Highlights
- •Exercise has better effects on physical performance than other interventions and on muscle strength than nutritional intervention alone.
- •The combination of exercise and nutrition improves muscle strength and physical performance, but the effects are similar to those of exercise alone.
- •It is not yet clear whether nutritional intervention alone improves sarcopenia indicators in older adults.
Abstract
It is unclear whether the combined effects of exercise and nutrition are better than
those of exercise alone or nutrition alone in older adults with sarcopenia. This paper
assesses the comparative effects of exercise, nutrition, and the combination of exercise
and nutrition on muscle mass, muscle strength, and physical performance in older adults
with sarcopenia. In this systematic review and network meta-analysis, 11 electronic
databases were searched up to November 2020. Inclusion criteria were: (1) adults aged
65 years and older with sarcopenia; (2) interventions of exercise, nutrition, or the
combination of both; (3) the outcomes include at least one of the following: muscle
mass, muscle strength (hand grip and knee extension strength), or physical performance
(gait speed and dynamic balance); and (4) randomized control trials. For each outcome
measurement, a network meta-analysis was conducted to determine the direct and indirect
effects of each intervention compared with each of the other interventions. A total
of 26 studies were included in the network meta-analysis. Compared with the control
group, exercise alone and the combination of exercise and nutrition significantly
increased handgrip strength (1.12 kg, 95% CI: 0.12, 2.11; 2.03 kg, 95% CI: 1.10, 2.97)
and improved dynamic balance (-1.76 seconds, 95% CI: -2.24, -1.28; -1.02 seconds,
95% CI: -1.64, -0.39). Both exercise alone and the combination of exercise and nutrition
have beneficial effects on muscle strength and physical performance in older adults
with sarcopenia.
Abbreviations:
ALM (appendicular lean mass), ALMI (appendicular lean mass index), AMM (Appendicular muscle mass), ASM (appendicular skeletal muscle), AWGS (Asian Working Group for Sarcopenia), C (control group), CENTRAL (Cochrane Central Register of Controlled Trials), CI (confidence interval), CINAHL (Cumulative Index to Nursing and Allied Health Literature), EWGSOP (European Working Group on Sarcopenia in Older People), F (female), I (intervention group), JBI (Joanna Briggs Institute), M (male), MeSH (Medical Subject Heading), PRISMA-NMA (Reviews and Meta-Analyses, specifically to the network meta-analysis), RoB2 (risk of bias 2), SMI (skeletal muscle index), SMM (skeletal muscle mass), SUCRA (surface under the cumulative ranking curve area), RCTs (Randomized controlled trials)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- European Working Group on Sarcopenia in Older People, Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People.Age. Ageing. 2010; 39: 412-423https://doi.org/10.1093/ageing/afq034
- Prevalence of sarcopenia in the world: A systematic review and meta-analysis of general population studies.J. Diabetes. Metab. Disord. 2017; 16: 1-10https://doi.org/10.1186/s40200-017-0302-x
- Health outcomes of sarcopenia: A systematic review and meta-analysis.PloS. one. 2017; 12: 1-16https://doi.org/10.1371/journal.pone.0169548
- Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2, Sarcopenia: Revised European consensus on definition and diagnosis.Age. Ageing. 2019; 48: 16-31https://doi.org/10.1093/ageing/afy169
- Sarcopenia in Asia: Consensus report of the Asian Working Group for Sarcopenia.J. Am. Med. Dir. Assoc. 2014; 15: 95-101https://doi.org/10.1016/j.jamda.2013.11.025
- Interventions for treating sarcopenia: A systematic review and meta-analysis of randomized controlled studies, J. Am.Med. Dir. Assoc. 2017; 18 (e551-553.e516): 553https://doi.org/10.1016/j.jamda.2017.03.019
