular disease (CVD) and sarcopenia. Optimising the management of sarcopenia by implementing early screening/diagnosis (e.g. during cardiac rehabilitation; CR) followed by multicomponent exercise and adequate nutrition is likely an effective treatment strategy. Personalising interventions specific to the individual with CVD is key to optimising sarcopenia management, including accounting for current medications. © The Author(s) 2025. European Journal of Preventive Cardiology (2025) 00, 1–22, https://doi.org/10.1093/eurjpc/zwaf432
What are challenges in practical implementation – and possible solutions?
- Lack of routine screening for sarcopenia in patients with CVD. Sarcopenia is often not diagnosed in clinical cardiology settings, due to time constraints, lack of awareness, and absence of clear screening guidelines. We need to introduce simple screening tools (e.g. questionnaires, grip strength tests) in routine practice and improve awareness of healthcare professionals to evaluate sarcopenia risk in CVD populations.
- Exercise is underprescribed or not individualised. We need to better utilise multidisciplinary teams (e.g., physiotherapists, exercise physiologists) in cardiac rehabilitation, as well as developing individualised exercise prescriptions that combine aerobic, resistance, and mobility training based on patient condition and health status.
- Malnutrition and poor nutritional support. Many CVD patients have inadequate protein intake or unrecognised malnutrition, especially elderly or hospitalised individuals. We need greater nutritional assessments in cardiology care and more support from dieticians to overcome this.
Which issues still need to be tackled, that are not yet addressed by the paper?
The feasibility and costs associated with delivering greater screening of sarcopenia in patients with CVD alongside more personalised exercise and nutritional treatments remains a challenge. Moreover, tackling inequality issues related to sex and race still require more attention, as does the issue of why some patients respond to exercise training better than others.
What further developments on the topic are emerging?
Sarcopenia is an exciting and emerging field. There are many promising drugs currently in development by pharmaceutical companies for treating sarcopenia, which may be especially useful for CVD patients that are simply unable or too sick to exercise, or that could be used in conjunction with exercise to optimise training adaptations. The rapid development in AI may also improve future screening and early detection of sarcopenia in CVD patients, but also improve our ability to evaluate patient-specific responses to exercise and nutritional interventions to improve personalised treatments.
Scientific statement: Influence of exercise and nutrition on sarcopenia in cardiovascular disease
Cornelissen V, Hanssen H, Hurst C, et al. Influence of exercise and nutrition on sarcopenia in cardiovascular disease: A Scientific Statement of the European Association of Preventive Cardiology of the ESC. Eur J Prev Cardiol. Published online July 15, 2025. doi:10.1093/eurjpc/zwaf432
Document types published by the ESC, Associations, Councils, Working Groups, and ESC Committees (according to the ESC Scientific Documents Policy):
