Comparative Effectiveness of Exercise and Protein-Based Interventions on Muscle Strength, Mass, and Function in Sarcopenia: A Systematic Review and Network Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of clinical trials
PubMed 41205420 · doi:10.1016/j.jnha.2025.100718
What was done
A systematic review and frequentist random-effects network meta-analysis of trials indexed in PubMed, Embase, Web of Science, and Cochrane CENTRAL through December 2024. The authors evaluated the comparative effectiveness of different exercise modalities (voluntary and simulated), protein-based nutritional supplementation, and their combinations on muscle strength, physical function, and muscle mass in individuals with sarcopenia. Evidence certainty was evaluated using the GRADE framework.
What was found
Across 96 studies and 7,596 participants: - Resistance and balance training combined with protein-based nutrition (RBT + Nu) was most effective for grip strength (MD = 5.45 kg, 95% CI: 3.58 to 7.33), gait speed (MD = 0.20 m/s, 95% CI: 0.11 to 0.29), SPPB (MD = 3.59 points, 95% CI: 1.91 to 5.27), and skeletal muscle index (MD = 0.95 kg/m², 95% CI: 0.16 to 1.74). - RBT alone achieved the largest improvement in the Timed Up and Go test (MD = -2.29 s, 95% CI: -3.16 to -1.41). - Aerobic and resistance training with nutrition was most effective for the five-times sit-to-stand test (MD = -2.86 s, 95% CI: -4.55 to -1.17). - Resistance training with nutrition yielded the largest gains in knee extension strength (SMD = 0.98, 95% CI: 0.63 to 1.33) and appendicular skeletal muscle mass (MD = 0.33 kg/m², 95% CI: 0.27 to 0.38). - Combined aerobic, resistance, and balance training produced the greatest benefit on balance performance (SMD = 0.73, 95% CI: 0.13 to 1.34).
Why it matters
This network meta-analysis identifies resistance and balance training paired with protein-based supplementation as the most effective combined intervention for sarcopenia, with functional gains in gait speed and SPPB exceeding minimal clinically important difference thresholds.
Limits
The abstract does not provide details on intervention durations, specific protein types or doses, participant adherence, baseline severity or diagnostic criteria differences across included trials, or long-term post-intervention maintenance of functional gains.
Cited by
- partial Two to three sessions per week of resistance training is the only intervention that reverses sarcopenia.