2025_Knowledge, awareness, behaviours, beliefs, attitudes, and perceptions of older Australians regarding muscle health and sarcopenia A national survey

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Knowledge, awareness, behaviours, beliefs, attitudes, and
perceptions of older Australians regarding muscle health and
sarcopenia: A national survey
Robin M. Daly , David Scott , Nicole Kiss , Michael Tieland ,
Brenton Baguley , Jackson J. Fyfe
PII: S0167-4943(25)00092-5
DOI: https://doi.org/10.1016/j.archger.2025.105835
Reference: AGG 105835
To appear in: Archives of Gerontology and Geriatrics
Received date: 28 February 2025
Revised date: 18 March 2025
Accepted date: 23 March 2025
Please cite this article as: Robin M. Daly , David Scott , Nicole Kiss , Michael Tieland ,
Brenton Baguley , Jackson J. Fyfe , Knowledge, awareness, behaviours, beliefs, attitudes, and per-
ceptions of older Australians regarding muscle health and sarcopenia: A national survey, Archives of
Gerontology and Geriatrics (2025), doi: https://doi.org/10.1016/j.archger.2025.105835
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© 2025 Published by Elsevier B.V.
https://doi.org/10.1016/j.archger.2025.105835
https://doi.org/10.1016/j.archger.2025.105835
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Highlights 
 To understand older adults’ knowledge, attitudes, and perceptions of muscle health. 
 Sound knowledge on common risks, consequences and treatments for poor muscle health. 
 Willingness to act if informed to be at risk of having poor muscle health. 
 Limited knowledge/confidence to adopt lifestyle changes for poor muscle health. 
 Older adults need guidance on effective lifestyle interventions for muscle health. 
 
 
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Knowledge, awareness, behaviours, beliefs, attitudes, and perceptions of older 
Australians regarding muscle health and sarcopenia: A national survey 
 
Robin M. Daly,
1
 David Scott,
1 
Nicole Kiss,
1
 Michael Tieland,
1
 
Brenton Baguley,
 1
 Jackson J. Fyfe
1
 
1
 Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, 
Deakin University, Burwood, Melbourne, Victoria, Australia. 
 
 
Address for correspondence: 
Professor Robin M. Daly 
Institute for Physical Activity and Nutrition 
School of Exercise and Nutrition Sciences 
Deakin University 
221 Burwood Highway, Burwood, 
Melbourne, Victoria, AUSTRALIA 3125 
Phone: +61 3 9244 6040 
Email: rmdaly@deakin.edu.au 
ORCID ID: 0000-0002-9897-1598 
 
 
 
 
 
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ABSTRACT 
Objective: This study evaluated older Australians understanding, awareness, knowledge, perceptions, 
behaviours, beliefs and attitudes towards muscle health and sarcopenia, and barriers towards exercise and 
nutrition as prevention options. 
Methods: A national, anonymous 41-question, online purpose-designed survey covering the concepts 
outlined in the study objective was conducted from March-May 2024. 
Results: 1261 adults (≥50-y) aged 50-94 years participated. Low muscle strength and poor function were the 
most common criteria associated with poor muscle health. Knowledge of common signs/symptoms, risk 
factors, consequences, and effective treatments was generally high. However, there was uncertainty about 
unintentional weight loss as a risk factor, increased risk for infection/reduced immunity and chronic 
conditions as consequences, and ineffective treatments options (only 5-12% recognised any form of exercise, 
aerobic exercise and eating more fruits/vegetables as ineffective treatments). Only 8.9% reported their doctor 
had discussed muscle health but 82-95% would act if they received information on risk factors or if informed 
they were at risk for poor muscle health. Two-thirds recognised sarcopenia as a serious condition, with 48% 
concerned about its potential impact, despite 90% acknowledging muscle health is very important to 
maintain. Only around half believed they had sufficient knowledge and confidence to adopt lifestyle changes 
to reduce their risk, with motivation the leading barrier to engaging in exercise or dietary strategies to 
optimize muscle health. 
Conclusion: Older Australians recognize the importance of muscle health, understand key strategies to 
manage it and would act if identified to be at risk, but many lack knowledge and confidence to adopt lifestyle 
changes to improve their muscle health. 
 
Key words: muscle health, sarcopenia, knowledge, community-dwelling older adults, survey 
 
 
 
 
 
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Highlights 
 To understand older adults’ knowledge, attitudes, and perceptions of muscle health. 
 Sound knowledge on common risks, consequences and treatments for poor muscle health. 
 Willingness to act if informed to be at risk of having poor muscle health. 
 Limited knowledge/confidence to adopt lifestyle changes for poor muscle health. 
 Older adults need guidance on effective lifestyle interventions for muscle health. 
 
