Effects of different exercise types and intensities in older adults with sarcopenia: a systematic review and network meta-analysis.

OBJECTIVE: Exercise is an important non-pharmacological strategy for the management of sarcopenia. However, the relative effects of different exercise modalities and dose parameters remain unclear. METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials. The analysis comprehensively evaluated the effects of different exercise interventions and prescription parameters on sarcopenia-related outcomes. RESULTS: Nineteen randomized controlled trials involving 1,267 participants were included. Compared with routine control, moderate-intensity resistance training (MRT) showed the clearest improvement in handgrip strength (mean difference [MD] = 2.37, 95% confidence interval [CI] 0.76-3.98). It also ranked highly for skeletal muscle mass index (SMI) and gait speed, but the related evidence remained uncertain. The findings for SMI were affected by local inconsistency. For gait speed, no intervention showed a significant advantage over routine control. Exploratory analyses suggested that training intensity, frequency, and intervention duration may jointly shape treatment responses across different outcomes. CONCLUSIONS: MRT may be considered a reasonable option for improving handgrip strength in older adults with sarcopenia. However, the current evidence does not support identifying a single best exercise approach across all outcomes. Exercise prescription for sarcopenia should therefore be guided by the target outcome and clinical relevance. REGISTRATION NUMBER: CRD42024603850.