Effects of Different Types of Exercise on Body Composition, Muscle Strength, and IGF-1 in the Elderly with Sarcopenic Obesity

Sarcopenic obesity: a review

The global increase in life expectancy has led to a concomitant rise in diagnoses of sarcopenia. At the same time, the epidemic levels of obesity have given rise to the emergence of a complex condition known as sarcopenic obesity. Characterized by the simultaneous presence of loss of muscle mass and strength along with obesity or excess body fat, sarcopenic obesity represents a concerning health condition. Contrary to prevailing assumptions, sarcopenic obesity is not exclusive to older adults, as it may also manifest in individuals with obesity and chronic diseases and in those who undergo rapid weight loss. This juxtaposition of fat accumulation and muscle depletion epitomizes a harmful combination, especially in healthy adults. A precise definition of sarcopenic obesity and an understanding of how different body composition components affect functional parameters, comorbidities, and mortality rates are crucial for grasping the full extent and significance of this condition. Despite its multifaceted nature, sarcopenic obesity is often undiagnosed and undertreated, posing a considerable challenge to healthcare systems worldwide. In this review, we explore the intricate interplay of factors contributing to the development and consequences of sarcopenic obesity and discuss newly proposed diagnostic guidelines aimed at improved screening. Enhancing awareness and understanding of sarcopenic obesity is imperative for addressing its growing prevalence and mitigating its adverse health effects.

Comparative efficacy of exercise, nutrition, and combined exercise and nutritional interventions in older adults with sarcopenic obesity: a protocol for systematic review and network meta-analysis

BACKGROUND

Sarcopenic obesity (SO) in older adults is associated with certain adverse outcomes, including falls, fractures, and disability, all of which affect patient quality of life, represent an economic burden, and potentially enhance the risk of death. Although a number studies have examined the effects of exercise, nutrition, and combined exercise and nutritional interventions on older adults with SO, the optimal therapeutic approach has yet to be sufficiently established. In this systematic review and network meta-analysis (NMA) protocol for SO in older adults, we aim to compare the combined effects of exercise and nutrition with those of exercise or nutritional interventions alone on the body composition and physical performance of older adults with SO.

METHODS

The PubMed, Web of Science, Embase, OVID, CINAHL, CNKI, Wanfang Data, and VIP databases will be used to systematically search for randomized controlled trials published from the time of database inception to December 2024. Outcomes will include body composition and physical performance, and data will be extracted independently by two researchers. In cases of disagreement, a consensus will be reached by consulting a third researcher. The Cochrane risk-of-bias tool will be used to assess randomized controlled trials, and data analysis will be performed using Stata 15.0 and R software, based on homogeneity, sensitivity, transitivity, consistency, and publication bias tests.

DISCUSSION

By comprehensively assessing the relative efficacies of exercise, nutrition, and combined interventions in older adults with SO, we aim in this systematic review and NMA to fill an important gap in the existing literature. These findings will provide a reference for healthcare providers and policymakers and facilitate the development of evidence-based guidelines that will contribute to optimizing SO management and gaining more favorable outcomes for this vulnerable population.

SYSTEMATIC REVIEW REGISTRATION

CRD42024504706.

The Effects of Concurrent Training Versus Aerobic or Resistance Training Alone on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

Introduction and Aim: The beneficial effects of aerobic training (AT) on preventing excess fat mass, and of resistance training (RT) on skeletal muscle adaptation, are well established. However, the effects of concurrent training (CT) compared to AT or RT alone on body composition in middle-aged and older adults are less understood, and therefore, the focus of this meta-analysis. Methods: Three databases, including PubMed, Web of Science, and Scopus, were searched from inception to March 2024. Randomized trials were included if they compared CT versus either AT or RT, and included body composition measures such as fat mass, body fat percentage, waist circumference, visceral fat mass, lean body mass (LBM), muscle mass/volume, or muscle or muscle fiber cross-sectional area (CSA), in middle-aged (50 to <65 years) and older adults (≥65 years). Weighted mean differences (WMD) or standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. Results: A total of 53 studies involving 2873 participants were included. Overall, CT increased body weight and LBM significantly more, trending toward significantly larger increases in muscle mass and CSA, compared with AT alone. However, there were no significant differences between CT and RT alone, for body weight, BMI, body fat percentage, fat mass, waist circumference, or visceral fat mass. Conclusions: CT is as effective as AT for decreasing body fat measures and as effective as RT for increasing muscle mass in middle-aged and older adults, and it should be recommended accordingly.

The Power of Exercise: Unlocking the Biological Mysteries of Peripheral-Central Crosstalk in Parkinson's Disease

BACKGROUND

Exercise is a widely recognized non-pharmacological treatment for Parkinson's Disease (PD). The bidirectional regulation between the brain and peripheral organs has emerged as a promising area of research, with the mechanisms by which exercise impacts PD closely linked to the interplay between peripheral signals and the central nervous system.

AIM OF REVIEW

This review aims to summarize the mechanisms by which exercise influences peripheral-central crosstalk to improve PD, discuss the molecular processes mediating these interactions, elucidate the pathways through which exercise may modulate PD pathophysiology, and identify directions for future research.

KEY SCIENTIFIC CONCEPTS OF REVIEW

This review examines how exercise-induced cytokine release promotes neuroprotection in PD. It discusses how exercise can stimulate cytokine secretion through various pathways, including the gut-brain, muscle-brain, liver-brain, adipose-brain, and bone-brain axes, thereby alleviating PD symptoms. Additionally, the potential contributions of the heart-brain, lung-brain, and spleen-brain axes, as well as multi-axis crosstalk-such as the brain-gut-muscle and brain-gut-bone axes-are explored in the context of exercise therapy. The study highlights the need for further research into peripheral-central crosstalk and outlines future directions to address challenges in clinical PD therapy.

Exercise and exerkines: Mechanisms and roles in anti-aging and disease prevention

Aging is a complex biological process characterized by increased inflammation and susceptibility to various age-related diseases, including cognitive decline, osteoporosis, and type 2 diabetes. Exercise has been shown to modulate mitochondrial function, immune responses, and inflammatory pathways, thereby attenuating aging through the regulation of exerkines secreted by diverse tissues and organs. These bioactive molecules, which include hepatokines, myokines, adipokines, osteokines, and neurokines, act both locally and systemically to exert protective effects against the detrimental aspects of aging. This review provides a comprehensive summary of different forms of exercise for older adults and the multifaceted role of exercise in anti-aging, focusing on the biological functions and sources of these exerkines. We further explore how exerkines combat aging-related diseases, such as type 2 diabetes and osteoporosis. By stimulating the secretion of these exerkines, exercise supports healthy longevity by promoting tissue homeostasis and metabolic balance. Additionally, the integration of exercise-induced exerkines into therapeutic strategies represents a promising approach to mitigating age-related pathologies at the molecular level. As our understanding deepens, it may pave the way for personalized interventions leveraging physical activity to enhance healthspan and improve quality of life.

Prevalence of and risk factors for sarcopenia in patients with epilepsy

BACKGROUND

Epilepsy is a chronic neurological disorder with a burden of comorbidities. Knowledge regarding sarcopenia prevalence and associated risk factors in patients with epilepsy remains limited, which prompted us to conduct the present study.

METHODS

This cross-sectional study enrolled patients with epilepsy from our epilepsy clinic and controls from the staff at National Cheng Kung University Hospital, Tainan, Taiwan. Sarcopenia was defined using the criteria outlined by the 2019 Asian Working Group for Sarcopenia and the 2010 European Working Group on Sarcopenia in Older People. Muscle mass (skeletal muscle mass index) was measured through bioelectrical impedance, muscle strength was assessed using hand grip tests, and physical performance was evaluated using the 6-m walk test. Hormone (testosterone, growth hormone, and insulin-like growth factor-1) and vitamin D levels were measured. Descriptive statistics and logistic regression models were used to estimate the prevalence of sarcopenia and identify sarcopenia risk factors in patients with epilepsy.