 
 
 
 
 
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1. INTRODUCTION 
Ageing is associated with progressive losses in muscle mass, strength and physical performance, which if left 
untreated, can lead to the geriatric syndrome sarcopenia. Sarcopenia is associated with adverse health 
outcomes, including falls, fractures, disability, reduced ability to undertake activities of daily living, quality 
of life, hospitalization and mortality [1-9]. In 2016, sarcopenia was formally recognised as an independent 
disease by an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) 
code [10]. Despite this, it remains largely under-recognised with relatively few healthcare professionals 
(HCPs) routinely screening/assessing and/or treating/managing sarcopenia, which is likely related to lack of 
knowledge, access to appropriate tools, priority and time [11-20]. This may explain in part, findings that 
many community-dwelling older people also have limited awareness, understanding and knowledge of 
sarcopenia [13,15,17,21-23]. 
Given the projected rise in the prevalence of sarcopenia in coming years [24], there is a need to raise 
awareness about the importance of optimising muscle mass, strength and physical function amongst the 
broader community (and HCPs) to reduce its burden. Indeed, a review on strengthening muscle health of 
community-dwelling older adults proposed a paradigm shift where “muscle health” is considered essential to 
good overall health, and not just to avoid adverse outcomes [25]. As sarcopenia remains poorly recognized 
and prevention receives limited attention, campaigns are needed to raise awareness, provide education, and 
promote evidence-based strategies to optimize muscle health across the lifespan. To inform such campaigns, 
it is first important to gain insights into the awareness, knowledge, understanding, perceptions and beliefs 
about muscle health in community-dwelling older adults. Therefore, the aim of this study was to conduct the 
first national survey of community-dwelling Australian adults aged 50 years and over to evaluate their 
understanding, awareness, knowledge, perceptions, behaviours, beliefs and attitudes towards muscle health 
and sarcopenia, as well as potential barriers towards evidence-based exercise and nutrition prevention and 
treatment options. 
2. METHODS 
2.1 Study Design 
This national cross-sectional study involving a voluntary, anonymous, online self-administered survey of 
adults aged 50 years and over located across all Australian states and territories was conducted between 
 
 
 
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March and May2024. The survey was administered through the Qualtrics
XM
 platform (Qualtrics, UT, USA) 
with bot detection, prevention of multiple submissions and CAPTCHA-protection, but no IP addresses or 
cookies were collected. Participant recruitment occurred via advertisements with a link (QR code) to the 
survey shared through various social media platforms (Facebook, X, LinkedIn) and via an email sent to 
people registered on our internal research database who had consented to be contacted for future research. As 
an incentive, participants received a free muscle health assessment via the five item SARC-F survey [26] and 
could download a free educational brochure on why muscle health matters and how to prevent and manage 
poor muscle health upon completion of the survey. The study was approved by the Deakin University 
Human Ethics Advisory Group for Health (16/2024, approved 18/03/2024). All participants were required to 
first review the plain language statement, which included information on the study aims, investigator details, 
time commitment to complete the survey, what data was stored, where and for how long, and then provide 
informed consent in Qualtrics. All study data were stored in a secure, password-protected server (and only 
accessible to the research team), hosted at Deakin University. The study adheres to the Checklist for 
Reporting Results of Internet E-surveys (CHERRIES) (Supplementary File 1) [27]. 
2.2 Survey 
A purpose-designed, multi-dimensional open survey, informed by previous surveys on sarcopenia targeting 
community-dwelling adults to enhance content validity [17,21-23], and founded on several constructs of the 
Health Belief Model scale (perceived susceptibility, severity, benefits, barriers, self-efficacy) [28], was 
developed by the research team that included senior academics with expertise in sarcopenia, and clinical and 
research exercise physiologists and dietitians. Face validity was tested with all team members and five 
community-dwelling older adults to assess structure, readability and understandability. Feedback informed a 
revision of the survey by RMD, with all team members agreeing on the final content and structure. The final 
survey contained 41 questions plus the 5-item SARC-F survey [26], distributed across 12 online pages in 
Qualtrics and took about 15-20 minutes to complete (Supplementary File 2). The survey had to be completed 
in one session, and participants were unable to return to any previous questions once they progressed to a 
new page of the survey. The survey was divided into seven sections with response options ranging from 
“select-all-that-apply”; “yes” or “no”; “multiple-choice”; “yes”, “don’t know” or “no” or a range of 5-point 
Likert-scale type questions (Supplementary File 2). 
 
