Sarcopenia Risk Assessment Tool

1

What is your age?

Under 50 years old 50-64 years old 65 years or older

2

Hand Grip Strength Assessment

Can you open a tightly sealed jar without assistance?

Yes No

Do you have difficulty carrying a bag of groceries?

No difficulty Yes, I have difficulty

Can you squeeze a tennis ball firmly?

Yes No

3

Physical Activity Level

"Daily" physical activity means at least 30 minutes per day

High - Physical activity daily (7 days/week) Moderate-High - 4-5 days per week Moderate - 2-3 days per week Low - 1 day or less per week

4

Chronic Health Conditions

Please select any conditions that apply to you:

Diabetes Mellitus Cardiovascular Disease Hypertension Recent Cancer (within one year)

5

Medical History

Past Bariatric Surgery Past GLP-1 Medication Use

🔍 Sarcopenia Risk Assessment