Exercise and Nutritional Interventions for Muscle Strength, Physical Performance, and Body Composition Among Older Adults With Sarcopenia or Pre‐Sarcopenia: A Network Meta‐Analysis
HongXia Yang, Qian Wang, BiQing Wang, JunNan Zhao, XiaoLei Xie, FengQin Xu, Ning Xiao, Ping ZhangABSTRACT
Objective
To compare the relative effects of exercise and nutritional interventions on muscle strength, physical performance, muscle mass, and body composition‐related outcomes in older adults with sarcopenia or pre‐sarcopenia using network meta‐analysis.
Methods
PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to August 8, 2026. Randomized controlled trials (RCTs) comparing exercise, nutritional, or combined interventions with control strategies in older adults with sarcopenia or pre‐sarcopenia were included. A frequentist network meta‐analysis compared four intervention nodes (Control, Exercise, Nutrition, and Combined). Risk of bias was assessed with RoB 2, and certainty of evidence with CINeMA.
Results
Sixty‐five reports representing 57 RCTs and 6017 participants were included. Compared with Control, Combined, Nutrition, and Exercise improved handgrip strength, with the largest estimate for Combined (mean difference [MD] 4.29 kg, 95% confidence interval [CI], 2.50–6.07; p ‐score 0.877). For physical function, Exercise improved the Timed Up and Go test (TUG; MD 1.19 s, 95% CI, 0.72–1.66) and ranked highly for gait speed (MD 0.11 m/s, 95% CI, 0.06–0.17). For appendicular skeletal muscle mass index (ASMI), Combined, Exercise, and Nutrition increased ASMI, with Combined ranked highest (MD 0.32 kg/m 2 , 95% CI, 0.17–0.48; p ‐score 0.831). Overall certainty of evidence was limited according to CINeMA.
Conclusions
Exercise and nutritional strategies showed different relative effects across clinical outcomes in older adults with sarcopenia or pre‐sarcopenia. Combined exercise and nutrition ranked more favorably for selected muscle‐related outcomes, whereas exercise showed a more consistent pattern of benefit for physical performance. These findings require confirmation in high‐quality trials because the overall certainty of evidence was limited.