Skip to main content
SpringerLink
Log in

Rationale for a preliminary operational definition of physical frailty and sarcopenia in the SPRINTT trial

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

In the present article, the rationale that guided the operationalization of the theoretical concept of physical frailty and sarcopenia (PF&S), the condition of interest for the “Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies” (SPRINTT) trial, is presented. In particular, the decisions lead to the choice of the adopted instruments, and the reasons for setting the relevant thresholds are explained. In SPRINTT, the concept of physical frailty is translated with a Short Physical Performance Battery score of ≥3 and ≤9. Concurrently, sarcopenia is defined according to the recent definitions of low muscle mass proposed by the Foundation for the National Institutes of Health—Sarcopenia Project. Given the preventive purpose of SPRINTT, older persons with mobility disability (operationalized as incapacity to complete a 400-m walk test within 15 min; primary outcome of the trial) at the baseline are not included within the diagnostic spectrum of PF&S.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marzetti E, Calvani R, Landi F et al (2015) Innovative medicines initiative: The SPRINTT Project. J Frailty. Aging 4:207–208. doi:10.14283/jfa.2015.69

    CAS  Google Scholar 

  2. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 332:556–561. doi:10.1056/NEJM199503023320902

    Article  CAS  PubMed  Google Scholar 

  3. Guralnik JM, Simonsick EM, Ferrucci L, et al. (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49: M85–94. doi:10.1093/geronj/49.2.M85

    Article  CAS  PubMed  Google Scholar 

  4. Guralnik JM, Ferrucci L, Pieper CF, et al. (2000) Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 55: M221–31. doi:10.1093/gerona/55.4.M221

    Article  CAS  PubMed  Google Scholar 

  5. Studenski S, Perera S, Wallace D et al (2003) Physical performance measures in the clinical setting. J Am Geriatr Soc 51:314–322. doi:10.1046/j.1532-5415.2003.51104.x

    Article  PubMed  Google Scholar 

  6. Cesari M, Kritchevsky SB, Newman AB et al (2009) Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study. J Am Geriatr Soc 57:251–259. doi:10.1111/j.1532-5415.2008.02126.x

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cesari M, Onder G, Zamboni V et al (2008) Physical function and self-rated health status as predictors of mortality: results from longitudinal analysis in the ilSIRENTE study. BMC Geriatr 8:34. doi:10.1186/1471-2318-8-34

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rodríguez-Mañas L, Féart C, Mann G et al (2012) Searching for an operational definition of frailty: a delphi method based consensus statement. The Frailty Operative Definition-Consensus Conference Project. J Gerontol A Biol Sci Med Sci 68:62–67. doi:10.1093/gerona/gls119

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fried LP, Walston J (2003) Frailty and failure to thrieve. In: Hazzard WR, Blass JP, Ettinger WH, Halter JB, Ouslander JG (eds) Principles of Geriatric Medicine and Gerontology. McGraw-Hill, New York, pp 1487–1502

    Google Scholar 

  10. Fried LP, Tangen CM, Walston J, et al. (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56: M146–56. doi:10.1093/gerona/56.3.M146

    Article  CAS  PubMed  Google Scholar 

  11. Morley JE (2013) Frailty: a time for action. Eur Geriatr Med 4:215–216. doi:10.1016/j.eurger.2013.08.006

    Article  Google Scholar 

  12. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. The Lancet 381:752–762. doi:10.1016/S0140-6736(12)62167-9

    Article  Google Scholar 

  13. Ferrucci L, Guralnik JM, Studenski S et al (2004) Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 52:625–634. doi:10.1111/j.1532-5415.2004.52174.x

    Article  PubMed  Google Scholar 

  14. Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E (2014) Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci 6: 192. doi:10.3389/fnagi.2014.00192

    PubMed  PubMed Central  Google Scholar 

  15. Abizanda P, Romero L, Sanchez-Jurado PM et al (2012) Association between functional assessment instruments and frailty in older adults: the FRADEA study. J Frailty. Aging 1:162–168. doi:10.14283/jfa.2012.25

    CAS  Google Scholar 

  16. Pahor M, Guralnik JM, Ambrosius WT et al (2014) Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 311:2387–2396. doi:10.1001/jama.2014.5616

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Vasunilashorn S, Coppin AK, Patel KV et al (2009) Use of the short physical performance battery score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. J Gerontol A Biol Sci Med Sci 64:223–229. doi:10.1093/gerona/gln022