 
 
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Section 1 included questions on demographics and self-reported health status (from 0 ‘worst health you can 
imagine’ to 100 ‘best health you can imagine’). Section 2 assessed understanding, awareness and knowledge 
related to poor muscle health (8 questions), including signs/symptoms, risk factors, consequences and 
treatment options. Some questions included both correct and incorrect options (e.g., factors that are unrelated 
to poor muscle health or treatments not considered effective). An overall knowledge score was derived from 
the number of correct responses to questions 2.3 to 2.8 (each assigned 1-point) with the highest possible 
knowledge score equal to 48 points. Section 3 assessed practices, perceptions and behaviours related to 
muscle health and/or sarcopenia (8 questions), including whether their doctor had discussed muscle health 
with them, whether they had engaged in any lifestyle-related programs for muscle health, how they rate their 
muscle health, whether their muscle health impacts their daily physical activities and if they would take 
action or seek support if informed they were at risk for poor muscle health. Section 4 included questions on 
beliefs related to muscle health and sarcopenia, including the role of exercise and nutritional strategies to 
reduce the risk (10 statements). Section 5 assessed attitudes about muscle health and sarcopenia (6 
statements) including concerns about its impact and confidence in making lifestyle choices or accessing 
information to optimize muscle health. Section 6 assessed barriers towards exercise and nutrition for muscle 
health or to reduce sarcopenia risk (2 questions with 10 statements). Finally, section 7 included the 5-item 
SARC-F survey to gain an insight into the participants potential risk for sarcopenia. 
The survey was completely anonymous, and incomplete surveys were automatically submitted (and available 
data included) once the survey was closed. The time to complete the entire survey was recorded and any 
responses with a completion timethat unintentional 
weight loss was a sign/symptom. Overall, 10.4% to 26.9% correctly answered five statements not considered 
signs/symptoms of muscle loss (13.6% to 42.7% reported ‘I don’t know’ (Table 2). 
For the 11 statements on risk factors for poor muscle health, the mean for correct responses was 55.2% 
(Table 2). Most participants (82.8% to 97.7%) correctly recognised six common risk factors (sedentary 
lifestyle, increasing age, poor nutrition and protein intake, presence of other chronic conditions, short-term 
bed rest), but only half (53.2%) correctly recognised unintentional weight loss as a risk factor (39.4% 
reported ‘I don’t know’). Only 10.2% to 17.8% correctly answered five other statements not considered risk 
factors for poor muscle health (28.8% to 51.6% reported ‘I don’ know’ (Table 2). 
For the 12 statements on consequences of poor muscle health, the mean for correct responses was 34.7% 
(Table 2). Most participants (81.8% to 98.1%) correctly recognised six known consequences, with 67.7% 
correctly identifying shortened life expectancy as a consequence. Around half (47.5% to 48.3%) correctly 
answered that an increased risk of cognitive decline or dementia and an increased risk for chronic conditions 
were consequences of poor muscle health. In contrast, only 36.1% correctly identified that higher risk of 
infection/reduced immunity was a consequence (39.8% reported ‘I don’t know’). For three other statements 
not considered consequences, only 11.4% to 23.3% of participants responded correctly (33.5% to 49.9% 
reported ‘I don’t know’) (Table 2). 
For the 11 statements related to treatment/management options for poor muscle health, the mean for correct 
responses was 47.7% (Table 2). A high proportion (82.5% to 98.6%) correctly answered that resistance 
training alone or combined with a high protein diet, a high protein diet alone, and limiting sedentary time 
were recognised treatment options. Around 58% correctly answered that a high carbohydrate diet was not 
effective but only 27.4% correctly answered that a multi-nutrient oral nutritional supplement (ONS) drink 
was an effective therapeutic strategy. For use of vitamin/multivitamin supplements and medication(s) 
prescribed by a doctor, 30.8% and 27.4%, respectively correctly answered they were not recognised 
treatment options. Only 5.0% to 11.5% correctly answered that aerobic exercise, eating more fruits and 
vegetables and any form of physical activity were not recognised treatment options for poor muscle health. 
 
 
 
 
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Practices, perceptions and behaviours related to muscle health and sarcopenia 
Only 8.9% of participants reported that a doctor/healthcare professional (HCP) had ever talked to them about 
their muscle health or risk for sarcopenia, but 74% reported they had participated in a muscle health lifestyle 
program in the last 5-years. When asked to rate their muscle mass, strength and physical function status, 
38.4% to 57.5% stated ‘average to very poor’ while 42.5% to 61.5% stated ‘good/excellent’; muscle mass 
status was rated the lowest of these three measures (Table 3). In terms of whether muscle health limits the 
respondent’s ability to undertake everyday activities, 55.4% reported ‘not at all’, 38.0% ‘a little/somewhat’ 
and 6.9% ‘a lot/completely’. Overall, 82.4% to 95.1% indicated they would take action to optimise their 
muscle health if they were informed they were at risk for sarcopenia, received information about risk factors 
or preventative strategies, or had access to reputable online information/apps/tools. Over 58% indicated they 
would be ‘very/extremely willing’ to seek support from an HCP about their muscle health, while 38.0% 
reported ‘somewhat/moderately willing’ (Table 3). 
Beliefs related to muscle health and sarcopenia 
Overall, 89.6% of participants indicated it was ‘very important’ to maintain their muscle health (Table 4), 
with the top five reasons being: 1) to keep the body strong to continue to undertake daily activities (98.1%); 
2) to maintain mobility to move freely (95.0%); 3) to maintain the strength of bones (89.3%); 4) to maintain 
independence (89.0%), and 5) to reduce the risk of falls (88.0%) (Supplementary Table 2). Half (50.9%) 
believed they were ‘somewhat/very likely’ to experience sarcopenia in the future, with two-thirds (66.9%) 
believing sarcopenia was a ‘very/extremely’ serious condition (Table 4). Around two-thirds (62.3%) 
‘agreed/strongly agreed’ it was possible to reduce the risk of sarcopenia through lifestyle approaches, with 
88.6% to 94.1% acknowledging the importance of a lack of exercise and resistance training as factors that 
could increase their susceptibility to sarcopenia. In addition, 62.3% believed that diet can influence their 
susceptibility (‘a lot/completely’) to sarcopenia and 82.2% ‘agreed/strongly agreed’ that a nutritious protein-
rich diet can reduce sarcopenia risk. In contrast, only 24.6% ‘agreed/strongly agreed’ that multi-nutrient 
ONS can reduce sarcopenia risk. 
Attitudes related to muscle health and sarcopenia 
In terms of the potential of having sarcopenia in the future and its impact on their ability to do everyday 
activities, 43.9% to 49.7% reported being ‘slightly/moderately’ concerned and 40.8% to 47.6% 
 
