COVID-19 has sharply increased the risk and severity of muscle loss (sarcopenia), with almost half of acute COVID patients and one in four long-COVID patients affected, according to new meta-analyses and recent reviews. This page examines how COVID-related inflammation, inactivity, and hormonal imbalances accelerate muscle breakdown, leading to poorer outcomes such as prolonged hospital stays, higher mortality, and persistent weakness even a year after infection. While muscle loss is common in aging—with 15-20% of older adults affected—COVID-19 amplifies this decline and creates new challenges for recovery. The page includes information about non-standing exercises to build muscle with Vitamin D
- SARS-CoV-2 Sarcopenia: An Update - Sept 2025
- Sarcopenia and COVID-19 Outcomes - March 2023
- Sarcopenia prevalence: COVID 48%, Long-COVID 23% - meta-analysis June 2025
- Muscles still weak 1 year into long-COVD - Aug 2025
- Sarcopenia non-COVID seniors is 15% to 20% (losing 5 lbs of muscle per decade)
- Related in Vitamin D Life
- Exercises which are seated, recumbent, or supine are better than standing if long-COVID, CFS, and Fibromyalgia (minimize POTS problems)
SARS-CoV-2 Sarcopenia: An Update - Sept 2025
Journal of Research and Practice on the Musculoskeletal System | Vol. 9, No. 3 | 104-114 104
Ioannis Kourniotis1,2, George I. Lambrou2,3,4,5 Greece
Sarcopenia, characterized by the loss of muscle mass and strength, has become a critical concern during the COVID-19 pandemic, influencing patient outcomes such as extended hospital stays, higher mortality, and slower recovery. Factors like chronic inflammation, immune dysfunction, respiratory muscle impairment, and sarcopenic dysphagia contribute to these poor outcomes. COVID-19 exacerbates sarcopenia through mechanisms such as cytokine storms, hormonal imbalances, hypoxia, and mitochondrial dysfunction, all of which accelerate muscle degradation and functional decline. Additionally, the pandemic's impact on physical activity, nutritional status and mental welfare has further worsened sarcopenia, especially in older adults and vulnerable populations. The relationship between COVID-19 and sarcopenia is bidirectional, where muscle loss compromises the immune response, increasing the risk of severe infection, while COVID-19 itself accelerates muscle wasting through inflammation, physical inactivity, malnutrition, and other factors. This interplay heightens vulnerability, prolongs recovery, and worsens overall health outcomes, emphasizing for effective management strategies. Addressing sarcopenia through tailored exercise programs and nutritional interventions is vital for improving long-term recovery and reducing the pandemic's lasting health effects.
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Sarcopenia and COVID-19 Outcomes - March 2023
Clinical Interventions in Aging, , 359-373, https://doi.org/10.2147/CIA.S398386
Yuhan Wang, Shuwen Tan, Qihui Yan &Ying Gao
Coronavirus disease 2019 (COVID-19) spread rapidly and became a severe global public health threat. Older adults have a high risk of COVID-19 and its associated mortality. Sarcopenia has emerged as a predictor of poor outcomes in COVID-19 patients, including lengthy hospital stays, mortality, intensive care unit admission, need for invasive mechanical ventilation, and poor rehabilitation outcomes. Chronic inflammation, immune dysfunction, respiratory muscle dysfunction, and swallowing dysfunction may underlie the association between sarcopenia and the poor outcomes of COVID-19 patients. Interleukin 6 receptor blockers (tocilizumab or sarilumab) are recommended for treating patients with severe COVID-19, and their therapeutic effects on sarcopenia are of great interest. This review aimed to analyze the current reports on the association between sarcopenia and COVID-19 and provide an update on the contribution of sarcopenia to the severity and adverse outcomes of COVID-19 and its underlying mechanisms. We also aimed to explore the different screening tools for sarcopenia concurrent with COVID-19, and advocate for early diagnosis and treatment of sarcopenia. Given that the fight against the COVID-19 pandemic may be long-term, further research into understanding the effects of sarcopenia in patients infected with the Omicron variant is necessary.
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Sarcopenia prevalence: COVID 48%, Long-COVID 23% - meta-analysis June 2025
Prevalence and prognosis of sarcopenia in acute COVID-19 and long COVID: a systematic review and meta-analysis
Annals of Medicine Volume 57, 2025 - Issue 1 https://doi.org/10.1080/07853890.2025.2519678
Ying XuORCID Icon ,Jia-Wen Xu ,You WuORCID Icon ,Li-Juan Rong ,Li Ye ,Oscar H. FrancoORCID Icon
Background
A comprehensive investigation delineating the prevalence of sarcopenia across different infection phases, from acute COVID-19 to long COVID, is lacking. Meanwhile, the relationship between sarcopenia and adverse outcomes among COVID-19 patients remains inconsistent.
Materials and methods
A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, Web of Science, and Scopus, before 22nd February 2025, was conducted to identify studies assessing sarcopenia prevalence in acute COVID-19 and long COVID. Random effects meta-analyses were performed to estimate the pooled prevalence of sarcopenia for acute COVID-19 and long COVID patients. Subgroup analyses stratified by assessment tool, region, income, hospitalization status, and age were performed. The associations between sarcopenia and COVID-19-related clinical outcomes were further quantified.
