Dose-response effects of resistance training in sarcopenic older adults: systematic review and meta-analysis

Currently, resistance training (RT) programs for sarcopenic older adults are numerous they remain controversial, and there is a lack of standardized programs specifically tailored for this population.

This study aims to investigate the dose-response effects between RT on grip strength, skeletal muscle mass index (SMI), and short physical performance battery (SPPB) in sarcopenic older adults, to identify key training parameters in RT.

A comprehensive search was conducted in databases including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and WANFANG for randomized controlled trials published up to March 2025. Studies were selected based on the inclusion and exclusion criteria outlined in this study, resulting in 12 studies. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence, while Cochrane's Risk of Bias Tool evaluated the methodological quality of the included studies. Meta-analysis of baseline data and outcomes was performed using Review Manager version 5.3.4 and R version 3.5 software.

12 studies involving 538 participants met the inclusion criteria. Compared to the control group, RT had a moderate effect on grip strength (SMD = 0.63, 95% CI 0.43-0.83; I² = 32%, X² = 11.73, df = 8, p < 0.00001) and SPPB (SMD = 0.56, 95% CI 0.18-0.94; I² = 53%, X² = 8.48, df = 4, p = 0.004) with in sarcopenic older adults, but it did not significantly improve SMI (SMD = 0.24, 95% CI -0.05-0.53; I² = 0%, X² = 2.85, df = 4, p = 0.10). Meta-regression analysis revealed that training frequency (p < 0.0001) and training intensity (p = 0.0019) were significant predictors of grip strength improvement, while training frequency (p = 0.052) may be a potential predictor for SPPB improvement. Additionally, subgroup analysis showed that incorporating pulling exercises into the training program significantly improved grip strength compared to studies that did not include such exercises (SMD = 0.90, 95% CI 0.61-1.19; I² = 0%, X² = 0.75, df = 2, p < 0.00001).

Our meta-analysis suggests that RT is associated with improvements in grip strength and SPPB scores in sarcopenic older adults, whereas its effect on SMI was not statistically significant. The findings indicate that performing moderate-intensity resistance training twice a week is a promising strategy for improving grip strength, while a similar frequency may also benefit SPPB scores. Furthermore, incorporating pulling exercises into the RT regimen may positively influence grip strength outcomes.