 
 
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‘very/extremely’ concerned (Table 5). Overall, 46.4% agreed ‘a lot/completely’ that the thought of 
sarcopenia is scary (27.3% responded ‘not at all/a little’). Over half (53.0%) ‘strongly disagreed/disagreed’ 
they lack the knowledge to adopt lifestyle changes to reduce sarcopenia risk (25.2% ‘agreed/strongly 
agreed’) and 53.8% and 63.8% indicated they were ‘very/extremely’ confident they could adopt healthy 
lifestyle habits and seek/understand information to reduce sarcopenia risk. 
Barriers to exercise and nutrition for managing muscle health 
Regarding barriers to engaging in exercise/resistance training for muscle health or sarcopenia prevention, 
motivation was the highest rated barrier with 38.9% of participants indicating ‘somewhat/a lot’ and 4.6% 
‘completely’ (Figure 2 and Supplementary Table 3). For other barriers (time, knowledge, confidence, cost, 
physical limitations, pain, fear of injury, social support, access to facilities) there were consistent responses; 
6.9% to 13.8% reported ‘a lot/completely’, 36.1% to 47.8% ‘a little/somewhat’ and 38.4% to 53.4% ‘not at 
all’. In terms of barriers toward maintaining a nutritious diet, motivation was also the highest rated (4.5% 
‘completely’ and 32.8% ‘somewhat/a lot’), with consistent responses for all other barriers (time, knowledge, 
cost, cooking skills, taste preferences, living arrangement, social support, food access and dietary 
restriction); 2.7% to 8.6% ‘a lot/completely’, 22.1% to 41.8% ‘alittle/somewhat’ and 52.1% to 75.2% ‘not at 
all’ (Figure 3 and Supplementary Table 3). 
4. DISCUSSION 
The key findings from this first national muscle health survey of Australian adults aged 50+ years were that: 
1) low muscle strength followed by poor physical function were rated as the two key criteria most recognised 
as characteristics of poor muscle health; 2) knowledge on common signs/symptoms, risk factors, 
consequences and effective treatment options for poor muscle health was generally high, but there was 
uncertainty about whether unintentional weight loss was a sign/symptom/risk factor, a higher risk of 
infection/reduced immunity and increased risk for chronic conditions were consequences, and what 
constituted ineffective treatment options; 3) ~90% reported their doctor/HCPs had never talked to them about 
muscle health, but up to 95% would take action if informed or received information on risk factors, although 
just over half were very/extremely willing to seek HCP support despite 57.5% rating their muscle mass and 
~38% their muscle strength and physical function as very poor/average; 4)two-thirds recognised sarcopenia 
as a serious condition, but less than half were concerned about its potential impact in the future despite 
 
 
 