RESULTS

This study enrolled 300 adults (mean age: 42.9 ± 14.7 years; women: 53.7 %). The epilepsy and control groups comprised 200 and 100 participants, respectively. The overall prevalence of sarcopenia was 31.3 % and it was significantly higher (p = 0.004) in women (20.7 %) than in men (10.6 %). The prevalence was higher in the epilepsy group than in the control group (36.0 % vs. 22.0 %, p = 0.014). Logistic regression revealed female, age (≥ 65 year) and low body mass index (BMI) were influenced the risk of sarcopenia in all participants. Importantly, epilepsy is significantly associated sarcopenia. The BMI, protein level, calf circumference, and use of enzyme-inducing antiseizure medications (EIASM) influenced the risk of sarcopenia in the epilepsy group.

CONCLUSION

The prevalence of sarcopenia is significantly higher in patients with epilepsy than in the control participants. Low BMI, protein level, calf circumference, and the use of EIASM may increase the risk of sarcopenia in this population. Our findings underscore the need for mitigating sarcopenia risk in patients with epilepsy.

Medical Nutrition Therapy and Physical Exercise for Acute and Chronic Hyperglycemic Patients with Sarcopenia

A wide range of factors contribute to the overlap of hyperglycemia-acute or chronic-and sarcopenia, as well as their associated adverse consequences, which can lead to impaired physical function, reduced quality of life, and increased mortality risk. These factors include malnutrition (both overnutrition and undernutrition) and low levels of physical activity. Hyperglycemia and sarcopenia are interconnected through a vicious cycle of events that mutually reinforce and worsen each other. To explore this association, our review compiles evidence on: (i) the impact of hyperglycemia on motor and muscle function, with a focus on the mechanisms underlying biochemical changes in the muscles of individuals with or at risk of diabetes and sarcopenia; (ii) the importance of the clinical assessment and control of sarcopenia under hyperglycemic conditions; and (iii) the potential benefits of medical nutrition therapy and increased physical activity as muscle-targeted treatments for this population. Based on the reviewed evidence, we conclude that a regular intake of key functional nutrients, together with structured and supervised resistance and/or aerobic physical activity, can help maintain euglycemia and improve muscle status in all patients with hyperglycemia and sarcopenia.

Clinical outcome changes in sarcopenic obesity: a meta-analysis of exercise training methods

AIM

Assessing the effect of various forms of exercise training on patients with sarcopenic obesity.

METHODS

Two independent reviewers systematically searched English and Chinese databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI) for randomized controlled trials on various exercise training effects in sarcopenic obesity patients until October 2023. Reference materials and grey literature were also included. Selected studies underwent screening, data extraction, and quality assessment. Meta-analysis was conducted using Review Manager 5.4 software.

RESULTS

A total of 8 studies were included in the final analysis. The Meta-analysis results indicated that resistance training (RT) significantly improved grip strength (MD = 3.85, 95%CI: 1.50 to 6.20, P < 0.01), percentage of body fat (MD = -2.96, 95%CI: -4.19 to -1.74, P < 0.01), walking speed (MD = 0.23, 95%CI: 0.01 to 0.46, P = 0.04), IGF-1(MD = 0.79, 95%CI: 0.05 to 1.52, P = 0.04) and knee extension strength (MD = 4.85, 95%CI: 1.97 to 7.72, P < 0.01). There was no statistically significant difference observed in weight (MD = -0.61, 95%CI: -4.06 to 2.84, P = 0.73). Aerobic training (AT) resulted in a significant reduction in weight among patients with SO (MD = -6.07, 95%CI: -9.89 to -2.25, P < 0.01), while no statistically significant differences were observed in other outcome measures. Mixed training (MT) significantly improved percentage of body fat (MD = -2.42, 95%CI: -3.58 to -1.26, P < 0.01), weight (MD = -4.40, 95%CI: -8.40 to -0.40, P = 0.03), IGF-1 (MD = 1.01, 95%CI: 0.45 to 1.56, P < 0.01), and walking speed (MD = 0.15, 95%CI: 0.04 to 0.26, P < 0.01). However, no statistically significant differences were observed in grip strength (MD = -0.70, 95%CI: -4.00 to 2.60, P = 0.68) and knee extension strength (MD = 1.73, 95%CI: -1.31 to 4.78, P = 0.26). RT, AT, and MT exercise could not significantly improve the level of serum IL-6 in patients with SO, and the difference was not statistically significant [MD = -0.01,95%CI:-0.27 to 0.24, P = 0.92].

CONCLUSION

Various exercise training methods have differing effects on muscle-reducing obesity treatment. Compared to aerobic training, resistance training, and mixed training may offer more pronounced improvements, enhancing physical functioning in sarcopenic obesity patients. This underscores the clinical significance of exercise intervention in treating muscle-reducing obesity, suggesting future studies explore exercise intervention's role and mechanism, particularly related to IGF-1, IL-6, and other cytokines.

Effectiveness of resistance training on body composition, muscle strength, and biomarker in sarcopenic older adults: A meta-analysis of randomized controlled trials

This study analyzed 22 randomized controlled trials involving 959 participants to determine the impact of resistance training (RT) on body composition, muscle strength, and biomarkers in sarcopenic older adults. Regarding body composition, RT had a small effect size on relative muscle mass (RMM, SMD = 0.25[0.06,0.45]) and absolute muscle mass (AMM, SMD = 0.28[0.06,0.50]) but no effect on reducing body fat percentage (BF%). Meta-regression analysis pinpointed key predictors (p < 0.05): training period, number of sets, contraction speed, and average age. Subgroup analysis revealed that 3 sets over an 8-12 weeks training period, with slower muscle contraction speed at a 60-70 % 1-repetition maximum (1RM) training intensity, produced the most significant effects on reducing BF% and increasing RMM, respectively. Regarding muscle strength, RT had a large effect size on handgrip strength (HS, SMD = 0.83[0.43,1.23]), knee extension strength (KES, SMD = 0.90[0.50,1.30]), but no effect on chair stand test. Meta-regression analysis pinpointed key predictors (p < 0.05): training intensity, number of sets, body mass index, and sample size. Subgroup analysis revealed that the number of sets ≥ 3 and training intensity >70 % 1RM produced the most significant effect of RT on HS. Regarding biomarkers, RT had a medium effect size on insulin-like growth factor-1 (SMD = 0.70[0.10,1.30]), interleukin-10 (SMD = 0.61[0.09,1.13]), follistatin (SMD = 0.56[0.16,0.96]), but no effect on interleukin-6, tumor necrosis factor-alpha, and myostatin. It concludes that RT is an effective way to improve muscle strength and the level of synthetic hormones and anti-inflammatory factors in sarcopenic older adults, with a slight impact on body composition and no impact on pro-inflammatory factors.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Effects of Resistance Training Volume on Physical Function, Lean Body Mass and Lower-Body Muscle Hypertrophy and Strength in Older Adults: A Systematic Review and Network Meta-analysis of 151 Randomised Trials

BACKGROUND

The optimal prescription and precise recommendations of resistance training volume for older adults is unclear in the current literature. In addition, the interactions between resistance training volume and program duration as well as physical health status remain to be determined when assessing physical function, muscle size and hypertrophy and muscle strength adaptations in older adults.

OBJECTIVES

This study aimed to determine which resistance training volume is the most effective in improving physical function, lean body mass, lower-limb muscle hypertrophy and strength in older adults. Additionally, we examined whether effects were moderated by intervention duration (i.e. short term, < 20 weeks; medium-to-long term, ≥ 20 weeks) and physical health status (i.e. physically healthy, physically impaired, mixed physically healthy and physically impaired; PROSPERO identifier: CRD42023413209).

