Comparative efficacy of combined exercise and nutritional interventions for sarcopenia: A systematic review and network meta-analysis incorporating remote delivery models.

OBJECTIVE To identify the most effective interventions to delay the progression of sarcopenia and potentially improve muscle strength and mass, with the ultimate goal of reversing sarcopenia, by comparing all pharmacological and non-pharmacological interventions.

DESIGN Systematic review and network meta-analysis.

FINDINGS This analysis identified 115 randomized controlled trials (RCTs) with 10,967 participants which an average age of 74.85 years, together evaluating 27 different interventions. For the primary outcome, endurance training followed by resistance training yielded the highest effect on muscle strength (SMD 2.59, 95% CI 1.50 to 3.69), while general remote training was most effective for lean mass (SMD 1.35, 95% CI 0.41 to 2.29) and physical performance (SMD 2.39, 95% CI 1.26 to 3.53). The combination of nutrition with aerobic and resistance training significantly improved muscle strength (SMD 1.25, 95% CI 0.64 to 1.87) and physical performance (SMD 1.73, 95% CI 1.09 to 2.37). Resistance training significantly improved multiple secondary outcomes: body fat mass (SMD -0.57, 95% CI -0.75 to -0.40), blood inflammatory markers (SMD -1.69, 95% CI -1.95 to -1.43), and knee extension strength (SMD 0.55, 95% CI 0.33 to 0.76). Aerobic exercise reduced body fat (SMD -0.48, 95% CI -0.87 to -0.09) and inflammation (SMD -1.98, 95% CI -2.31 to -1.66), while improving quality of life (SMD 0.71, 95% CI 0.53 to 1.03). Subgroup and meta-regression analyses identified sample size, age, and intervention duration as significant moderators of treatment effects, while sensitivity analyses confirmed the robustness of findings to statistical methods.

CONCLUSIONS This network meta-analysis concludes that applying a multimodal approach involves combining resistance training, aerobic exercise, and targeted nutrition to the sarcopenia population, which will be the most effective strategy for managing sarcopenia. Future efforts should focus on enhancing remote intervention delivery to improve accessibility and adherence among older adults.