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around 90% recognizing it was very important to maintain their muscle health mostly to keep the body 
strong to continue to undertake daily activities and maintain mobility; 5) most (94.1%) recognised that 
resistance training and to a lesser extent a nutritious, protein-rich diet (82.2%) can reduce their susceptibility 
to sarcopenia (yet only a quarter thought that multi-nutrient ONS could play a role) and just over half 
believed they had the knowledge and confidence to adopt lifestyle changes or seek information to reduce 
their risk, and 6) motivation was the leading barrier to engaging in regular exercise/resistance training and 
maintaining a nutritious diet for muscle health or to reduce sarcopenia risk. 
Understanding, awareness and knowledge 
The finding that 32% of Australian adults aged 50+ years stated they were familiar with the term sarcopenia 
is higher than reported for community-dwelling older adults (17%) and geriatric rehabilitation patients (3%) 
in the Netherlands in 2017-18 and 2020-21 [17,21]. This difference may reflect the exponential growth in 
research [29] and recognition of sarcopenia as a disease since being assigned an ICD-10-CM code in 2016 
[10]. Interestingly, when participants in our study were asked to rank the key criteria associated with having 
poor muscle health, low muscle strength (45.3%) followed by poor physical function (25.7%) were the two 
most recognised (55% thought loss of muscle mass commenced between 40 and 59 years (not 30-39 years), and 
around 65% incorrectly identified (or stated I don’t know) that the average lifetime loss in muscle strength is 
>40%. This is consistent with previous research in Dutch community-dwelling older adults [17] and geriatric 
rehabilitation patients [21] in which participants reported that age-related muscle loss begins at 46 and 60 
years, respectively. Nevertheless, the main reason for the modest knowledge scores in our study was that 
most participants did not recognise (or were unsure) about factors unrelated to poor muscle health (e.g., 
stiff/inflexible muscles, cramps, increased resting heart rate and persistent muscle pain) and risk factors not 
related to muscle loss (e.g., inadequate calcium intake, dehydration, stress, being female and high cholesterol 
levels). 
Clinical guidelines for the prevention and management of sarcopenia recommend a combination of resistance 
training with increased dietary protein [31-35]. Previous work in older Dutch adults revealed only 21% 
selected resistance training and 14% a high protein diet as appropriate treatment options [17], with similar 
findings among Dutch geriatric rehabilitation patients [21]. In contrast, we found that most participants 
correctly identified that resistance training (98.6%), increased dietary protein (82.5%), their combination 
(92.4%), and limiting sedentary time (82.7%) were effective options. Despite this, we also found that only 
5.0% to 11.5% correctly identified any form of activity or exercise, aerobic exercise and eating more fruits 
and vegetables were ineffective treatments, and only one quarter (~27%) correctly answered that multi-
nutrient ONS drinks were an effective option (with 46% stating ‘I don’t know’). In the two Dutch studies 
mentioned earlier, relatively few participants (~20% or less) selected treatment options that are known to be 
ineffective for sarcopenia (e.g., balance training, cardiovascular training, fruits/vegetables, low carbohydrate 
diet, vitamin supplements and medications), although ~30% of geriatric patients indicated they ‘don’t know’ 
how sarcopenia should be treated [17,21]. Collectively, these results highlight the need to raise awareness 
and educate older people on evidence-based strategies for treating poor muscle health or sarcopenia, 
 
 
 
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particularly that not all forms of activity/exercise or nutritional approaches are effective, despite many 
providing other health benefits. 
Perceptions, beliefs and attitudes 
An interesting observation from this study was that over half (57.5%) the participants rated their muscle 
mass, and ~38% their muscle strength and physical function, as very poor to average, yet 89.6% indicated it 
was very important to maintain their muscle health. Two-thirds (66.9%) also recognised that sarcopenia is a 
very/extremely serious condition with around three-quarters (72.7%) moderately/extremely concerned about 
it in the future. Dutch community-dwelling and geriatric rehabilitation patients also rated highly (8-9/10) the 
importance of muscle health for overall health and/or that sarcopenia is a serious condition [17,21]. While 
collectively these results suggest that most older people recognise that maintaining muscle health is 
important, our findings suggest many may not be taking appropriate measures to optimise their muscle health 
given ~40-60% perceived they have poor to average muscle mass, strength and function. This does not 
appear to be related to either a lack of knowledge or beliefs about the importance of exercise (resistance 
training) and nutrition (dietary protein) as a high proportion (~82-99%) recognised these are important 
treatment options. Furthermore, 74% reported they had participated in lifestyle-related programs for their 
muscle health in the last 5-years, but whether this involved evidence-based approaches is uncertain. 
Interestingly, just over half were very/extremely confident to adopt healthy lifestyle behaviours (or 
seek/understand relevant information) to reduce their sarcopenia risk and very/extremely willing to seek 
support from an HCP about their muscle health. This suggests there is a need to develop initiatives to instil 
greater confidence in older people to adopt appropriate lifestyle approaches (and improve their health 
literacy to seek/understand health/medicalinformation) to optimise their muscle health including the role that 
specific HCPs (especially exercise physiologist and dietitians) can play to prevent/treat muscle loss. The 
development of a self-assessment (risk) tool(s) would allow consumers to better understand risk factors for 
poor muscle health which may facilitate them seeking HCP support and/or undertaking lifestyle-changes to 
optimise their muscle health. 
Practices and behaviours 
Despite significant progress in the field of sarcopenia over the past decade, only 8.9% of participants 
indicated their doctor or other HCPs had consulted them about their muscle health. This is not unexpected 
 
 
 