METHODS

CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to April 2023. Eligible randomised trials examined the effects of supervised resistance training in older adults (i.e. ≥ 60 years). Resistance training programs were categorised as low (LVRT), moderate (MVRT) and high volume (HVRT) on the basis of terciles of prescribed weekly resistance training volume (i.e. product of frequency, number of exercises and number of sets) for full- and lower-body training. The primary outcomes for this review were physical function measured by fast walking speed, timed up and go and 6-min walking tests; lean body mass and lower-body muscle hypertrophy; and lower-body muscle strength measured by knee extension and leg press one-repetition maximum (1-RM), isometric muscle strength and isokinetic torque. A random-effects network meta-analysis was undertaken to examine the effects of different resistance training volumes on the outcomes of interest.

RESULTS

We included a total of 161 articles describing 151 trials (n = 6306). LVRT was the most effective for improving timed up and go [- 1.20 standardised mean difference (SMD), 95% confidence interval (95% CI): - 1.57 to - 0.82], 6-min walk test (1.03 SMD, 95% CI: 0.33-1.73), lean body mass (0.25 SMD, 95% CI: 0.10-0.40) and muscle hypertrophy (0.40 SMD, 95% CI: 0.25-0.54). Both MVRT and HVRT were the most effective for improving lower-limb strength, while only HVRT was effective in increasing fast walking speed (0.40 SMD, 95% CI: - 0.57 to 0.14). Regarding the moderators, our results were independent of program duration and mainly observed for healthy older adults, while evidence was limited for those who were physically impaired.

CONCLUSIONS

A low resistance training volume can substantially improve healthy older adults' physical function and benefits lean mass and muscle size independently of program duration, while a higher volume seems to be necessary for achieving greater improvements in muscle strength. A low volume of resistance training should be recommended in future exercise guidelines, particularly for physically healthy older adults targeting healthy ageing.

Digital assessment of muscle adaptation in obese patients with osteoarthritis: Insights from surface electromyography (sEMG)

BACKGROUND

Obesity and severe knee osteoarthritis (KOA) lead to significant gait and muscle adaptations. However, the relationship between core muscle strength and the severity of KOA in obese patients remains unclear. This study aimed to determine the association between muscle strength adaptation and the severity of KOA in obese individuals.

METHODS

We recruited 119 obese participants with unilateral KOA from January 2021 to December 2023, all classified with mild to moderate KOA grades. KOA severity was assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), which categorized participants into two groups based on disease severity. Electromyographic data from the psoas, gluteus medius, vastus lateralis, vastus medialis, rectus femoris, medial gastrocnemius, lateral gastrocnemius, tibialis anterior, and biceps femoris muscles were collected during isometric and dynamic knee extension.

RESULTS

Significant differences were observed in all selected muscles between the affected knee joint and the contralateral side during both dynamic and isometric knee extensions. The difference in electromyographic data-including mean absolute value (MAV), root mean square (RMS), and center frequency (CF)-was significantly different across groups categorized by KOA severity. Notably, the MAV values of the vastus medialis, lateral gastrocnemius, and biceps femoris, as well as the CF values of the medial and lateral gastrocnemius, showed no significant differences in some instances during both dynamic and isometric extensions.

CONCLUSION

This study indicates that obese individuals with KOA exhibit lower muscle intensity and higher fatigability in comparison to the contralateral side during both isometric and dynamic knee extensions. Furthermore, significant reductions in muscle intensity were observed in the psoas, gluteus medius, vastus lateralis, rectus femoris, medial gastrocnemius, and tibialis anterior muscles, correlating with the advanced severity of KOA.

Prevalence of sarcopenic obesity in patients with gastric cancer and effects on adverse outcomes: A meta-analysis and systematic review

PURPOSE

To assess the prevalence of sarcopenic obesity in patients with gastric cancer and its impact on adverse outcomes.

METHODS

A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL databases was performed to search for articles related to sarcopenic obesity in patients with gastric cancer. The search was conducted until June 16, 2024, from the date of the creation of the database.

RESULTS

A total of sixteen studies were included, including fifteen cohort studies and one cross-sectional study involving 4087 patients. The results of the meta-analysis showed that the prevalence of sarcopenic obesity in gastric cancer patients was 16.3 % (95 % CI: 12.2 %-20.4 %). Sarcopenic obesity significantly shortened the overall survival of gastric cancer patients (HR = 1.64, 95 % CI: 1.20 to 2.25, P = 0.002) and increased the risk of postoperative significant complications (OR = 2.84, 95 % CI: 1.95 to 4.16, P < 0.001), severe complications (OR = 2.60, 95 % CI: 1.45 to 4.64, P = 0.001), surgical site infection (OR = 3.82, 95 % CI: 1.47 to 9.89, P = 0.006), and mortality (OR = 4.84, 95 % CI: 1.38 to 17.02, P = 0.014), but no significant effect on 30-day readmission (OR = 1.90, 95 % CI: 0.31 to 11.84, P = 0.491).

CONCLUSIONS

The prevalence of sarcopenic obesity is high in patients with gastric cancer and is strongly associated with poor postoperative outcomes. Healthcare providers should evaluate patients with gastric cancer for sarcopenic obesity early to prevent or reduce the incidence of adverse outcomes.

Aerobic and Resistance Training Attenuate Differently Knee Joint Damage Caused by a High-Fat-High-Sucrose Diet in a Rat Model

OBJECTIVE

Obesity and associated low-level local systemic inflammation have been linked to an increased rate of developing knee osteoarthritis (OA). Aerobic exercise has been shown to protect the knee from obesity-induced joint damage. The aims of this study were to determine (1) if resistance training provides beneficial metabolic effects similar to those previously observed with aerobic training in rats consuming a high-fat/high-sucrose (HFS) diet and (2) if these metabolic effects mitigate knee OA in a diet-induced obesity model in rats.

DESIGN

Twelve-week-old Sprague-Dawley rats were randomized into 4 groups: (1) a group fed an HFS diet subjected to aerobic exercise (HFS+Aer), (2) a group fed an HFS diet subjected to resistance exercise (HFS+Res), (3) a group fed an HFS diet with no exercise (HFS+Sed), and (4) a chow-fed sedentary control group (Chow+Sed). HFS+Sed animals were heavier and had greater body fat, higher levels of triglycerides and total cholesterol, and more joint damage than Chow+Sed animals.

RESULTS

The HFS+Res group had higher body mass and body fat than Chow+Sed animals and higher OA scores than animals from the HFS+Aer group. Severe bone lesions were observed in the HFS+Sed and Chow+Sed animals at age 24 weeks, but not in the HFS+Res and HFS+Aer group animals.

CONCLOSION

In summary, aerobic training provided better protection against knee joint OA than resistance training in this rat model of HFS-diet-induced obesity. Exposing rats to exercise, either aerobic or resistance training, had a protective effect against the severe bone lesions observed in the nonexercised rats.

Diet and physical exercise in elderly people with obesity: The state of the art

Obesity is a disease that is assuming pandemic proportions in recent decades. With the advancement of medicine and increased access to care, average survival has increased, resulting in a larger number of elderly people. As a result, the amount of elderly people living with obesity is increasing, and the morbidity and impact of obesity on ageing implies severe limitations for these people. The link between obesity and ageing is not only epidemiological, but also strictly pathophysiological. Obesity accelerates the ageing process and ageing is characterised by pathophysiological mechanisms shared by obesity itself. Some examples of alterations shared by ageing and obesity are metabolic changes, sarcopenia and reduced functional capacity related to both loss of muscle strength and reduced cardiorespiratory fitness, as well as a general reduction in the perception of quality of life. The specific ability to antagonize these mechanisms through non-pharmacological treatment based on nutrition and exercise has always been one of the focal points of the international literature. Therefore, this review provides the state of the art on scientific knowledge regarding the main effects of an adequate nutritional plan and an individualised exercise prescription on the general health of elderly with obesity. In particular, this paper addresses the effect of nutrition and physical exercise on pathophysiological changes peculiar of ageing and obesity, providing also the scientific rational for nutritional and exercise prescription in the population.

