Peng Bai, Qiang Xiong, Tao Wu
In middle-aged and older adults with sarcopenia, exercise prescription should consider both dose and modality rather than total volume alone. Handgrip strength and functional mobility may require different modality-dose strategies, supporting outcome-targeted exercise planning. For geriatric nursing practice, these findings may help nurses guide individualized exercise recommendations according to patients' primary functional limitations, such as reduced grip strength or impaired mobility.
OBJECTIVE: To examine the non-linear dose-response effects of different exercise modalities on handgrip strength and functional mobility in middle-aged and older adults with sarcopenia, and whether modality-dose combinations produce outcome-specific functional responses.
METHODS: Cochrane Library, Web of Science, PubMed, Embase, and SPORTDiscus were searched through 5 February 2026 for eligible randomized controlled trials. Exercise interventions were standardized using metabolic equivalents. Bayesian model-based network meta-analysis was performed in R to model non-linear dose-response relationships for handgrip strength and functional mobility and compare modality-specific effects across dose ranges.
RESULTS: Twenty-nine randomized controlled trials were included. Overall exercise dose showed an inverted U-shaped association with both outcomes. Handgrip strength improved from a dose of 140 metabolic equivalent-minutes, with the largest effect at 690 and an optimal range of 560-830 metabolic equivalent-minutes. Functional mobility showed a similar non-linear pattern, improving from 140 and peaking at 830. When disaggregated by modality, the largest effect for handgrip strength was observed with whole-body vibration at 280, and a stable peak for functional mobility occurred only under resistance training at 580 metabolic equivalent-minutes.
CONCLUSIONS: In middle-aged and older adults with sarcopenia, exercise prescription should consider both dose and modality rather than total volume alone. Handgrip strength and functional mobility may require different modality-dose strategies, supporting outcome-targeted exercise planning. For geriatric nursing practice, these findings may help nurses guide individualized exercise recommendations according to patients' primary functional limitations, such as reduced grip strength or impaired mobility.