Exercise interventions of ≥8 weeks improve body composition, physical function, metabolism, and inflammation in older adults with stage I sarcopenic obesity: a systematic review and meta-analysis

Huiting Wei^1,2Jiabao Zhang²Kaiyin Cui^1,2Hao Su^2*

• ¹Beijing Sport University, Beijing, China
• ²School of Sports and Human Sciences, Beijing Sport University, Beijing, Beijing Municipality, China

This study aimed to assess the benefits of 8-week-plus exercise interventions for stage I sarcopenic obesity (SO) without complications. Randomized controlled trials (RCTs) from 2004 to July 2024 were searched in PubMed, Embase, Web of Science, Cochrane Library, and EBSCO. Publication bias was assessed via funnel plots and Egger's test; heterogeneity (I² >50%) was managed with random-effects models. Fifteen parallel-group RCTs involving 623 elderly (≥60 years) patients were included. The results showed that exercise significantly reduced BMI (MD = -0.58, P < 0.0001), with combined exercise (CE) most effective (MD = -0.67, P < 0.0001). Body fat percentage decreased (MD = -0.52, P < 0.00001), with CE outperforming resistance training (RT). No significant changes in fat mass or muscle mass indices were found (fat mass: P = 0.19; appendicular skeletal muscle mass: P = 0.88; appendicular skeletal muscle mass index: P = 0.86). Physical function (grip strength, gait speed, timed Up and Go test) improved significantly (P < 0.00001); RT and CE enhanced muscle strength, with RT superior (MD= 3.43 vs. 2.64, both P < 0.00001). Additionally, CE lowered insulin (MD = -1.73, P < 0.05) and total cholesterol (MD = -11.07, P < 0.05), with marginal IL-6 reduction (MD = -0.51, P = 0.08); other metabolic and inflammatory markers (glucose, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, tumor necrosis factor-α, and C-reactive protein) were unchanged. Overall, these data indicate that 8-week-plus exercise improves body composition in stage I SO, with CE superior for fat loss. Functional indices improve with both RT and CE, and RT is better for muscle strength; CE benefits metabolism and inflammation. We recommend that CE (≥3 times/week, 45 minutes/session, including aerobic exercise and RT) for high inflammation and RT (2 times/week, 60%-80% 1-RM) for low inflammation. Based on observed data trends, promoting a CE model of 3 AR + 2 RT sessions weekly is advisable, with intensity adjusted to 40%-50% 1-RM for elderly patients. Future research needs large-sample, long-term RCTs with subgroup analyses and exercise-nutrition combinations.