Non-pharmacological treatment strategies for anthropometric, physical capacity and physiological indicators among sarcopenic obesity patients: a systematic review of rigorous randomized controlled trials

OBJECTIVES

To investigate the effects of non-pharmacological treatments on sarcopenic obesity (SO).

METHODS

A search for randomized controlled trials (RCTs) on SO was conducted in PubMed, Web of Science, CINAHL, CENTRAL, SPORTDiscus, CNKI, Wanfang and VIP. A meta-analysis was conducted using random-effects models for MDs.

RESULTS

The meta-analysis on 21 RCTs showed that exercise improved PBF (MD: -1.67%, p < .01, I2 = 35%), grip strength (MD: 2.2 kg, p = .03, I2 = 61%), GS (MD: 0.08 m/s, p = .02, I2 = 0%), TCR (MD: 2.22 repetitions, p < .01, I2 = 0%), TUG (MD: -1.48 s, p < .01, I2 = 61%), UE strength (MD: 1.88 kg/kg, p < .01, I2 = 0%) and LE strength (MD: 2.19 kg/kg, p < .01, I2 = 0%). Nutritional interventions improved grip strength (MD: 1.52 kg, p < .01, I2 = 0%). Combine interventions improved PBF (MD: -1.97%, p < .01, I2 = 38%), ASMM (MD: 0.4 kg, p < .01, I2 = 6%), grip strength (MD: 1.83 kg, p < .01, I2 = 38%) and GS (MD: 0.04 m/s, p < .01, I2 = 0%). Combined interventions were more effective than nutrition alone for reducing PBF (MD: -0.8%, p = .05, I2 = 0%).

CONCLUSION

The effects of exercise and nutrition interventions on SO are limited individually, especially regarding muscle mass, but their combination can yield optimal results. Additionally, physical therapy also demonstrated some potential.

The effect of resistance training on patients with secondary sarcopenia: a systematic review and meta-analysis

To analyse the effectiveness of resistance training on secondary sarcopenia, we conducted a meta-analysis to elucidate the effects of resistance training (RT) on muscle strength (handgrip strength [HGS]), muscle mass (Skeletal muscle mass index [SMI]), and physical function (Gait speed [GS]) in patients with secondary sarcopenia. All studies published between 2015 and January 2024 on the effects of resistance training on patients with secondary sarcopenia were retrieved from 6 electronic databases: PubMed, Web of Science Core Collection, Embase, the Cochrane Library, the China National Knowledge Infrastructure (CNKI) Core journals and the Wanfang Database. Two researchers independently extracted and evaluated studies that met the inclusion and exclusion criteria. Finally, 12 randomized controlled trials were included. Pooled analyses of baseline data and results were performed using Review Manager 5.3 with standardized mean variance (SMD) and random effects model. The study included 12 randomized controlled trials involving 639 patients (mean age 57.28 ± 2.66 to 79.6 ± 5.4 years). There are five types of complications among the patients: obesity, type 2 diabetes, Alzheimer's disease, hemodiaysis, and pancreatic cancer. Compared with the control group, RT effectively improved HGS [SMD = 2.47, 95% CI (1.50, 3.43), p < 0.01, I2 = 94%]; SMI [SMD = 0.94, 95% CI (0.52, 1.36), p < 0.01, I2 = 56%]; and GS [SMD = 2.18, 95% CI (-0.01, 4.37), p ≥ 0.05, I2 = 97%]. Further subgroup analysis of the results showed that the intervention effect on grip strength was greater for non-elastic band resistance [SMD = 2.40, 95% CI (1.05, 3.75), p < 0.01, I2 = 94%] than for elastic band resistance (EBRT) [SMD = 1.22, 95% CI (-0.14, 2.58), p < 0.01, I2 = 95%]. The intervention effect of RT on grip strength is more significant in patients with T2D [SMD = 0.59, 95%CI (0.26-0.93, p < 0.01, I2 = 27%] and obesity [SMD = 0.74, 95%CI (0.32-1.15, p < 0.01, I2 = 0%]. For patients with secondary sarcopenia, Resistance training (RT) can effectively enhance muscle strength and muscle mass; however, it does not significantly improve physical function. Different RT intervention methods have different effects on patients, such as elastic band training and non-elastic band training (bounce ball RT; equipment RT, etc.). Different types of complications may influence the effectiveness of RT intervention.

Sarcobesity: New paradigms for healthy aging related to taurine supplementation, gut microbiota and exercise

Enigmatic sarcopenic obesity is still a challenge for science and adds to the global public health burden. The progressive accumulation of body fat combined with a dysfunctional skeletal muscle structure and composition, oxidative stress, mitochondrial dysfunction, and anabolic resistance, among other aggravating factors, together represent the seriousness and complexity of treating the metabolic disorder of sarcobesity in aging. For this reason, further studies are needed that encourage the support of therapeutic management. It is along these lines that we direct the reader to therapeutic approaches that demonstrate important, but still obscure, outcomes in the physiological conditions of sarcobesity, such as the role of taurine in modulating inflammatory and antioxidant mechanisms in muscle and adipose tissue, as well as the management of gut microbiota, able to systemically re-establish the structure and function of the gut-muscle axis, in addition to the merits of physical exercise as an instrument to improve muscular health and lifestyle quality.

Myokines May Be the Answer to the Beneficial Immunomodulation of Tailored Exercise-A Narrative Review

Exercise can regulate the immune function, activate the activity of immune cells, and promote the health of the organism, but the mechanism is not clear. Skeletal muscle is a secretory organ that secretes bioactive substances known as myokines. Exercise promotes skeletal muscle contraction and the expression of myokines including irisin, IL-6, BDNF, etc. Here, we review nine myokines that are regulated by exercise. These myokines have been shown to be associated with immune responses and to regulate the proliferation, differentiation, and maturation of immune cells and enhance their function, thereby serving to improve the health of the organism. The aim of this article is to review the effects of myokines on intrinsic and adaptive immunity and the important role that exercise plays in them. It provides a theoretical basis for exercise to promote health and provides a potential mechanism for the correlation between muscle factor expression and immunity, as well as the involvement of exercise in body immunity. It also provides the possibility to find a suitable exercise training program for immune system diseases.

Sarcopenic obesity in patients with head and neck cancer is predictive of critical weight loss during radiotherapy

The impact of computed tomography-defined sarcopenia on outcomes in head and neck cancer has been well described. Sarcopenic obesity (SO) (depleted muscle mass combined with obesity) may pose a more serious risk than either condition alone. We investigated SO and its impact on survival and critical weight loss (≥ 5 %) in patients with head and neck cancer who received curative radiotherapy (± other modalities). Retrospective analysis of computed tomography cross-sectional muscle at cervical (C3), thoracic (T2) and lumbar (L3) regions was conducted. Patients were grouped by BMI and sarcopenia status based on established thresholds. A total of 413 patients were included for analysis, the majority having oropharyngeal carcinoma (52 %), and 56 % received primary concurrent chemoradiotherapy. The majority of the cohort (65 %) was overweight or obese (BMI ≥ 25 kg/m2). Sarcopenia was found in 43 %, with 65 % having SO (n 116), equating to 28 % of the whole cohort. Critical weight loss was experienced by 58 % (n 238). A significantly higher proportion of patients with SO experienced critical weight loss (n 70 v. 19, P < 0·001) and were four times more likely to do so during treatment (OR 4·1; 95 % CI 1·5, 7·1; P = 0·002). SO was not found to impact on overall or cancer-specific survival; however, in patients with sarcopenia, those with SO had better overall survival (median 9·1 v. 7·0 years; 95 % CI 5·2, 16·8; P = 0·021). SO at the time of presentation in patients with head and neck cancer is predictive of critical weight loss during treatment, and muscle evaluation can be useful in identifying patients at nutritional risk regardless of BMI and obvious signs of wasting.

