Cluster Randomized Trial of Reablement Strategies Targeting Sarcopenia (ReStart-S) in Long-Term Care Settings

Background Sarcopenia prevalence is high in long-term care settings (LTCS), yet existing guidelines often overlook this population. The Reablement Strategies targeting Sarcopenia (ReStart-S) program was developed to address this gap. This study evaluated its effects on muscle outcomes, physical performance, quality of life (QoL), and a blood biomarker. Methods A cluster-randomized trial was conducted in LTCS across Udupi and neighbouring districts. Sarcopenic older adults (≥60 years, Barthel Index ≥60, Mini-Cog ≥3, AWGS-2019 criteria) were recruited. LTCS were randomized into intervention (IG) and control (CG) groups. IG received a 6-week ReStart-S program, while CG continued usual activities. Outcomes at baseline, 6, 12, and 18 weeks included handgrip strength (HGS, primary outcome), skeletal muscle index, Short Physical Performance Battery (SPPB), SarQoL, and C-terminal Agrin Fragment (CAF; not assessed at 12 weeks). Linear mixed models evaluated group*time interactions with Bonferroni correction. Results Of 12 LTCS screened, 7 were eligible; 78 participants enrolled (IG = 39; CG = 39). CG was older than IG (74.3 ± 9.4 vs. 67.9 ± 6.0; p < 0.001). Significant group*time interaction was observed for HGS (F = 5.524; p = 0.001), improving at 12 (2.49; 95% CI: 1.16–3.82; p < 0.001) and 18 weeks (2.14; 0.79–3.48; p = 0.002). SPPB improved at 6, 12, and 18 weeks (all p < 0.001). SarQoL improved at all follow-ups (all p < 0.001). Skeletal muscle index improved at 18 weeks (0.20; p = 0.011). CAF decreased at 18 weeks (-61.77; p < 0.001). Conclusion ReStart-S improved muscle strength, physical performance, and QoL, reduced CAF, and showed delayed muscle mass gains, supporting its role in sarcopenia care in LTCS.