Exercise and nutritional interventions for sarcopenia-related fall prevention in older adults: An umbrella review

Sarcopenia-progressive age-related loss of muscle mass and function-substantially elevates fall susceptibility among older adults. While exercise and nutritional interventions have been studied separately for either sarcopenia management or fall prevention, no comprehensive synthesis has evaluated the convergence of these evidence streams. This umbrella review aimed to synthesize and appraise evidence on exercise and nutritional interventions for sarcopenia management and fall prevention in older adults, examining where these evidence streams converge. Adhering to Joanna Briggs Institute (JBI) umbrella review methodology and PRISMA 2020 guidelines, three databases (Scopus, Web of Science, and PubMed/MEDLINE) were searched for systematic reviews and meta-analyses up to February 2026. Dual independent screening, data extraction, and quality assessment used the JBI Critical Appraisal Checklist. Primary study overlap was measured via Corrected Covered Area (CCA), and evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The protocol was prospectively registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/T6YQ9). From 2466 identified records across three databases, 1489 unique records were screened after duplicate removal, yielding 41 systematic reviews for assessment (37 in main synthesis at JBI ≥7; 41 in sensitivity analysis at JBI ≥4), encompassing approximately 4475 unique primary studies. The CCA was 0.66%, indicating slight overlap. Two convergent evidence streams emerged: (1) for sarcopenia outcomes, moderate-to-high certainty evidence demonstrated that combined exercise with protein supplementation (≥1.2 g/kg/day) yielded superior improvements in muscle mass (standardized mean difference [SMD] 0.22), handgrip strength (mean difference [MD] 4.19 kg), and physical performance; (2) for fall prevention outcomes, high-certainty evidence established that balance and multicomponent exercise reduced fall rates by 23-34% (rate ratios [RaR] 0.66-0.77). One meta-analysis of observational studies established the sarcopenia-falls association (odds ratio [OR] 1.60-1.89), providing the conceptual foundation linking these streams. Vitamin D supplementation (≥700 IU/day) reduced falls by 13% (risk ratio [RR] 0.87, moderate certainty). Convergent evidence supports integrated interventions combining resistance and balance training, protein optimization, and vitamin D supplementation for older adults with or at risk of sarcopenia who are also at fall risk, though direct evidence that sarcopenia reversal reduces fall incidence remains limited and requires further investigation.