Exercise for sarcopenia in older people: A systematic review and network meta‐analysis

Abstract

Background Sarcopenia is a serious public health concern among older adults worldwide. Exercise is the most common intervention for sarcopenia. This study aimed to compare the effectiveness of different exercise types for older adults with sarcopenia. Methods Randomized controlled trials (RCTs) that examined the effectiveness of exercise interventions on patient-important outcomes for older adults with sarcopenia were eligible. We systematically searched MEDLINE, Embase and Cochrane Central Register of Controlled Trials via Ovid until 3 June 2022. We used frequentist random-effects network meta-analyses to summarize the evidence and applied the Grading of Recommendations, Assessment, Development, and Evaluations framework to rate the certainty of evidence. Results Our search identified 5988 citations, of which 42 RCTs proved eligible with 3728 participants with sarcopenia (median age: 72.9 years, female: 73.3%) with a median follow-up of 12 weeks. We are interested in patient-important outcomes that include mortality, quality of life, muscle strength and physical function measures. High or moderate certainty evidence suggested that resistance exercise with or without nutrition and the combination of resistance exercise with aerobic and balance training were the most effective interventions for improving quality of life compared to usual care (standardized mean difference from 0.68 to 1.11). Moderate certainty evidence showed that resistance and balance exercise plus nutrition (mean difference [MD]: 4.19 kg) was the most effective for improving handgrip strength (minimally important difference [MID]: 5 kg). Resistance and balance exercise with or without nutrition (MD: 0.16 m/s, moderate) were the most effective for improving physical function measured by usual gait speed (MID: 0.1 m/s). Moderate certainty evidence showed that resistance and balance exercise (MD: 1.85 s) was intermediately effective for improving physical function measured by timed up and go test (MID: 2.1 s). High certainty evidence showed that resistance and aerobic, or resistance and balance, or resistance and aerobic exercise plus nutrition (MD from 1.72 to 2.28 s) were intermediately effective for improving physical function measured by the five-repetition chair stand test (MID: 2.3 s). Conclusions In older adults with sarcopenia, high or moderate certainty evidence showed that resistance exercise with or without nutrition and the combination of resistance exercise with aerobic and balance training were the most effective interventions for improving quality of life. Adding nutritional interventions to exercise had a larger effect on handgrip strength than exercise alone while showing a similar effect on other physical function measures.

iMS‐Bmal1−/− mice show evident signs of sarcopenia that are counteracted by exercise and melatonin therapies

“…There is increasing evidence in mice and humans that physical exercise and melatonin have a protective role in age-related sarcopenia, 22,[49][50][51][52][53] including studies from our laboratory. 19,26,27 Exercise helps people with sarcopenia, although it is not sufficient to prevent or reverse this disease.…”

“…67 On the other hand, exercise is known to improve sarcopenia in the older and it may prevent the loss of skeletal muscle fibers. [49][50][51] So, a primary intervention in humans could in exercise plus 50 mg melatonin in a daily schedule, although it would be very interesting to do a clinical trial to assess these approaches.…”

“…Studies conducted in resistance‐trained athletes showed an alteration of their motor activity rhythm that was restored after daily administration of 100 mg melatonin for 4 weeks 67 . On the other hand, exercise is known to improve sarcopenia in the older and it may prevent the loss of skeletal muscle fibers 49–51 . So, a primary intervention in humans could in exercise plus 50 mg melatonin in a daily schedule, although it would be very interesting to do a clinical trial to assess these approaches.…”

Myoprotective whole foods, muscle health and sarcopenia in older adults

“…As there are currently no approved drugs for sarcopenia [6 ▪ ], a healthy lifestyle comprising a high-quality diet and resistance exercise have been championed as the most effective strategy for sarcopenia prevention and treatment [7,8 ▪▪ ,9 ▪▪ ,10 ▪ ]. The nutrition-sarcopenia research field has grown substantially since the implementation of the sarcopenia concept 30 years ago [11], and several nutrition approaches have been adopted to test their effectiveness in mitigating sarcopenia; from a single nutrient to a whole food and a whole diet approach [9 ▪▪ ,12 ▪ ].…”

Impact of Chinese herbal medicine on sarcopenia in enhancing muscle mass, strength, and function: A systematic review and meta‐analysis of randomized controlled trials

“…However, the interventions are still in the experimental stage, and their long-term effectiveness in preventing or treating sarcopenia is not well-established. Exercise therapies, especially resistance training (Vikberg et al, 2019) and aerobic exercise (Shen et al, 2023), have been established as effective interventions to prevent and treat sarcopenia but compliance with exercise regimens, especially resistance training, can be challenging for older individuals due to physical limitations, comorbidities, or lack of motivation. In terms of nutritional interventions, research has consistently highlighted the role of protein (Rogeri et al, 2021), amino acids (Cereda et al, 2022), and other nutrients in preventing muscle loss.…”