- Optimal management of sarcopenia.Clin. Interv. Aging. 2010; 5: 217-228https://doi.org/10.2147/cia.s11473
- International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management.J. Nutr. Health. Aging. 2018; 22: 1148-1161https://doi.org/10.1007/s12603-018-1139-9
- Effect of exercise alone or combined with dietary supplements on anthropometric and physical performance measures in community-dwelling elderly people with sarcopenic obesity: A meta-analysis of randomized controlled trials.Maturitas. 2018; 116: 24-35https://doi.org/10.1016/j.maturitas.2018.07.007
- Effects of protein supplementation on lean body mass, muscle strength, and physical performance in nonfrail community-dwelling older adults: A systematic review and meta-analysis.Am. J. Clin. Nutr. 2018; 108: 1043-1059https://doi.org/10.1093/ajcn/nqy192
- Exercise interventions in healthy older adults with sarcopenia: A systematic review and meta-analysis.Australas. J. Ageing. 2018; 37: 169-183https://doi.org/10.1111/ajag.12521
- Nutrition and physical activity in the prevention and treatment of sarcopenia: Systematic review.Osteoporos Int. 2017; 28: 1817-1833https://doi.org/10.1007/s00198-017-3980-9
- Exercise and nutritional supplementation on community-dwelling elderly Japanese women with sarcopenic obesity: A randomized controlled trial.J. Am. Med. Dir. Assoc. 2016; 17: 1011-1019https://doi.org/10.1016/j.jamda.2016.06.016
- Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial.Geriatr. Gerontol. Int. 2013; 13: 458-465https://doi.org/10.1111/j.1447-0594.2012.00923.x
- The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations.Ann. Intern. Med. 2015; 162: 777-784https://doi.org/10.7326/M14-2385
- Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta‐analysis.J. Cachexia. Sarcopenia. Muscle. 2019; 10: 485-500https://doi.org/10.1002/jcsm.12411
- Is sarcopenia associated with hepatic encephalopathy in liver cirrhosis? A systematic review and meta-analysis.J. Formos. Med. Assoc. 2019; 118: 833-842https://doi.org/10.1016/j.jfma.2018.09.011
- RoB 2: A revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366: l4898https://doi.org/10.1136/bmj.l4898
- Variance imputation for overviews of clinical trials with continuous response.J. Clin. Epidemiol. 1992; 45: 769-773https://doi.org/10.1016/0895-4356(92)90054-Q
- Effects of resistance training, endurance training and whole-body vibration on lean body mass, muscle strength and physical performance in older people: A systematic review and network meta-analysis.Age. Ageing. 2018; 47: 367-373https://doi.org/10.1093/ageing/afy009
- Network meta-analysis.Stata. J. 2015; 15: 951-985https://doi.org/10.1177/1536867X1501500403
- Statistical models for meta-analysis: A brief tutorial.World. J. Methodol. 2012; 2: 27-32https://doi.org/10.5662/wjm.v2.i4.27
- Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: An overview and tutorial.J. Clin. Epidemiol. 2011; 64: 163-171https://doi.org/10.1016/j.jclinepi.2010.03.016
- More than numbers: The power of graphs in meta-analysis.Am. J. Epidemiol. 2008; 169: 249-255https://doi.org/10.1093/aje/kwn340
- Multivariate and network meta-analysis of multiple outcomes and multiple treatments: Rationale, concepts, and examples.BMJ. 2017; 358: 1-13https://doi.org/10.1136/bmj.j3932
- Consistency and inconsistency in network meta-analysis: Model estimation using multivariate meta-regression.Res. Synth. Methods. 2012; 3: 111-125https://doi.org/10.1002/jrsm.1045
- Evidence synthesis for decision making 4: Inconsistency in networks of evidence based on randomized controlled trials.Med. Decis. Making. 2013; 33: 641-656https://doi.org/10.1177/0272989X12455847
- Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: A randomized controlled trial.Braz. J. Phys. Ther. 2016; 20: 432-440https://doi.org/10.1590/bjpt-rbf.2014.0174