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given most prior research indicates few clinicians (7-26%) report undertaking any form of 
screening/assessment, with most reporting low awareness, understanding, and knowledge around sarcopenia 
and how to treat it [14,18,20]. Educating and upskilling HCPs will be important as 82.4% to 95.1% of 
participants in our study indicated they were somewhat/very likely to act on their muscle health if they 
received information about risk factors and/or prevention strategies or were informed they were at risk for 
sarcopenia. Previous research in Dutch [21] and South Korean [15] older adults also showed >80% would be 
willing to start treatment if diagnosed with sarcopenia, with exercise/resistance training followed by nutrition 
management or a high protein-diet the two preferred options. In a study of 24 Australian older adults most 
reported they preferred resistance training (75%) followed by taking prescribed medication (if available, 
71%) and then making dietary modification (67%) to prevent sarcopenia [36]. In our study, only 27.4% of 
participants correctly identified that medication prescribed by their doctor was not an effective treatment 
option. This highlights that education is also warranted to raise awareness amongst community-dwelling 
older people that there are currently no pharmacological agents available to treat sarcopenia. 
Barriers to exercise and nutrition 
Since exercise and nutrition are central to the prevention and management of poor muscle health, this study 
also aimed to explore potential barriers to engaging in these behaviours. Of the 10 potential barriers listed for 
exercise/resistance training, around one in five (20.8%) rated (‘a lot/completely’) motivation as a barrier, but 
~70-80% responded ‘not at all/a little’ to all other barriers. Motivation was also rated as the main barrier for 
nutrition (18% reported ‘a lot/completely’), with ~80-90% reporting ‘not at all/a little’ to other potential 
barriers. Based on these findings, there appears no single barrier for HCPs to target to enhance adoption 
and/or adherence to exercise or nutritional approaches to optimise muscle health in middle-aged and older 
Australian adults. For comparison, a study of Dutch community-dwelling older adults revealed that 44% 
reported obstacles to sarcopenia treatment, with time (32%), expense (23%) and aversion to seeing an HCP 
(15%) as the key barriers [17]. In geriatric rehabilitation patients, dislike for oral nutrition supplements 
(17%), too many other health issues (13.6%), doubts of treatment effectiveness or importance (12.9%), 
difficulty/dislike to adjust diet (10.9%) and resistance training being too difficult/intense (10.2%) were the 
main barriers to treatment [21]. This suggests that potential barriers to sarcopenia treatment may be country 
 
 
 
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and patient specific but supports best practice clinical guidelines which recommends personalized treatment 
plans that address individual health/medical status, needs and preferences. 
 
Strengths and limitations 
This is the first Australian national study (and largest globally) to examine knowledge, awareness, practices, 
behaviours, perceptions, beliefs and attitudes towards muscle health, and barriers related to exercise and 
nutrition to optimise muscle health and prevent sarcopenia. Additional strengths of this study include the 
high survey completion rate (88%), and the anonymous nature of the survey which minimizes social-
desirability bias. Limitations include: 1) the use of a custom survey since there are no validated muscle 
health/sarcopenia surveys related to the study aims for community-dwelling adults; 2) the use of an online 
survey which was only available in English; 3) the potential for selection bias with recruitment since some 
participants were recruited from our exiting research database who may have pre-existing knowledge/interest 
in muscle health as they were mostly recruited for exercise/nutrition interventions, and 4) the inclusion of 
predominantly Caucasian adults (~91%) aged 60-80 years (~78%), women (~70%), those residing in 
metropolitan regions (~76%), and with University/Tertiary level education (~44%) which limits the 
generalizability of our findings, particularly for people living in rural/remote locations and other ethnicities 
including Aboriginal and Torres Strait Islanders. For comparison, it is estimated that 35% of the Australian 
population is aged 50 years and over (16% are aged 65 years and over), 54% are female, 85-90% are of 
European ancestry, around two-thirds reside in major cities and one-quarter having a bachelor degree or 
higher [37,38]. Therefore, further research may be required to understand the perspectives of populations that 
were not well represented in our cohort, including males, First Nations people and those from other non-
Caucasian backgrounds, those residing in regional, rural and remote locations, and people with lower 
education levels. 
5. Conclusion 
Community-dwelling middle-aged and older Australian adults demonstrated an awareness of the importance 
of muscle health, common signs/symptoms, risk factors, and consequences of poor muscle health, key 
strategies required for its maintenance and a willing to act if their muscle health is at risk. However, many 
 
 
 
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lack knowledge and confidence to adopt lifestyle changes to manage their muscle health. This suggests 
healthcare professionals must play an active role to support consumers to recognise signs/symptoms and risk 
factors for poor muscle health and to provide guidance on effective evidence-based lifestyle interventions to 
optimize muscle health. 
 
 
Acknowledgement 
The authors thank Belinda De Ross and Jenny Gianoudis for their assistance with preparing the study 
database and survey in the Qualtrics platform and all the clinicians that completed the survey. 
 
