Exercise, nutrition, physical agent therapy in older adults with sarcopenic obesity: a systematic review and network meta-analysis

Sarcopenic obesity (SO) is characterized by the co-existence of excess adiposity and low muscle performance, with a high prevalence and poor prognosis in the geriatric population. This systematic review and network meta-analysis (NMA) aims to assess the most effective non-pharmacological interventions for SO patients, including nutrition, exercise, and physical agent therapy. A systematic search of six electronic databases was conducted from their inception until July 5, 2025, for randomized controlled trials. The NMA utilized a random-effects model, pooled mean difference (MD) and standardized mean difference (SMD), with 95% credible intervals (CrI), accounting for correlations within multi-arm trials. Subgroup analyses and sensitivity analyses were also performed. Twenty-five studies were included, with 19 studies (n = 1,085 participants) eligible for the NMA. Interventions were categorized into 12 groups: no intervention, nutrition, whole-body electromyostimulation (WBEMS), WBEMS plus nutrition, resistance training (RT), aerobic training (AT), mixed exercise (RT + AT), mixed exercise plus nutrition, energy restriction plus nutrition, high-speed resistance training, RT plus nutrition, and electrical acupuncture plus nutrition. Intervention duration ranged from 8 weeks to 8 months. Mixed exercise was the most effective intervention for reducing body fat percentage (BF%) (MD: -3.8, 95% CrI: -6.8, -0.8), followed by RT (MD: -2.4, 95% CrI: -4.5, -0.46). RT also significantly improved grip strength (MD: 4.4, 95% CrI: 1.6, 6.8). In the fat outcomes combined model, electrical acupuncture plus nutrition showed efficacy (MD: -2.2, 95% CrI: -3.5, -0.78). In the muscular outcomes combined model, both RT (MD: 0.36, 95% CrI: 0.14, 0.56) and RT plus nutrition (MD: 0.83, 95% CrI: 0.092, 1.7) were effective. Sensitivity analyses indicate that the models for body weight, BF%, and the two composite outcomes lack robustness. RT can reduce BF% while simultaneously improving grip strength, representing an effective management strategy for SO.