Mediterranean diet and exercise in the prevention and management of sarcopenic obesity: a scoping review

Sarcopenic obesity is an emerging public health condition characterized by the coexistence of excess adiposity and reduced skeletal muscle mass and function. It is associated with functional decline, metabolic complications, and increased mortality in adults and older populations. Although physical exercise and Mediterranean-style dietary patterns are widely recommended to improve body composition and metabolic health, evidence regarding their specific and potentially combined effects in individuals with sarcopenic obesity remains limited and heterogeneous. This scoping review aimed to map and synthesize the available evidence on the effects of physical exercise and the Mediterranean diet, applied alone or in combination, in the prevention and management of sarcopenic obesity in adults and older adults. A systematic literature search was conducted in accordance with PRISMA-ScR guidelines in PubMed, Scopus, and Google Scholar up to May 31, 2026. Studies were eligible if they included adults aged ≥ 18 years diagnosed with sarcopenic obesity and evaluated physical exercise interventions and/or adherence to a Mediterranean-style dietary pattern. Outcomes of interest included anthropometric measures, body composition, muscle strength, physical function, and metabolic or inflammatory markers. Among 822 records identified, 13 studies met the inclusion criteria, including 10 randomized controlled trials and 3 cross-sectional studies. Exercise interventions lasting 8–24 weeks included resistance training, aerobic exercise, or combined training protocols. Overall, exercise interventions were associated with reductions in fat mass and improvements in muscle strength and physical performance, particularly gait speed. Combined aerobic and resistance training programs were also associated with improvements in insulin sensitivity and reductions in inflammatory markers such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in some studies. Only three cross-sectional studies assessed adherence to the Mediterranean diet, with mixed findings. While some associations were observed for functional outcomes, associations with adiposity and muscle strength were attenuated after adjustment for confounding factors. No intervention study specifically evaluated the combined effects of a Mediterranean diet and structured exercise program in individuals with sarcopenic obesity. Physical exercise, particularly combined resistance and aerobic training, appears effective for improving body composition, muscle function, and metabolic outcomes in individuals with sarcopenic obesity. However, evidence regarding the Mediterranean diet in this population remains scarce and largely observational. Future well-designed randomized controlled trials investigating multimodal lifestyle interventions integrating Mediterranean dietary patterns with structured exercise programs are needed to better understand potential synergistic effects.