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SYSTEMATIC REVIEW article

Front. Nutr.

Sec. Sport and Exercise Nutrition

Volume 12 - 2025 | doi: 10.3389/fnut.2025.1685014

This article is part of the Research TopicSports, Nutrition and Public Health: Analyzing their Interconnected ImpactsView all 33 articles

Exercise and nutrition strategies for sarcopenia in older adults: evidence from a network meta-analysis based on EWGSOP and AWGS criteria

Provisionally accepted
Rongting  ZhaoRongting Zhao1Yangjian  DongYangjian Dong1,2Quansheng  ZhengQuansheng Zheng1,3Jiwei  YaoJiwei Yao1*
  • 1Guangxi Normal University, Guilin, China
  • 2China Three Gorges University, Yichang, China
  • 3Guizhou University of Commerce, Guiyang, China

The final, formatted version of the article will be published soon.

Objectives: This network meta-analysis aimed to evaluate the comparative effectiveness of different exercise and nutritional interventions on muscle strength, skeletal muscle mass, and physical function in older adults with sarcopenia diagnosed according to the European Working Group on Sarcopenia in Older People and Asian Working Group for Sarcopenia criteria. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to August 2025. A Bayesian random-effects network meta-analysis was performed, with additional subgroup and meta-regression analyses. Certainty of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework, and interventions were ranked according to their relative effectiveness and certainty of evidence. Results: A total of 35 randomised controlled trials involving 2331 participants were included. Exercise combined with nutritional supplementation was the most effective intervention for improving handgrip strength (MD = 3.69, 95% CrI 0.72 to 5.10; SUCRA 99.04%), gait speed (MD = 0.11, 95% CrI 0.03 to 0.17; SUCRA 87.12%), and appendicular skeletal muscle mass index (ASMI) (MD = 0.35, 95% CrI 0.19 to 0.49; SUCRA 99.82%), with improvements in handgrip strength and ASMI significantly greater than those achieved with Exercise or Nutrition alone. Exercise alone improved handgrip strength, gait speed, and ASMI, whereas protein supplementation alone improved handgrip strength and gait speed but had no significant effect on ASMI. Subgroup analyses indicated that resistance training with protein supplementation produced the most significant improvements in handgrip strength and gait speed. In contrast, resistance training with protein and vitamin D supplementation was most effective for improving ASMI. Meta-regression analysis did not identify any significant sources of heterogeneity. Conclusions: These findings support combined exercise and nutritional interventions as a preferred treatment option for improving muscle strength, muscle mass, and physical function in older adults with sarcopenia. However, the overall certainty of the evidence ranged from low to very low. In particular, multicomponent exercise programmes centred on resistance training and combined with protein supplementation may offer superior benefits for enhancing muscle strength and physical function.

Keywords: Sarcopenia, Exercise, nutrition, older adults, Resistance Training

Received: 13 Aug 2025; Accepted: 30 Sep 2025.

Copyright: © 2025 Zhao, Dong, Zheng and Yao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jiwei Yao, 15150550801@163.com

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