Research Progress on the Effect and Mechanism of Exercise Intervention on Sarcopenia Obesity

With the increasingly severe situation of obesity and population aging, there is growing concern about sarcopenia obesity (SO). SO refers to the coexistence of obesity and sarcopenia, which imposes a heavier burden on individuals and society compared to obesity or sarcopenia alone. Therefore, comprehending the pathogenesis of SO and implementing effective clinical interventions are vital for its prevention and treatment. This review uses a comprehensive literature search and analysis of PubMed, Web of Science, and CNKI databases, with search terms including "Sarcopenic obesity", "exercise", "cytokines", "inflammation", "mitochondrial quality control", and "microRNA", covering relevant studies published up to July 2024. The results indicate that the pathogenesis of SO is complex, involving mechanisms like age-related changes in body composition, hormonal alterations, inflammation, mitochondrial dysfunction, and genetic and epigenetic factors. Regarding exercise interventions for SO, aerobic exercise can reduce fat mass, resistance exercise can increase skeletal muscle mass and strength, and combined exercise can achieve both, making it the optimal intervention for SO. The potential mechanisms by which exercise may prevent and treat SO include regulating cytokine secretion, inhibiting inflammatory pathways, improving mitochondrial quality, and mediating microRNA expression. This review emphasizes the effectiveness of exercise interventions in mitigating sarcopenic obesity through comprehensive analysis of its multifactorial pathogenesis and the mechanistic insights into exercise's therapeutic effects. Understanding these mechanisms informs targeted therapeutic strategies aimed at alleviating the societal and individual burdens associated with SO.

Nutritional Management and Physical Activity in the Treatment of Sarcopenic Obesity: A Review of the Literature

BACKGROUND

The prevalence of sarcopenic obesity among adults aged ≥65 years is increasing worldwide. It is a condition that describes the concomitant presence of sarcopenia and obesity, but it appears to be associated with greater increases in the risks for disability, morbidity, and mortality than the two conditions combined. The current review aims to summarize the available literature data on the effectiveness of lifestyle modification for the management of this high-risk geriatric syndrome.

METHODS

We conducted a comprehensive search across multiple databases, including PubMed, Scopus, Web of Science, and Cochrane Library, for publications published from January 1950 to June 2024.

RESULTS

The detection of early preventive and therapeutic approaches to combat sarcopenic obesity is essential for healthy aging. There is ample evidence that suggests that poor dietary habits and physical inactivity are the main reasons for the development of sarcopenic obesity and should thus be the main targets for intervention. In the absence of effective pharmacological interventions, the best effect on sarcopenic obesity is achieved by combination with proper dietary intervention and regular physical activity according to the individual's health condition.

CONCLUSIONS

Further research is needed to discover the most effective strategy for the prevention and treatment of sarcopenic obesity, as well as potential pharmacological options to improve muscle mass and function in older populations with physical restrictions.

Dynapenic abdominal obesity and incident functional disability: Results from a nationwide longitudinal study of middle-aged and older adults in China

BACKGROUND

There is little epidemiological evidence on the relationship of dynapenic abdominal obesity (DAO) and the development of functional disability, particularly in Asian populations. We aimed to investigate the association of DAO with new-onset functional disability in Chinese adults.

METHODS

A total of 7881 participants aged ≥45 years from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 were included in the study. Dynapenia and abdominal obesity were respectively defined based on handgrip strength (<28 kg for male and <18 kg for female) and waist circumference (≥ 90 cm for male and ≥85 cm for female). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). Functional status was assessed by basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Logistic regression model was used to explore the longitudinal association between dynapenic abdominal obesity and incident functional disability.

RESULTS

After a 4-year follow-up, 1153 (14.6 %) developed BADL disability and 1335 (16.9 %) developed IADL disability. The multivariable-adjusted odds ratios (95 % CIs) for the D/AO versus ND/NAO were 2.21 (1.61-3.03) for BADL disability, and 1.68 (1.23-2.30) for IADL disability. In addition, DAO was associated with an increased risk for functional dependency severity (odds ratio, 2.08 [95 % CI, 1.57-2.75]).

CONCLUSIONS

DAO was significantly associated with greater risk of functional disability among Chinese middle-aged and older adults. Our findings indicated that interventions targeted DAO might be effective in the primary prevention of functional disability.

Dietary Protein and Physical Exercise for the Treatment of Sarcopenia

Sarcopenia is a multifactorial age-related disorder that causes a decrease in muscle mass, strength, and function, leading to alteration of movement, risk of falls, and hospitalization. This article aims to review recent findings on the factors underlying sarcopenia and the strategies required to delay and counteract its symptoms. We focus on molecular factors linked to ageing, on the role of low-grade chronic and acute inflammatory conditions such as cancer, which contributes to the onset of sarcopenia, and on the clinical criteria for its diagnosis. The use of drugs against sarcopenia is still subject to debate, and the suggested approaches to restore muscle health are based on adequate dietary protein intake and physical exercise. We also highlight the difference in the amount and quality of amino acids within animal- and plant-based diets, as studies have often shown varying results regarding their effect on sarcopenia in elderly people. In addition, many studies have reported that non-pharmacological approaches, such as an optimization of dietary protein intake and training programs based on resistance exercise, can be effective in preventing and delaying sarcopenia. These approaches not only improve the maintenance of skeletal muscle function, but also reduce health care costs and improve life expectancy and quality in elderly people.

Effect of a 12-Week Strength Training Program on Muscle Strength Measures of Institutionalized Older Adults-A Pilot Study

Institutionalized older adults are characterized by high levels of dependence and low levels of physical activity compared to those living in the community. This combination of factors leads to an increased risk of loss of muscle mass. Sarcopenia can be countered through strength training. The aim of the present study was to evaluate the effect of a strength training program on the physical fitness of institutionalized older adults. This study included a sample of 31 institutionalized older adults (20 females, 11 males) aged between 65 and 96 years (M = 81.64, SD = 8.67). Participants reported an average institutionalization duration of 2.43 years (SD = 2.20), ranging from half a year to ten years. A 12-week strength training program was implemented, with sessions held twice a week. Strength fitness was assessed through the following parameters: handgrip strength, upper limb muscular endurance, lower limb muscular endurance, agility and balance, body mass index, and waist circumference. The results demonstrated that a 12-week strength training program improved physical fitness in terms of lower limb muscular endurance, upper limb muscular endurance, agility, and dynamic balance (p < 0.05).

Dynapenic abdominal obesity and the risk of depressive symptoms in middle-aged and older Chinese adults: Evidence from a national cohort study

BACKGROUND

Population-based evidence on the relationship between dynapenic abdominal obesity and depressive symptoms is rare. We aimed to prospectively investigate the relationship between dynapenic abdominal obesity and depressive symptoms among middle-aged and older Chinese adults.

METHODS

A total of 9322 participants free of depressive symptoms in the China Health and Retirement Longitudinal Study were included. The participants were divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO) according to the sex-specific grip strength (<28 kg for men and <18 kg for women) and waist circumference (≥85 cm for men and ≥80 cm for women) that in line with the Chinese criteria. Depressive symptoms was defined as a score of ≥12 for the 10-item Center for Epidemiological Studies Depression Scale. Logistic regression model was used to explore the association between dynapenic abdominal obesity and depressive symptoms.

RESULTS

After an approximately 3-year of follow-up, 1810 participants (19.4 %) developed depressive symptoms. The multivariable-adjusted odds ratio for the D/AO versus ND/NAO was 1.61 (95 % CI: 1.31-1.98) for depressive symptoms. In addition, this relationship was more profound in participants aged<60 years (OR = 2.27, 95 % CI: 1.60-3.22) than participants aged ≥60 (OR = 1.36, 95 % CI: 1.05-1.77; P-interaction = 0.04). However, dynapenic obesity (defined by body mass index) was not linked to depressive symptoms.