Results
A total of 39 studies with 6,982 individuals were included.
The pooled prevalence of sarcopenia was
- 48.7% (95% confidence interval (CI): 39.6–57.9%) in acute COVID-19 and
- 23.5% (95% CI: 12.7–39.4%) in long COVID.
In acute COVID-19 patients, sarcopenia was not significantly associated with length of stay (mean difference = 2.215, 95% CI: −0.004 to 4.433), mechanical ventilation (Odds ratio (OR) = 1.80, 95% CI: 0.84–3.85), admission to the intensive care unit (OR = 1.05, 95% CI: 0.63–1.77), or mortality (OR = 1.41, 95% CI: 0.86–2.32), but was significantly associated with tracheostomy (OR = 2.48, 95% CI: 1.28–4.82).
Conclusion
In conclusion, our findings indicate that sarcopenia is highly prevalent in acute COVID-19 and persists in a substantial proportion of long COVID patients, suggesting prolonged muscle loss beyond the acute phase. Future well-designed studies are needed to further investigate the association between sarcopenia and short-term and long-term prognostic outcomes in both acute and long COVID patients.
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Muscles still weak 1 year into long-COVD - Aug 2025
Long COVID-19 alters muscle architecture and muscle-tendon force transmission: a one-year longitudinal study
Front. Physiol., 24 August 2025 Volume 16 - 2025 | https://doi.org/10.3389/fphys.2025.1641046
Introduction: There are limited studies on the long-term effects of COVID-19 on skeletal muscle morphology and architecture. Therefore, this study aims to address this gap by assessing the effects of prior COVID-19 infection on quadriceps muscle architecture and tendon-aponeurosis complex (TAC) properties over a one-year period, comparing three cohorts: individuals with moderate COVID-19, individuals with severe COVID-19, and a healthy control group.
Methods: Seventy participants were included in the study and allocated to three groups: moderate COVID-19 (n = 22), severe COVID-19 (n = 18), and control (n = 30). Four assessments were conducted over 1 year for the COVID groups. Maximal voluntary isometric (MVIC) knee extension contractions were performed on an isometric dynamometer, with simultaneous ultrasound imaging of the vastus lateralis (VL) and rectus femoris (RF) muscles. Fascicle length (FL) and pennation angle (PA) were obtained at rest and during MVIC, along with TAC displacement. Generalized Estimating Equation models were used to evaluate muscle variables, with “group” and “time” as factors. The model fit was adjusted, with ‘torque’ as a covariate.
Results: Regarding muscle architecture, FL was greater in the severe COVID-19 group during early post-infection assessments for the RF at rest (p = 0.043). Additionally, both COVID-19 groups exhibited longer VL fascicles compared to controls (p = 0.032). TAC displacement was reduced in the severe COVID-19 group (RF: p = 0.008; VL: p = 0.047) compared to control. TAC stiffness did not differ between groups (p = 0.517), but torque production demonstrated an effect on this variable (p = 0.001). Both COVID-19 groups presented reduced PA for the VL at rest (p = 0.012) compared to control. Additionally, torque played a crucial role in influencing PA in both muscles, at rest and during contraction.
Conclusion: Participants with severe COVID-19 exhibited alterations in muscle architecture, which may contribute to persistent muscular weakness even one-year post-infection. The findings underscore the potential role of muscle strength, particularly the impact of torque on TAC stiffness and PA across all groups. Long COVID-19 rehabilitation and exercise physiologists should prioritize quadriceps strengthening strategies to restore muscle architecture and optimize force transmission.
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Sarcopenia non-COVID seniors is 15% to 20% (losing 5 lbs of muscle per decade)
Related in Vitamin D Life
- Sarcopenia (muscle loss) fought by Vitamin D, exercise and protein - many studies
- Sarcopenia was 42% more likely if low vitamin D – Dec 2024
- Muscle loss with aging (Sarcopenia) is 7.7 X more likely if Vitamin D deficient – July 2023
- Seniors can restore lost muscle (Sarcopenia) – first restore vitamin D, then exercise – July 2018
- Restore in 1 month, start with high initial dosing (e.g. 50,000 IU daily for a week)
- Restore in 4-6 months if constant dosing (say 2,000 IU daily)
- Muscle loss (sarcopenia) may be both prevented and treated by Omega-3 – Feb 2019
- Sarcopenia (muscle loss) is reduced by vitamin D and many other supplements - July 2023
- Chronic Fatigue Syndrome reduced by D-Ribose – 2012
- Founder of Vitamin D Life uses D-Ribose to relieve muscle pain after intense exercise
- COVID fought by Vitamin D as well as both mild and intense exercise - March 2022
Exercises which are seated, recumbent, or supine are better than standing if long-COVID, CFS, and Fibromyalgia (minimize POTS problems)
The founder of Vitamin D Life uses his recumbent trike on a hill 7 minutes a day to build his muscles at age 79
Note: the seat is very high, so there are no problems with getting onto it Sun Seeker Trike
Physical therapists can recommend many other non-standing exercises
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