CRediT authorship contribution statement 
R. M Daly: Conceptualization, Methodology, Funding acquisition, Formal analysis, Writing – original draft, 
Writing – review & editing. D Scott: Conceptualization, Methodology, Funding acquisition, Writing – 
review & editing. N Kiss: Methodology, Writing – review & editing. M Tieland: Methodology, Writing – 
review & editing. B Baguley: Methodology, Writing – review & editing. J.J Fyfe: Methodology, Writing – 
review & editing. 
 
Funding 
This study was supported by an education grant from Abbott Australasia Pty Ltd. The sponsor was not 
involved in the conduct of the study, collection, management or analysis of the data or the decision to 
publish the results. 
 
Conflict of interest statement 
RMD reports honoraria and/or consulting fees from Abbott Australasia Pty Ltd and honoraria from Fresenius 
Kabi. DS is supported by a National Health and Medical Research Council Australia Investigator Grant 
(GNT1174886) and reports consulting fees from Pfizer Consumer Healthcare and Abbott Australasia Pty 
Ltd. He has received research funding from Amgen and Alexion AstraZenica Rare Disease. NK reports 
honoraria from Abbott Australasia Pty Ltd. MT, BB, JF report no conflicts of interest. 
 
 
 
 
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Data Statement 
The dataset usedfor this study is available from the corresponding author on reasonable request. 
 
 
 
 
 
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Table 1: Characteristics of participants 
Characteristics All Men Women 
N * 1261 365 894 
Age, years 66.3 ± 7.6 67.3 ± 7.6 65.9 ± 7.5 
50 to80 and above 49 (3.9%%) 14 (3.8%) 35 (3.9%) 
Ethnicity 
Caucasian 1152 (91.4%) 338 (92.6%) 812 (90.8%) 
Asian 80 (6.3%) 14 (3.8%) 66 (7.4%) 
Other 29 (2.3%) 13 (3.6%) 16 (1.8%) 
State/Territory, n (%) 
Victoria 657 (52.1%) 148 (40.5%) 508 (56.8%) 
New South Wales 217 (17.2%) 74 (20.3%) 143 (16.0%) 
Queensland 165 (13.1%) 67 (18.4%) 98 (11.0%) 
South Australia 77 (6.1%) 20 (5.5%) 56 (6.3%) 
Western Australia 80 (6.3%) 35 (9.6%) 45 (5.0%) 
Tasmania 34 (2.7%) 11 (3.0%) 23 (2.6%) 
Australian Capital Territory 22 (1.7%) 6 (1.6%) 16 (1.8%) 
Northern Territory 9 (0.7%) 4 (1.1%) 5 (0.6%) 
Geographical Location, n (%) 
1
 
Metropolitan 952 (75.5%) 248 (68.1%) 703 (79%) 
Regional 137 (10.9%) 60 (16.5%) 76 (8.5%) 
Rural/remote 167 (13.2%) 56 (15.4%) 111 (12.5%) 
Highest Education 
Primary school or some high school 70 (5.6%) 24 (6.4%) 45 (5.0%) 
Completed high school 140 (11.1%) 47 (12.9%) 93 (10.4%) 
Technical Trade Certificate / TAFE 190 (15.1%) 74 (20.3%) 116 (13.0%) 
Graduate diploma or certificate 301 (23.9%) 71 (19.5%) 229 (25.6%) 
University / Tertiary level 560 (44.4%) 149 (40.8%) 411 (46.0%) 
Current Health Status Rating 
2
 77 ± 15 78 ± 14 77 ± 15 
SARC-F (n=1103), mean (median) 1.0 (0.0) 0.7 (0.0) 1.1 (1.0) 
 0 574 (52.0%) 188 (64.4%) 385 (47.5%) 
 1 246 (22.3%) 54 (18.5%) 192 (23.7%) 
 2 122 (11.1%) 21 (7.3%) 101 (12.5%) 
 3 83 (7.5%) 15 (5.1%) 68 (8.4%) 
 ≥4 78 (7.1%) 14 (4.8%) 64 (7.9%) 
* Two participants reported ‘prefer not to say’ to what is your sex question or unless stated. 
1
 Based on 
Modified Monash Model: metropolitan – Modified Monash (MM) category 1; regional – MM category 2; 
rural/remote – MM category 3-7. Values represent means  SD or number (n) with proportions (%). 
2
 
Current health status rating ranges from 0 (worst health) to 100 (best health). 
 