LIMITATIONS

Causal link and residual confounding were not addressed because of the observational study design.

CONCLUSIONS

Dynapenic abdominal obesity was associated with an increased risk of depressive symptoms, especially among those aged<60 years.

Navigating the Intersection: Sarcopenia and Sarcopenic Obesity in Inflammatory Bowel Disease

Inflammatory bowel diseases (IBDs) are intricate systemic conditions that can extend beyond the gastrointestinal tract through both direct and indirect mechanisms. Sarcopenia, characterized by a reduction in muscle mass and strength, often emerges as a consequence of the clinical course of IBDs. Indeed, sarcopenia exhibits a high prevalence in Crohn's disease (52%) and ulcerative colitis (37%). While computed tomography and magnetic resonance imaging remain gold-standard methods for assessing muscle mass, ultrasound is gaining traction as a reliable, cost-effective, and widely available diagnostic method. Muscle strength serves as a key indicator of muscle function, with grip strength test emerging nowadays as the most reliable assessment method. In IBDs, sarcopenia may arise from factors such as inflammation, malnutrition, and gut dysbiosis, leading to the formulation of the 'gut-muscle axis' hypothesis. This condition determines an increased need for surgery with poorer post-surgical outcomes and a reduced response to biological treatments. Sarcopenia and its consequences lead to reduced quality of life (QoL), in addition to the already impaired QoL. Of emerging concern is sarcopenic obesity in IBDs, a challenging condition whose pathogenesis and management are still poorly understood. Resistance exercise and nutritional interventions, particularly those aimed at augmenting protein intake, have demonstrated efficacy in addressing sarcopenia in IBDs. Furthermore, anti-TNF biological therapies showed interesting outcomes in managing this condition. This review seeks to furnish a comprehensive overview of sarcopenia in IBDs, elucidating diagnostic methodologies, pathophysiological mechanisms, and clinical implications and management. Attention will also be paid to sarcopenic obesity, exploring the pathophysiology and possible treatment modalities of this condition.

Construction of an Exercise Intervention Program for Patients with Sarcopenic Obesity: A Delphi Method Study

Purpose

Construct an exercise intervention program for patients with sarcopenic obesity.

Material and Methods

Based on the COM-B theoretical model and evidence-based principles, the program was constructed using qualitative methods of literature analysis and Delphi method. The Delphi panel consisted of 15 experts from the fields of clinical medicine, rehabilitation medicine, medical technology, and nursing.

Results

Fifteen experts were consulted, and the consultation recovery rate was 100%; the authority coefficient of the 1st round was 0.83, with coefficients of variation ranging from 0.00 to 0.27, and importance scores ranging from (4.13±1.13) to (5±0); the authority coefficient of the 2nd round was 0.82, with coefficients of variation ranging from 0.00 to 0.20, and importance scores ranging from (4.53±0.64) to (5±0); Kendall's harmony coefficient was 0.102, 0.115, respectively, and the differences were statistically significant(P < 0.05). The constructed exercise intervention program for patients with sarcopenic obesity included 4 primary indicators, 12 secondary indicators, and 28 tertiary indicators.

Conclusion

The constructed exercise intervention program for patients with sarcopenic obesity is scientific, feasible and generalizable, and can provide useful reference for related personnel to develop exercise programs for patients with sarcopenic obesity.

Sarcopenic obesity in older adults: a clinical overview

Sarcopenic obesity is characterized by a concurrent decline in muscle mass and function, along with increased adipose tissue. Sarcopenic obesity is a growing concern in older adults owing to significant health consequences, including implications for mortality, comorbidities and risk of developing geriatric syndromes. A 2022 consensus statement established a new definition and diagnostic criteria for sarcopenic obesity. The pathophysiology of this condition involves a complex interplay between muscle, adipose tissue, hormonal changes, inflammation, oxidative stress and lifestyle factors, among others. Sarcopenic obesity is treated with a range of management approaches, such as lifestyle interventions, exercise, nutrition and medical therapies. Emerging therapies that were developed for treating other conditions may be relevant to sarcopenic obesity, including novel pharmacological agents and personalized approaches such as precision medicine. In this Review, we synthesize the current knowledge of the clinical importance of sarcopenic obesity, its assessment and diagnosis, along with current and emerging management strategies.

Nutritional approaches targeting mitochondria for the prevention of sarcopenia

A decline in function and loss of mass, a condition known as sarcopenia, is observed in the skeletal muscles with aging. Sarcopenia has a negative effect on the quality of life of elderly. Individuals with sarcopenia are at particular risk for adverse outcomes, such as reduced mobility, fall-related injuries, and type 2 diabetes mellitus. Although the pathogenesis of sarcopenia is multifaceted, mitochondrial dysfunction is regarded as a major contributor for muscle aging. Hence, the development of preventive and therapeutic strategies to improve mitochondrial function during aging is imperative for sarcopenia treatment. However, effective and specific drugs that can be used for the treatment are not yet approved. Instead studies on the relationship between food intake and muscle aging have suggested that nutritional intake or dietary control could be an alternative approach for the amelioration of muscle aging. This narrative review approaches various nutritional components and diets as a treatment for sarcopenia by modulating mitochondrial homeostasis and improving mitochondria. Age-related changes in mitochondrial function and the molecular mechanisms that help improve mitochondrial homeostasis are discussed, and the nutritional components and diet that modulate these molecular mechanisms are addressed.

A meta-analysis on the impact of resistance training on phase angle in middle-aged and older individuals

PURPOSE

To determine the impact of resistance training (RT) on phase angle (PhA) in middle-aged and older individuals via meta-analysis, explore effects in subgroups, and identify optimal RT protocol.

MATERIALS AND METHODS

We searched five databases using predefined criteria, assessed literature quality per Cochrane 5.1 Handbook, and used Revman 5.3 for effect size aggregation, bias assessment, sensitivity analysis, and subgroup analysis.

RESULTS

RT improved PhA in middle-aged and older individuals (d = 0.34, 95 % CI: 0.27-0.40, P < 0.05). Effective subgroups included Suspension (d = 0.62, 95 % CI: 0.33-0.90, P < 0.05), free-weights and machine (d = 0.36, 95 % CI: 0.28-0.45, P < 0.05), equipment training (d = 0.24, 95 % CI: 0.13-0.36, P < 0.05), and moderate-intensity RT (d = 0.34, 95 % CI: 0.27-0.42, P < 0.05). RT was conducted 2-3 times/week (d = 0.20, 95 % CI: 0.01-0.38, P < 0.05) or (d = 0.38, 95 % CI: 0.30-0.47, P < 0.05). PhA improved after 8 weeks (d = 0.37, 95 % CI: 0.23-0.51, P < 0.05), 12 weeks (d = 0.35, 95 % CI: 0.26-0.44, P < 0.05), and ≥ 24 weeks (d = 0.26, 95 % CI: 0.11-0.41, P < 0.05) of RT in aged and older individuals. Low- and high-intensity RT, elastic band training, and weekly exercises did not significantly improve PhA.

CONCLUSIONS

RT enhances PhA in middle-aged and older adults. For optimal results, we recommend 2-3 weekly sessions of free weights and machine training lasting at least 8 weeks.

Effects of various exercise types on visceral adipose tissue in individuals with overweight and obesity: A systematic review and network meta-analysis of 84 randomized controlled trials

The purpose of this systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was to investigate the effects of various exercise categories on visceral adipose tissue (VAT) and other anthropometric variables in individuals with overweight and obesity. A total of 84 RCTs (4836 patients) were included. Aerobic exercise (AE) of at least moderate intensity, resistance training (RT), AE combined with RT (AE + RT), and high-intensity interval training (HIIT) were beneficial for reducing VAT. A subgroup analysis showed that RT improves VAT in males and those with BF% < 40% but not in females and those with body fat percentage (BF%) ≥ 40%. AE, RT, AE + RT, and HIIT significantly improved weight (except RT), total body fat (TBF), body mass index (BMI), waist circumference (WC), and subcutaneous adipose tissue (SAT). Surface under the cumulative ranking curve (SUCRA) probability ranking showed that AE with vigorous intensity and HIIT have the highest probability of being the best exercise intervention for improving VAT, weight, TBF, BMI, WC, and SAT. These findings suggest that regular exercise can improve VAT in individuals with overweight and obesity. AE of vigorous intensity and HIIT may be the best exercise treatment, and RT is the least effective intervention.

