Persevering or quitting? A systematic review of adherence and dropout in nutrition and exercise interventions for...

The global rise in sarcopenic obesity necessitates identifying key adherence determinants in nutritional and exercise interventions to optimize outcomes. This systematic review identifies characteristics affecting adherence and dropout in these interventions.

We searched Web of Science, PubMed, Scopus, and Cochrane Library through January 2025, including reference lists. Using the Cochrane Risk of Bias Tool, we assessed RCTs on nutritional/exercise interventions for sarcopenic obesity. High heterogeneity and insufficient adherence reporting precluded meta-analysis for adherence; outcomes were narratively synthesized. For dropout rates, meta-analysis was conducted, including subgroup analyses (exercise, nutrition, multi-component) and meta-regression to explore moderators.

From 1,205 records, 57 studies (4,166 participants) were included. The overall dropout rate was 9%, increasing with intervention duration. Only 45.6% of studies reported adherence data. Among exercise interventions, elastic resistance had the highest adherence (91.5%), resistance training the lowest (85%). In nutritional interventions, low-calorie diets with nutraceuticals outperformed diet-only (92.1% vs. 77%). Professionally supervised interventions showed superior adherence to self-monitored programs.

Current trials often inadequately report adherence data, with longer durations correlating to higher dropout rates. Evidence suggests elastic resistance exercise, low-calorie diets with nutraceuticals, and professional supervision may improve adherence. Future research should refine intervention methods and prioritize adherence reporting to enhance sarcopenic obesity care quality.