- Effect of whey protein supplementation combined with resistance training on body composition, muscular strength, functional capacity, and plasma-metabolism biomarkers in older women with sarcopenic obesity: A randomized, double-blind, placebo-controlled trial.Clin. Nutr. ESPEN. 2019; 32: 88-95https://doi.org/10.1016/j.clnesp.2019.04.007
- Physiological effects beyond the significant gain in muscle mass in sarcopenic elderly men: Evidence from a randomized clinical trial using a protein-rich food.Clin. Interv. Aging. 2012; 7: 225-234https://doi.org/10.2147/CIA.S32356
- The effects of group and home-based exercise programs in elderly with sarcopenia: A randomized controlled trial.J. Clin. Med. 2018; 7: 1-18https://doi.org/10.3390/jcm7120480
- Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: A randomised controlled trial.Brit. J. Nutr. 2015; 114: 1237-1245https://doi.org/10.1017/S0007114515002810
- Dietary protein intake in sarcopenic obese older women.Clin. Interv. Aging. 2016; 11: 133-140https://doi.org/10.2147/CIA.S96017
- Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly.Am. J. Clin. Nutr. 2016; 103: 830-840https://doi.org/10.3945/ajcn.115.113357
- Effects of resistance training of peripheral muscles versus respiratory muscles in older adults with sarcopenia who are institutionalized: A randomized controlled trial.J. Aging. Phys. Activ. 2018; 26: 637-646https://doi.org/10.1123/japa.2017-0268
- Whole-body electromyostimulation to fight sarcopenic obesity in community-dwelling older women at risk. Results of the randomized controlled FORMOsA-sarcopenic obesity study.Osteoporosis. Int. 2016; 27: 3261-3270https://doi.org/10.1007/s00198-016-3662-z
- Whole-body electromyostimulation and protein supplementation favorably affect sarcopenic obesity in community-dwelling older men at risk: The randomized controlled FranSO study.Clin. Interv. Aging. 2017; 12: 1503-1513https://doi.org/10.2147/CIA.S137987
- Effects of resistance training on functional strength and muscle mass in 70-year-old individuals with pre-sarcopenia: A randomized controlled trial.J. Am. Med. Dir. Assoc. 2019; 20: 28-34https://doi.org/10.1016/j.jamda.2018.09.011
- Effect of Protein Supplementation on Physical Performance in Older People With Sarcopenia-A Randomized Controlled Trial.J. Am. Med. Dir. Assoc. 2020; 21 (e1): 226-232https://doi.org/10.1016/j.jamda.2019.09.006
- Vitamin D supplementation and muscle strength in pre-sarcopenic elderly Lebanese people: A randomized controlled trial.Arch. Osteoporosis. 2018; 14: 1-11https://doi.org/10.1007/s11657-018-0553-2
- Effects of fortified nutrition combining with resistance exercise on physical function and activity of daily living for elderly patients with sarcopenia.J. Nurs. Sci. 2017; 32: 8-10
- Whole body vibration training improves muscle and physical performance in community dwelling with sarcopenia: A randomized controlled trial.Int. J. Phys. Ther. Rehabil. 2016; 2: 1-6https://doi.org/10.15344/2455-7498/2016/116
- Effects of exercise and nutrition supplementation in community-dwelling older Chinese people with sarcopenia: A randomized controlled trial.Age. Ageing. 2018; 48: 220-228https://doi.org/10.1093/ageing/afy179
- A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: A double-blind randomized controlled trial.Clin. Nutr. 2019; 38: 159-164https://doi.org/10.1016/j.clnu.2017.12.020
- Effect of health Qigong Yi Jin Jing exercise for sarcopenia patients’ rehabilitation efficacy.Zhongguo Laonianxue Zazhi. 2016; 36: 898-899
- Effects of different types of exercise on body composition, muscle strength, and IGF-1 in the elderly with sarcopenic obesity.J. Am. Geriatr. Soc. 2017; 65: 827-832https://doi.org/10.1111/jgs.14722
- Effects of 8-week kettlebell training on body composition, muscle strength, pulmonary function, and chronic low-grade inflammation in elderly women with sarcopenia.Exp. Gerontol. 2018; 112: 112-118https://doi.org/10.1016/j.exger.2018.09.015
- Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial.Sci. Rep. 2018; 8: 1-13https://doi.org/10.1038/s41598-018-20677-7
- Effects of 24-Week aerobic and resistance training on carotid artery intima-media thickness and flow velocity in elderly women with sarcopenic obesity.J. Atheroscler. Thromb. 2017; 24: 1117-1124https://doi.org/10.5551/jat.39065
- Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial.J. Am. Geriatr. Soc. 2012; 60: 16-23https://doi.org/10.1111/j.1532-5415.2011.03776.x
- Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: A multicenter randomized controlled trial.Geriatr. Gerontol. Int. 2019; 19: 12-17https://doi.org/10.1111/ggi.13547
- Effect of a simple and adherent home exercise program on the physical function of community dwelling adults sixty years of age and older with pre-sarcopenia or sarcopenia.J Phys Ther Sci. 2016; 8: 3183-3188https://doi.org/10.1589/jpts.28.3183
- Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial, J. Am.Med. Dir. Assoc. 2015; 16: 740-747https://doi.org/10.1016/j.jamda.2015.05.021
- Exercise Interventions for the Prevention and Treatment of Sarcopenia. A Systematic Umbrella Review.J Nutr Health Aging. 2019; 23: 494-502https://doi.org/10.1007/s12603-019-1196-8
- Prevalence of and interventions for sarcopenia in ageing adults: A systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).Age. Ageing. 2014; 43: 748-759https://doi.org/10.1093/ageing/afu115
- Role of exercise in age-related sarcopenia.J Exerc Rehabil. 2018; 14: 551-558https://doi.org/10.12965/jer.1836268
- The loss of skeletal muscle strength, mass, and quality in older adults: The health, aging and body composition study.J. Gerontol. A. Biol. Sci. Med. Sci. 2006; 61: 1059-1064https://doi.org/10.1093/gerona/61.10.1059
- The scientific basis of exercise prescribing for the very old.J. Am. Geriatr. Soc. 1990; 38: 62-70https://doi.org/10.1111/j.1532-5415.1990.tb01600.x
- Association between muscle mass, leg strength, and fat mass with physical function in older adults: Influence of age and sex.J. Aging. Health. 2010; 23: 313-328https://doi.org/10.1177/0898264310388562
- Affiliatio Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: Time to abandon the term sarcopenia?.Osteoporosis. Int. 2017; 28: 59-70https://doi.org/10.1007/s00198-016-3691-7
- Lower body function and mortality in Mexican American elderly people.J. Gerontol. A. Biol. Sci. Med. Sci. 2001; 56: M243-M247https://doi.org/10.1093/gerona/56.4.M243
- Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort.J. Gerontol. A. Biol. Sci. Med. Sci. 2006; 61: 72-77https://doi.org/10.1093/gerona/61.1.72
- Protein supplementation does not significantly augment the effects of resistance exercise training in older adults: A systematic review.J. Am. Med. Dir. Assoc. 2016; 17 (e1-e9): 959https://doi.org/10.1016/j.jamda.2016.07.002
- Keeping older muscle “young” through dietary protein and physical activity.Adv Nutr. 2014; 5: 599S-607Shttps://doi.org/10.3945/an.113.005405
- Does nutrition play a role in the prevention and management of sarcopenia?.Clin. Nutr. 2018; 37: 1121-1132https://doi.org/10.1016/j.clnu.2017.08.016
- Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group.Clin. Nutr. 2014; 33: 929-936https://doi.org/10.1016/j.clnu.2014.04.007
- Carotenoids as protection against disability in older persons.Rejuvenation. Res. 2008; 11: 557-563https://doi.org/10.1089/rej.2007.0581
- Exercise and protein intake: A synergistic approach against sarcopenia.Biomed. Res. Int. 2017; (Article ID 2672435): 1-7https://doi.org/10.1155/2017/267243565
- Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: A systematic review and meta-analysis.J. Am. Geriatr. Soc. 2011; 59: 2291-2300https://doi.org/10.1111/j.1532-5415.2011.03733.x
Article info
Publication history
Published online: December 31, 2020
Accepted:
December 23,
2020
Received in revised form:
November 7,
2020
Received:
September 15,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