Mitochondrial involvement in sarcopenia

Sarcopenia lowers the quality-of-life for millions of people across the world, as accelerated loss of skeletal muscle mass and function contributes to both age- and disease-related frailty. Physical activity remains the only proven therapy for sarcopenia to date, but alternatives are much sought after to manage this progressive muscle disorder in individuals who are unable to exercise. Mitochondria have been widely implicated in the etiology of sarcopenia and are increasingly suggested as attractive therapeutic targets to help restore the perturbed balance between protein synthesis and breakdown that underpins skeletal muscle atrophy. Reviewing current literature, we note that mitochondrial bioenergetic changes in sarcopenia are generally interpreted as intrinsic dysfunction that renders muscle cells incapable of making sufficient ATP to fuel protein synthesis. Based on the reported mitochondrial effects of therapeutic interventions, however, we argue that the observed bioenergetic changes may instead reflect an adaptation to pathologically decreased energy expenditure in sarcopenic muscle. Discrimination between these mechanistic possibilities will be crucial for improving the management of sarcopenia.

Effectiveness of exercise interventions on muscle mass among older adults with sarcopenic obesity: A scoping review

A disease known as sarcopenic obesity is characterized by decreased lean body mass in conjunction with excessive amounts of adipose tissue. Skeletal muscle mass, also known as SMM, is responsible for the largest share of fat-free mass in the body and plays an extremely vital role in the maintaining of metabolic health. Physical activity and exercise boosts the physiological health and overall quality of life of senior citizens. The objective of the study is to investigate the effectiveness of varied exercise interventions among the geriatric people with sarcopenic obesity. During the time period (2016-2023), a scoping review was undertaken using PubMed, orthopedic journals, and the Google Scholar database, and six literature evidences relating to the topic were discovered and subsequently analyzed. The study includes six randomized control trial publications that investigated the effectiveness and impact of exercise therapies on sarcopenic obesity. According to the pre and post-test values found in the reviewed articles, we discovered that resistance exercise is more effective than aerobic or combination exercise therapies. In conclusion, according to this scoping analysis, resistance training is more effective than other types of exercise in improving muscle mass in older people with sarcopenic obesity.

Effect of Resistance Exercise on Body Composition and Functional Capacity in Older Women with Sarcopenic Obesity-A Systematic Review with Narrative Synthesis

BACKGROUND

Resistance exercise has shown effectiveness in reducing various risk factors related to sarcopenic obesity (SO) compared to other types of exercise, e.g., aerobic exercise.

OBJECTIVE

This systematic review evaluates the effect of resistance exercise on body composition, muscular strength, and functional capacity among older women with sarcopenic obesity aged ≥ 60 years.

METHODS

This systematic review is registered on PROSPERO (registration No. CRD42023394603) and follows the PRISMA guidelines. The following electronic databases were used to search the literature: Pedro, Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science. We included only RCTs that investigated the effect of resistance exercise on body composition and functional capacity. Two independent reviewers conducted the process of study selection and data extraction.

RESULTS

The search strategy retrieved 687 results. One hundred and twenty-six records were deleted as duplicates. Consequently, 534 studies were excluded after the title/abstract assessment. After further detailed evaluation of twenty-seven full texts, seven RCTs were included; all the RCTs examined the isolated effect of resistance exercise in women with sarcopenic obesity. The included studies comprised 306 participants, with an average age of 64 to 72 years. We noticed a trend of improvement in the included studies among the intervention groups compared to the control groups among the different outcomes. The study protocol was inconsistent for the intervention settings, duration, and outcomes. Including a modest number of trials made it impossible to perform data meta-analysis.

CONCLUSIONS

Heterogeneity among studies regarding training protocols and the outcome measures reported limited robust conclusions. Still, resistance exercise intervention can improve body composition and functional capacity among elderly women with sarcopenic obesity.

Impact of EASO/ESPEN-Defined Sarcopenic Obesity Following a Technology-Based Weight Loss Intervention

BACKGROUND

Sarcopenic Obesity is the co-existence of increased adipose tissue (obesity) and decreased muscle mass or strength (sarcopenia) and is associated with worse outcomes than obesity alone. The new EASO/ESPEN consensus provides a framework to standardize its definition. This study sought to evaluate whether there are preliminary differences observed in weight loss or physical function in older adults with and without sarcopenic obesity taking part in a multicomponent weight loss intervention using these new definitions.

METHODS

A 6-month, non-randomized, non-blinded, single-arm pilot study was conducted from 2018 to 2020 in adults ≥ 65 years with a body mass index (BMI) ≥ 30 kg/m2. Weekly dietitian visits and twice-weekly physical therapist-led exercise classes were delivered using telemedicine. We conducted a secondary retrospective analysis of the parent study (n = 53 enrolled, n = 44 completers) that investigated the feasibility of a technology-based weight management intervention in rural older adults with obesity. Herein, we applied five definitions of sarcopenic obesity (outlined in the consensus) to ascertain whether the response to the intervention differed among those with and without sarcopenic obesity. Primary outcomes evaluated included weight loss and physical function (30-s sit-to-stand).

RESULTS

In the parent study, mean weight loss was - 4.6 kg (95% CI - 3.6, - 5.6; p < 0.001). Physical function measures of 30-s sit-to-stand showed a mean increase of 3.1 in sit-to-stand repetitions (+ 1.9, + 4.3; p < 0.001). In this current analysis, there was a significant decrease in weight and an increase in repetitions between baseline and follow-up within each group of individuals with and without sarcopenia for each of the proposed definitions. However, we did not observe any significant differences in the changes between groups from baseline to follow-up.

CONCLUSIONS

The potential lack of significant differences in weight loss or physical function between older adults with and without sarcopenic obesity participating in a weight loss intervention may suggest that well-designed, multicomponent interventions can lead to similar outcomes irrespective of sarcopenia status in persons with obesity. Fully powered randomized clinical trials are critically needed to confirm these preliminary results.

NAFLD Associates with Sarcopenia Defined by Muscle Mass and Slow Walking Speed: A Cross-Sectional Analysis from the Framingham Heart Study

Sarcopenia is associated with NAFLD. It is unknown if the association is explained by shared risk factors. Our study sought to investigate the association between liver fat and sarcopenia in our cohort. Liver fat was measured on CT between 2008 and 2011. We excluded heavy alcohol use and missing covariates. Muscle mass in a subset (n = 485) was measured by 24 h urinary creatinine. Physical function was defined by h strength and walking speed. Sarcopenia was defined as low muscle mass and/or low physical function. We created multivariable-adjusted regression models to evaluate cross-sectional associations between liver fat and low muscle mass, grip strength, and walking speed. The prevalence of hepatic steatosis was 30% (n = 1073; 58.1% women; mean age 65.8 ± 8.6 years). There was a significant positive association between liver fat and muscle mass in linear regression models. The association was not significant after adjusting for BMI. The odds of sarcopenia increased by 28% for each SD in liver fat (OR 1.28; 95% CI 1.02, 1.60) and persisted after accounting for confounders in multivariable-adjusted models (OR 1.30, 95% CI 1.02, 1.67). Further studies are needed to determine if there is a causal relationship between liver fat and sarcopenia and whether treatment of sarcopenia improves liver fat.

