Clinical Assessment and Exercise Rehabilitation of Sarcopenia in Cardiovascular Disease

Sarcopenia complicates cardiovascular disease, but diagnostic definitions and outcome selection can substantially alter the interpretation of exercise rehabilitation. This critical review examines how these differences affect the translation of muscle biology into clinical assessment and treatment, with heart failure as the principal clinical setting. Targeted literature retrieval prioritized recent consensus statements, clinical studies, and intervention trials, while experimental evidence was considered separately. Human biopsy studies associate inflammatory and mitochondrial abnormalities with muscle dysfunction; causal manipulation of muscle-derived signaling remains predominantly experimental. European and Asian consensus frameworks differ in their thresholds and the diagnostic role of physical performance. These distinctions matter because trials frequently enroll patients with frailty or exercise intolerance without confirming sarcopenia. Resistance and combined interventions improve selected measures of strength or physical performance, whereas muscle quantity, diagnostic status, and clinical events may respond differently. A small coronary artery disease trial provides direct, short-term evidence in confirmed sarcopenia, but durability remains uncertain. Rehabilitation should therefore link an explicit diagnostic framework to individualized exercise, nutritional assessment, and repeated measurement of the intended outcomes. Future trials should establish whether improvements in defining muscle components persist and translate into sustained independence and fewer clinical events.