Nutritional and Exercise Interventions for Sarcopenia in Older Adults: A Systematic Review and Network Meta-Analysis

Abstract

Maximiliano Arlettaz, Daniel Jesus Garcia Martinez, Pratyush Kumar, Amrit Sharma, Kumar Abhishek, Ronahy Haidar, Sneha Kurian, Pratibha Thomas, Roberta Voci, Sukanya Nachimuthu, Mohamed Khaled Al-Haggagi, Asmitha Prabhakara Reddy and Ewelina Baginska

Background and Purpose: Sarcopenia is a progressive condition that impairs strength, physical function, and quality of life in older adults. Both nutritional and exercise interventions have been proposed, but their comparative effectiveness remains unclear. This systematic review and network meta-analysis aimed to evaluate the effects of these interventions on muscle strength, mass, and physical performance in older adults with sarcopenia.

Methods: Electronic databases (PubMed, Embase, Scopus, Cochrane CENTRAL, and Web of Science) were searched from inception to February 2024 for randomized controlled trials including adults aged ≥60 years with sarcopenia. Eligible studies evaluated nutritional or exercise interventions and reported outcomes on handgrip strength, appendicular muscle mass, or gait speed. A frequentist random-effects model was used to conduct the network meta-analysis. Treatment effects were expressed as standardized mean differences with 95% confidence intervals and ranked using P-scores. Publication bias and heterogeneity were assessed.

Results and Discussion: Twenty studies were included. For handgrip strength, no intervention produced significant effects. Vitamin C (treatment effect [TE]: 0.148, P-score: 0.65) and vitamin E (TE: 0.091, P-score: 0.64) ranked highest, followed by resistance training (TE: 0.081, Pscore: 0.62). For appendicular muscle mass, resistance training showed the most favorable trend (TE: 0.436, P-score: 0.66), while protein supplementation was associated with a negative effect (TE: –0.235, P-score: 0.23). Gait speed improved significantly only with calcium supplementation (TE: 1.174; 95% CI: 0.294 to 2.053; p = 0.009; P-score: 0.89).

Conclusions: Calcium supplementation demonstrated a significant improvement in gait speed, while resistance training showed favorable trends across multiple outcomes. These findings underscore the clinical importance of promoting resistance exercise and highlight calcium as a potential adjunct to enhance physical performance in older adults with sarcopenia.

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