    Article  PubMed  Google Scholar 

  18. Studenski SA, Peters KW, Alley DE et al (2014) The FNIH Sarcopenia Project: Rationale, Study Description, Conference Recommendations, and Final Estimates. J Gerontol A Biol Sci Med Sci 69:547–558. doi:10.1093/gerona/glu010

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423. doi:10.1093/ageing/afq034

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fielding RA, Vellas B, Evans WJ et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12:249–256. doi:10.1016/j.jamda.2011.01.003

    Article  PubMed  Google Scholar 

  21. Muscaritoli M, Anker SD, Argiles J et al (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 29:154–159. doi:10.1016/j.clnu.2009.12.004

    Article  CAS  PubMed  Google Scholar 

  22. Morley JE, Abbatecola AM, Argiles JM et al (2011) Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 12:403–409. doi:10.1016/j.jamda.2011.04.014

    Article  PubMed  PubMed Central  Google Scholar 

  23. Reginster JY, Cooper C, Rizzoli R et al (2016) Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia. Aging Clin Exp Res 28:47–58. doi:10.1007/s40520-015-0517-y

    Article  PubMed  Google Scholar 

  24. Cawthon PM, Peters KW, Shardell MD et al (2014) Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol A Biol Sci Med Sci 69:567–575. doi:10.1093/gerona/glu023

    Article  PubMed  PubMed Central  Google Scholar 

  25. Baumgartner RN, Koehler KM, Gallagher D et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763

    Article  CAS  PubMed  Google Scholar 

  26. Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896. doi:10.1046/j.1532-5415.2002.50216.x

    Article  PubMed  Google Scholar 

  27. Newman AB, Kupelian V, Visser M et al (2003) Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 51:1602–1609. doi:10.1046/j.1532-5415.2003.51534.x

    Article  PubMed  Google Scholar 

  28. Dam TT, Peters KW, Fragala M et al (2014) An evidence-based comparison of operational criteria for the presence of sarcopenia. J Gerontol A Biol Sci Med Sci 69:584–590. doi:10.1093/gerona/glu013

    Article  PubMed  PubMed Central  Google Scholar 

  29. Newman AB, Kupelian V, Visser M et al (2006) Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 61:72–77

    Article  PubMed  Google Scholar 

  30. Newman AB, Haggerty CL, Goodpaster B et al (2003) Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 51:323–330. doi:10.1046/j.1532-5415.2003.51105.x

    Article  PubMed  Google Scholar 

  31. Cesari M, Pahor M, Lauretani F et al (2009) Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 64:377–384. doi:10.1093/gerona/gln031

    Article  PubMed  Google Scholar 

  32. Visser M, Goodpaster BH, Kritchevsky SB et al (2005) Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 60:324–333. doi:10.1093/gerona/60.3.324

    Article  PubMed  Google Scholar 

  33. McLean RR, Shardell MD, Alley DE et al (2014) Criteria for Clinically Relevant Weakness and Low Lean Mass and Their Longitudinal Association With Incident Mobility Impairment and Mortality: The Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. J Gerontol A Biol Sci Med Sci 69:576–583. doi:10.1093/gerona/glu012

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rolland YM, Cesari M, Miller ME et al (2004) Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults. J Am Geriatr Soc 52:972–976. doi:10.1111/j.1532-5415.2004.52267.x

    Article  PubMed  Google Scholar 

  35. Sayers SP, Guralnik JM, Newman AB, Brach JS, Fielding RA (2006) Concordance and discordance between two measures of lower extremity function: 400 m self-paced walk and SPPB. Aging Clin Exp Res 18:100–106

    Article  PubMed  Google Scholar 

  36. Chang M, Cohen-Mansfield J, Ferrucci L et al (2004) Incidence of loss of ability to walk 400 meters in a functionally limited older population. J Am Geriatr Soc 52:2094–2098. doi:10.1111/j.1532-5415.2004.52570.x

    Article  PubMed  Google Scholar 

  37. Rejeski WJ, Fielding RA, Blair SN et al (2005) The lifestyle interventions and independence for elders (LIFE) pilot study: design and methods. Contemp Clin Trials 26:141–154. doi:10.1016/j.cct.2004.12.005

    Article  PubMed  Google Scholar 

  38. Pahor M, Blair SN, Espeland M et al (2006) Effects of a physical activity intervention on measures of physical performance: results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 61:1157–1165

