The effects of combined aerobic and resistance exercise on older adults with sarcopenia: a meta-analysis

This study investigated the effects of combined aerobic and resistance exercise on muscle strength, physical performance, and body composition in older adults with sarcopenia. A systematic search was conducted across PubMed, Web of Science, Embase, Scopus, The Cochrane Library, CINAHL, and SPORTDiscus for randomized controlled trials on combined exercise interventions for sarcopenia, covering studies up to January 18, 2026. Data were analyzed using Review Manager (version 5.4.1) and Stata 18.0. The search identified 24,102 records, from which 14 randomized controlled trials (involving 786 participants) met the inclusion criteria. The methodological quality of the included studies was generally high, and the independent quality assessments by two researchers showed substantial inter-rater agreement (K = 0.80). Meta-analysis showed that combined exercise can improve handgrip strength (MD = 2.68, 95%CI = 1.36-4.00, P = 0.000), the five-time chair stand test (5CST) (MD=-0.43, 95%CI=-0.65–-0.22, P = 0.000), gait speed (SMD = 0.08, 95%CI = 0.03–0.12, P = 0.001), skeletal muscle mass (SMM) (SMD = 0.62, 95%CI = 0.23–1.02, P = 0.002), skeletal muscle mass index (SMI) (SMD = 0.42, 95%CI = 0.14–0.71, P = 0.03), and body fat percentage (BFP)(MD=-1.16, 95%CI=-1.92–-0.40, P = 0.003). No significant effects were noted on the 6-minute walk test (6MWT) (MD = 14.51, 95%CI=-20.82-49.85, P = 0.421) and appendicular skeletal muscle mass (ASM) (SMD = 0.16, 95%CI=-0.20-0.51, P = 0.38). Combined aerobic and resistance exercise confers definite health benefits on older adults with sarcopenia. It effectively enhances muscle strength (as reflected by handgrip strength), improves physical performance (gait speed and 5CST), and optimizes body composition (by increasing SMM and SMI, while reducing BFP). Although this combined exercise regimen exerts no significant effects on 6MWT distance, or ASM, the overall findings demonstrate its positive efficacy in targeting the core pathological features of sarcopenia (e.g., reduced muscle mass and impaired muscle strength) as well as improving relevant physical functions. These results provide scientific evidence for the rehabilitation intervention of older adults with sarcopenia, supporting the promotion and application of this combined exercise protocol in clinical practice. Individualized intervention protocol should be formulated based on the specific conditions of each patient. This study fills the research gap in evaluating the intervention efficacy of stand-alone combined aerobic and resistance exercise for elderly patients with pure sarcopenia, and provides a valuable reference for the incorporation of combined aerobic and resistance training into the design of exercise protocols for sarcopenia.