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Malnutrition and physical frailty are major complications of decompensated cirrhosis. They are associated with significant morbidity (ie, unplanned hospitalisation, critical care unit utilisation, infections) and a two-fold increase in mortality. It is, therefore, essential to identify patients at risk and initiate specific nutritional, lifestyle, exercise and mental health interventions to stabilise and/or ideally reverse the negative effects of physical frailty. This overview aims to summarise the clinical tools available to assess nutritional status and physical frailty, together with the benefits and future challenges of a multidisciplinary team approach to optimise muscle health and physical fitness in patients with decompensated cirrhosis.