Influence of exercise and nutrition on sarcopenia in cardiovascular disease: a Scientific Statement of the European Association of Preventive Cardiology of the European Society of Cardiology

This document aims to review current scientific evidence on exercise and nutrition as a treatment for sarcopenia in the context of cardiovascular disease (CVD). First, we introduce the topic of sarcopenia and its estimated prevalence in patients with CVD. Then, we critically analyse the available evidence to support the use of exercise and nutrition, both alone and combined, for treating sarcopenia in patients with CVD followed by discussing factors that may optimize management. We further discuss the relevance of how medications used in CVD impact sarcopenia and how they may negatively interact with exercise/nutritional interventions. Finally, we provide insights into the practical implications and future directions for managing sarcopenia in patients with CVD. In summary, optimized physical exercise interventions (dedicated resistance training in addition to endurance training and other modalities) together with adequate nutritional intake (avoiding malnutrition and ensuring sufficient protein consumption) is advised for the prevention and management of sarcopenia. However, there currently remains a lack of high-quality evidence to support these approaches in the context of CVD, where baseline sarcopenia status has typically not been evaluated. Future work, therefore, is required in CVD populations with confirmed sarcopenia to better understand what optimal exercise and nutritional strategies are required to further improve sarcopenia management. Keywords Cardiovascular disease, Exercise, Heart failure, Nutrition, Sarcopenia, Skeletal muscle