Exercise interventions for gait and balance performances among older adults with sarcopenic obesity: a scoping review

Abstract Background Recent evidence has shown that older adults coexisting with sarcopenia and obesity are more likely to have impaired gait and balance performances than those with either sarcopenia or obesity alone. Recently, physical activity (PA) interventions have been shown to confer beneficial effects, yet a comprehensive review on the association of movement behaviors (PA and sedentary behavior (SB)) with gait and balance performances in sarcopenic obesity (SO) is missing. Given that it was difficult and complex to visualize the range of relevant evidence that may be available, the primary aim of this scoping review approach was to systematically map existing relevant evidence and identify research gaps in this area. Our secondary aim was to examine the association of PA and SB with balance and gait performances among older adults with SO. Methods Experimental and observational studies with a primary focus on examining the associations of PA and SB with gait and balance performances among older adults with SO aged 60 years and older were included. Five electronic databases (MEDLINE via PubMed, Academic Search Premier, CINAHL, SPORTDiscus, and Sedentary Research Database) were searched from their inceptions until October 2025. A narrative approach was adopted to synthesize the charted results categorized by gait and balance outcomes. Results A total of 13 studies ( n = 502; mean ages: 64.1─77.0 years) were included. Compared with different types of comparison controls (e.g., usual/standard care, health education, and no treatment), exercise interventions (≥ 75% of randomized controlled trials), such as power training, resistance training, and multicomponent training (aerobic and resistance exercises), have been shown to improve gait performance (speed and step length), functional mobility, static balance, and postural control among older adults with SO. Only mild adverse effects, including muscle soreness and joint pains, were reported. However, no studies examining interventions targeting reduction in SB have been conducted. Conclusion Given potentially effective and safe, exercise training can be a treatment option for alleviating gait and balance impairments in older adults with SO. Since nearly 70% of included studies were conducted merely in older women, the generalizability of the findings to older men was largely questionable. Further high-quality experimental studies, for example, randomized controlled trials, in sex-balanced samples are imperatively needed to confirm the causal relationships of PA/SB with gait and balance performances in older adults with SO.