Preventing Sarcopenia and Promoting Musculoskeletal Health in Middle-Aged Adults: The Role of Exercise and Nutrition

Theocharis Ispoglou ^1* Catherine Norton ² Deaglan McCullough ¹

• ¹ Leeds Beckett University, Leeds, United Kingdom
• ² University of Limerick, Limerick, Ireland

Acute sarcopenia, referring to rapid muscle loss following illness or hospitalisation, has gained attention but remains inconsistently defined. Before Welch et al. [6] introduced the term "acute sarcopenia", this phenomenon was typically defined as disease-related muscle wasting. EWGSOP2 (2019) [5] incorporated acute sarcopenia into its diagnostic framework, yet its clinical application remains limited. A recent systematic review by Aldrich et al. [7] found that acute sarcopenia develops in 18% of hospitalised patients, reaching 59% in intensive care settings, yet current diagnostic criteria may underestimate muscle deterioration, impacting recovery, quality of life, and long-term health outcomes.Despite ongoing efforts by multiple working groups [8], variability in definitions and diagnostic criteria hinder clinical recognition and intervention. Strengthening collaboration between organisations such as EWGSOP2 and the Global Leadership Initiative on Sarcopenia remains critical for advancing standardised diagnostic frameworks.While diagnostic precision is important, prevention must not be delayed, particularly in middle-aged adults, where early action may prevent muscle decline. Midlife represents a key period for musculoskeletal health, with declines in neuromuscular efficiency [9], physical activity [10], hormonal alterations (e.g., oestrogen) [11], and poor dietary habits accelerating muscle loss [12,13]. Genderspecific barriers also influence sarcopenia risk, particularly in women during the perimenopausal phase [14,15]. Developing inclusive, accessible resistance training (RT) programmes tailored to women's needs -addressing social, cultural, and practical barriers -could improve long-term engagement.A summary of the key intervention strategies and modifying factors for midlife sarcopenia prevention is presented in Figure 1. This Research Topic explored key lifestyle approaches, including nutrition, exercise, and gut-muscle interactions, offering solutions for sustaining musculoskeletal health through early, targeted intervention.Diet is fundamental to muscle health, yet modern dietary patterns are increasingly dominated by UPFs, which may accelerate muscle loss. Kong et al. [16] investigated the association between ultra-processed food (UPF) consumption and muscle health, revealing that higher UPF intake was significantly associated with low muscle mass in young to middle-aged adults. These findings reinforce the need to prioritise whole, nutrient-dense foods to reduce early muscle deterioration.However, not all UPFs are inherently harmful. High-protein products, such as protein shakes and bars, fall within the UPF category but can support protein intake when consumed as part of a balanced diet. Alternatives, such as high-protein yoghurts containing probiotics, may also promote gut health. Future research should assess dietary quality holistically, considering both benefits and risks when evaluating UPFs in muscle health strategies.Emerging research highlights the gut-muscle axis as a key regulator of muscle health, linking gut microbiota to metabolism, inflammation, and function. Microbiome-targeted interventions may complement exercise and nutrition, offering therapeutic potential beyond sarcopenia prevention [17].Li et al. [18] examined exercise-induced microbiome shifts, proposing they may enhance muscle protein synthesis and metabolic resilience. Furthermore, diet critically influences gut health, with UPFs (associated with low muscle mass [16]) shown to reduce microbial α-diversity and increase proinflammatory bacteria [19,20]. By linking gut health with muscle function, new holistic health strategies may help mitigate muscle loss, metabolic diseases, autoimmune disorders, and chronic inflammation. While promising, causal mechanisms remain unclear, and future research must determine whether microbiome modulation -via diet, probiotics, or exercise -can offer viable therapeutic approaches for sarcopenia and broader health outcomes.While protein remains crucial, diet alone is insufficient without exercise. Research shows muscle protein synthesis declines with age, necessitating higher protein intake thresholds to stimulate an adequate anabolic response. Reviews highlight protein quality, timing, and distribution as key factors in maximising muscle preservation [21,22]. Schalla et al. [23] found that high-protein diets had minimal impact on muscle mass and strength in physically active middle-aged adults, reinforcing the need for an integrated approach combining diet and RT. This highlights a gap in current nutritional recommendations, where protein supplementation is often prioritised over exercise (i.e., RT), limiting its efficacy in sarcopenia prevention.Among all interventions, exercise (i.e., RT) remains the most effective strategy for preventing muscle loss and function. Li et al. [24] conducted a network meta-analysis identifying RT as the most effective approach for counteracting sarcopenia, particularly in clinical populations.Despite strong evidence supporting RT, participation remains low, with global participation rates of 18-35% in men and 14-26% in women [14]. Common barriers, especially among midlife women, include perceived time constraints, lack of knowledge and education, exercise modality preferences, and social factors [15]. Addressing these barriers through education, community-based programmes, and genderinclusive training environments is crucial for improving adherence and maximising public health.Despite growing recognition of sarcopenia as a midlife health concern, prevention efforts remain fragmented. This collection highlights the urgent need for integrated, proactive strategies targeting modifiable lifestyle factors -diet, resistance exercise, and gut health -before significant muscle loss occurs.Public health initiatives must prioritise early intervention, with a coordinated effort to educate healthcare professionals, policymakers, and the public on the importance of exercise and nutrition in muscle health. While resistance exercise remains the most effective intervention, complementary nutritional strategies should focus on reducing UPF consumption, promoting gut health, and ensuring adequate, high-quality protein intake to preserve muscle.Policymakers and healthcare systems must invest in accessible, evidence-based interventions tailored to midlife adults, embedding sarcopenia prevention within public health frameworks. Future research should enhance intervention accessibility, adherence, and long-term sustainability, making sarcopenia prevention a midlife priority rather than an ageing afterthought.