 
 
23 
 
Table 2: Participants (n=1206) knowledge of the signs/symptoms, risk factors, consequences and effective 
treatment options related to low muscle mass, strength and/or impaired function. Correct responses represent 
the proportion of participants that identified the correct answer and are ranked from highest to lowest. 
 Correct (%) Don’t Know (%) 
 Signs and symptoms (n=1252) 
Trouble lifting, carrying or opening items 95.9% 1.7% 
Difficulty getting out of a chair 93.3% 2.7% 
Difficulty climbing stairs 91.2% 4.6% 
More frequent falling 88.6% 6.3% 
Walking more slowly 87.7% 7.5% 
Losing weight without trying 44.4% 29.0% 
Gain in body weight or body fat * 26.9% 32.4% 
More frequent muscle cramps or spasms * 24.1% 40.2% 
Increase in resting heart rate * 21.3% 42.7% 
Persistent muscle pain or discomfort * 16.5% 27.4% 
Stiff or inflexible muscles * 10.4% 13.6% 
Mean (±SD) % scores for correct responses 52.6 ± 16.9 
 Risk factors (n=1206) 
Sedentary lifestyle 97.7% 1.7% 
Increasing age 96.2% 1.6% 
Poor nutritional intake 95.0% 3.5% 
Low dietary protein intake 86.6% 11.4% 
Presence of other chronic conditions 84.3% 12.9% 
Short-term bed rest (about their muscle health. 
Concerned about potential impact of sarcopenia in the 
future (n=1124) 
Not at all Slightly Moderately Very Extremely 
8.5% 18.8% 25.1% 29.3% 18.3% 
Concerned that sarcopenia will impact ability to do 
everyday activities (n=1124) 
Not at all Slightly Moderately Very Extremely 
9.5% 22.0% 27.7% 25.8% 15.0% 
Thought of having sarcopenia is scary (n=1124) 
Not at all A little Somewhat A lot Completely 
8.5% 18.8% 26.3% 29.4% 17.0% 
Don’t have knowledge to adopt lifestyle changes to 
reduce sarcopenia risk (n=1124) 
Strongly disagree Disagree Neutral Agree Strongly agree 
16.1% 36.9% 21.7% 20.8% 4.4% 
Confidence to adopt healthy lifestyle habits to reduce 
sarcopenia risk (n=1124) 
Not at all Somewhat Moderately Very Extremely 
4.0% 11.7% 30.6% 31.1% 22.7% 
Confidence to seek/understand information to reduce 
sarcopenia risk (n=1124) 
Not at all Slightly Moderately Very Extremely 
1.4% 10.3% 24.6% 36.6% 27.2% 
 
 
 
 
 
28 
 
Figure Captions 
 
Figure 1: Participants (n=1206) knowledge of age-related changes in muscle mass and strength. 
 
Figure 2: Participants (n=1100) barriers towards engaging in regular exercise, particularly muscle 
strengthening activities, for muscle health or reducing the risk of sarcopenia. 
 
Figure 3: Participants (n=1100) barriers towards maintaining a nutritious diet for muscle health or 
reducing the risk of sarcopenia. 
 
 
 
 
 
 
 
 
 
29 
 
 
 
Figure 1 
 
 
 
30 
 
 
 
Figure 2 
 
 
 
31 
 
 
 
Figure 3 
 
 
 
 
 
 
 
32 
 
Declaration of interests 
 
☐ The authors declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this paper. 
 
☒ The authors declare the following financial interests/personal relationships which may be 
considered as potential competing interests: 
 
Robin M. Daly reports financial support was provided by Abbott Australasia Pty Ltd. Robin M. Daly 
reports a relationship with Abbott Australasia Pty Ltd that includes: consulting or advisory and 
speaking and lecture fees. Robin M. Daly reports a relationship with Fresenius Kabi Australia Pty Ltd 
that includes: speaking and lecture fees. If there are other authors, they declare that they have no 
known competing financial interests or personal relationships that could have appeared to influence 
the work reported in this paper. 
 
 
 
Declaration of interests 
 
☐ The authors declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this paper. 
 
☒ The authors declare the following financial interests/personal relationships which may be 
considered as potential competing interests: 
 
David Scott reports financial support was provided by National Health and Medical Research Council. 
David Scott reports a relationship with Pfizer Inc that includes: consulting or advisory. David Scott 
reports a relationship with Abbott Nutrition that includes: consulting or advisory. David Scott reports 
a relationship with Alexion Pharmaceuticals Australasia Pty Ltd that includes: funding grants. If there 
are other authors, they declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this paper. 
 
 
 
 
 
 
 
Declaration of interests 
 
☐ The authors declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this paper. 
 
 
 
33 
 
 
☒ The authors declare the following financial interests/personal relationships which may be 
considered as potential competing interests: 
 
Nicole Kiss reports financial support was provided by Deakin University. Nicole Kiss reports a 
relationship with Abbott Nutrition that includes: consulting or advisory and speaking and lecture 
fees. If there are other authors, they declare that they have no known competing financial interests 
or personal relationships that could have appeared to influence the work reported in this paper. 
 
 
Declaration of interests 
 
☒ The authors declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this paper. 
 
 ☐The authors declare the following financial interests/personal relationships which may be 
considered as potential competing interests: 
 
All other authors declare that they have no known competing financial interests or personal 
relationships that could have appeared to influence the work reported in this paper.