    Article  PubMed  Google Scholar 

  39. Cesari M, Scarlata S (2014) What the 4-metre gait speed measures and why it cannot replace functional capacity tests. Eur Respir J 43:1819–1820. doi:10.1183/09031936.00207913

    Article  PubMed  Google Scholar 

  40. Simonsick EM, Montgomery PS, Newman AB, Bauer DC, Harris T (2001) Measuring fitness in healthy older adults: the health ABC long distance corridor walk. J Am Geriatr Soc 49:1544–1548. doi:10.1046/j.1532-5415.2001.4911247.x

    Article  CAS  PubMed  Google Scholar 

  41. Rosow I, Breslau N (1966) A Guttman health scale for the aged. J Gerontol 21:556–559

    Article  CAS  PubMed  Google Scholar 

  42. Cesari M, Vellas B, Gambassi G (2013) The stress of aging. Exp Gerontol 48:451–456. doi:10.1016/j.exger.2012.10.004

    Article  PubMed  Google Scholar 

  43. Abellan van Kan G, Rolland YM, Andrieu S et al (2009) Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 13:881–889. doi:10.1007/s12603-009-0246-z

    Article  CAS  PubMed  Google Scholar 

  44. Ensrud K, Ewing SK, Taylor BC et al (2008) Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 168:382–389. doi:10.1001/archinternmed.2007.113

    Article  PubMed  Google Scholar 

  45. Cesari M (2011) Role of gait speed in the assessment of older patients. JAMA 305:93–94. doi:10.1001/jama.2010.1970

    Article  CAS  PubMed  Google Scholar 

  46. Alley DE, Shardell MD, Peters KW et al (2014) Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci 69:559–566. doi:10.1093/gerona/glu011

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The present work was Funded by a Grant from the Innovative Medicines Initiative—Joint Undertaking (IMI-JU 115621). The work was also partly supported by the “Centro Studi Achille e Linda Lorenzon” (E.M., R.C.), Fondazione Roma (NCDs Call for Proposals 2013; E.M., R.C.), and intramural research Grants from the Catholic University of the Sacred Heart (D3.2 2013 and D3.2 2015; E.M., F.L., R.C.).

Author information

Authors and Affiliations

  1. Gérontopôle, Centre Hospitalier Universitaire de Toulouse III, Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France

    Matteo Cesari & Bruno Vellas

  2. Université de Toulouse III Paul Sabatier, Toulouse, France

    Matteo Cesari & Bruno Vellas

  3. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart School of Medicine, Rome, Italy

    Francesco Landi, Riccardo Calvani, Roberto Bernabei & Emanuele Marzetti

  4. Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy

    Antonio Cherubini

  5. Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Mauro Di Bari

  6. Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Mauro Di Bari

  7. Physical Medicine and Rehabilitation Service, Sacramento VA Medical Center, Sacramento, CA, USA

    Patrick Kortebein

  8. Department of Physical Medicine and Rehabilitation, University of California Davis, Sacramento, CA, USA

    Patrick Kortebein

  9. Novartis Institutes of Biomedical Research, Cambridge, MA, USA

    Patrick Kortebein

  10. Bluecompanion LTD, London, UK

    Susanna Del Signore

  11. Sanofi R&D, Chilly-Mazarin, France

    Regis Le Lain

  12. Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA

    Marco Pahor

  13. Global Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland

    Ronenn Roubenoff

Authors
  1. Matteo Cesari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Landi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Riccardo Calvani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Cherubini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mauro Di Bari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Kortebein
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Susanna Del Signore
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Regis Le Lain
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bruno Vellas
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marco Pahor
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ronenn Roubenoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Roberto Bernabei
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Emanuele Marzetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

For the SPRINTT Consortium

Corresponding author

Correspondence to Matteo Cesari.

Ethics declarations

Conflict of interest

The authors of the present work are partners of the SPRINTT Consortium, which is partly funded by the European Federation of Pharmaceutical Industries and Associations (EFPIA). E.M. served as a consultant for Huron Consulting Group, Genactis, and Novartis. M.C. served as a consultant for and/or received honoraria for scientific presentations from Nestlé.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cesari, M., Landi, F., Calvani, R. et al. Rationale for a preliminary operational definition of physical frailty and sarcopenia in the SPRINTT trial. Aging Clin Exp Res 29, 81–88 (2017). https://doi.org/10.1007/s40520-016-0716-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-016-0716-1

Keywords

Search

Navigation