A comprehensive review on the risks assessment and treatment options for Sarcopenia in people with diabetes

Objectives

This comprehensive review aims to examine the reciprocal interplay between Type 2 diabetes mellitus (T2DM) and sarcopenia, identify prevailing research gaps, and discuss therapeutic approaches and measures to enhance healthcare practices within hospital settings.

Methods

A thorough literature review was conducted to gather relevant studies and articles on the relationship between T2DM and sarcopenia. Various databases were searched, including Google Scholar, PubMed, Scopus, and Science Direct databases. The search terms included T2DM, sarcopenia, inflammation, insulin resistance, advanced glycation end products, oxidative stress, muscle dimensions, muscle strength, muscle performance, aging, nutrition, hormone levels, and physical activity. The collected articles were critically analysed to extract key findings and identify gaps in current research.

Results

The prevalence and incidence of metabolic and musculoskeletal disorders, notably T2DM and sarcopenia, have surged in recent years. T2DM is marked by inflammation, insulin resistance, accumulation of advanced glycation end products, and oxidative stress, while sarcopenia involves a progressive decline in skeletal muscle mass and function. The review underscores the age-related correlation between sarcopenia and adverse outcomes like fractures, falls, and mortality. Research gaps regarding optimal nutritional interventions for individuals with T2DM and sarcopenia are identified, emphasizing the necessity for further investigation in this area.

Conclusions

The reciprocal interplay between T2DM and sarcopenia holds significant importance. Further research is warranted to address knowledge gaps, particularly in utilizing precise measurement tools during clinical trials. Lifestyle modifications appear beneficial for individuals with T2DM and sarcopenia. Additionally, practical nutritional interventions require investigation to optimize healthcare practices in hospital settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01262-w.

Effects of resistance training on muscular strength, endurance, body composition and functional performance among sarcopenic patients: a systematic review

Background

Sarcopenia, a gradual loss of muscle mass and strength associated with ageing, contributes to a decline in physical abilities, increase in disability and frailty and loss of functional independence. This functional deterioration which comes with ageing, can be slowed in pace with exercise.

Objective

The objective of the current review was to thoroughly search for literature assessing impact of RT on physical performance, body composition, muscle strength and endurance in sarcopenic elderly patients.

Methods

PubMed, Scopus, Web of Science, and PEDro databases were brought in use for a thorough search for articles published from 2010 to 2023. Two researchers independently retrieved data from studies that complied with the inclusion and exclusion criteria, while they also evaluated quality of the evidence.

Results

In total, 14 studies with 742 patients with mean age of 72.4 ± 9.22 years were included in the analysis for this review. Results indicate, RT improves body composition (p = 0.001), functional performance (p 0.001), postural stability (p = 0.005) and muscle strength (p 0.001) in elderly sarcopenic patients.

Conclusion

A promising intervention for the management of sarcopenia is RT. To yield RT's positive effects, a well-designed prescription is the need of the hour, just like it is with other treatment strategies.

Is moderate resistance training adequate for older adults with sarcopenia? A systematic review and network meta-analysis of RCTs

BACKGROUND

Resistance training (RT) and nutritional supplementation are recommended for the management of sarcopenia in older adults. However, optimal RT intensity for the treatment of sarcopenia has not been well investigated.

METHODS

This network meta-analysis aims to determine the comparative effectiveness of interventions for sarcopenia, taking RT intensity into consideration. RT intensity was classified into light-to-moderate intensity RT(LMRT), moderate intensity RT(MRT), and moderate-to-vigorous intensity RT(MVRT) based on percentage of one repetition maximum (%1RM) and/or rating of perceived exertion.

RESULTS

A total of 50 RCTs (N = 4,085) were included after screening 3,485 articles. The results confirmed that RT with or without nutrition was positively associated with improved measures of muscle strength and physical performance. Regarding RT intensity, LMRT only demonstrated positive effects on hand grip (aerobic training + LMRT + nutrition: mean difference [MD] = 2.88; 95% credential intervals [CrI] = 0.43,5.32). MRT provided benefits on improvement in the 30-s chair stand test (repetitions) (MRT: MD = 2.98, 95% CrI = 0.35,5.59), timed up and go test (MRT: MD = -1.74, 95% CrI: = -3.34,-0.56), hand grip (MRT: MD = 2.44; 95% CrI = 0.03,5.70), and leg press (MRT: MD = 8.36; 95% CrI = 1.87,13.4). MVRT also improved chair stand test repetitions (MVRT: MD = 5.64, 95% CrI = 0.14,11.4), gait speed (MVRT + nutrition: MD = 0.21, 95% CrI = 0.003,0.48), appendicular skeletal muscle index (MVRT + nutrition: MD = 0.25, 95% CrI = 0.01,0.5), and leg press (MVRT: MD = 14.7, 95% CrI: 5.96,22.4; MVRT + nutrition: MD = 17.8, 95% CrI: 7.55,28.6).

CONCLUSION

MVRT had greater benefits on muscle mass, lower extremity strength, and physical performance compared to MRT. Increasing RT intensity may be recommended for sarcopenic older adults.

Adipokines in Rheumatoid Arthritis: Emerging Biomarkers and Therapeutic Targets

Rheumatoid arthritis (RA) is a chronic inflammatory disease manifested by joint involvement, extra-articular manifestations, and general symptoms. Adipose tissue, previously perceived as an inert energy storage organ, has been recognised as a significant contributor to RA pathophysiology. Adipokines modulate immune responses, inflammation, and metabolic pathways in RA. Although most adipokines have a pro-inflammatory and aggravating effect on RA, some could counteract this pathological process. The coexistence of RA and sarcopenic obesity (SO) has gained attention due to its impact on disease severity and outcomes. Sarcopenic obesity further contributes to the inflammatory milieu and metabolic disturbances. Recent research has highlighted the intricate crosstalk between adipose tissue and skeletal muscle, suggesting potential interactions between these tissues in RA. This review summarizes the roles of adipokines in RA, particularly in inflammation, immune modulation, and joint destruction. In addition, it explores the emerging role of adipomyokines, specifically irisin and myostatin, in the pathogenesis of RA and their potential as therapeutic targets. We discuss the therapeutic implications of targeting adipokines and adipomyokines in RA management and highlight the challenges and future directions for research in this field.

Exploring the implications of modified advanced lung cancer inflammation index on outcomes in patients with advanced non-small cell lung cancer

Aim

Sarcopenia and skeletal muscle density (SMD) have been shown to be both predictive and prognostic marker in oncology. Advanced lung cancer inflammation index (ALI) has been shown to predict overall survival (OS) in small cell lung cancer (SCLC). Computed tomography (CT) enables skeletal muscle to be quantified, whereas body mass index (BMI) cannot accurately reflect body composition. The purpose was to evaluate the prognostic value of modified ALI (mALI) using CT-determined third lumbar vertebra (L3) muscle index beyond original ALI and see the interaction between sarcopenia, SMD, neutrophil-lymphocyte ratio (NLR), ALI and mALI at baseline and post 4 cycles of chemotherapy and their effects on OS and progress free survival (PFS) in patients with advanced non-SCLC (NSCLC).

Methods

This retrospective study consisted of a total of 285 advanced NSCLC patients. The morphometric parameters such as SMD, skeletal muscle index (SMI) and fat-free mass (FFM) were measured by CT at the L3 vertebra. ALI was defined as BMI × serum albumin/NLR and mALI was defined as SMI × serum albumin/NLR.

Results

Sarcopenia was observed in over 70% of patients across all BMI categories. Patients having sarcopenia suffered from a higher incidence of chemotherapeutic drug toxicities but this was not found to be statistically significant. Concordance was seen between ALI and mALI in the pre-treatment setting and this was statistically significant. A significant proportion of patients with poor ALI (90.9%), poor pre-chemotherapy mALI (91.3%) and poor post-chemotherapy mALI (89%) had poor NLR and each of them was statistically significant.

Conclusions

In both univariate and multivariate analyses, this study demonstrated the statistical significance of sarcopenia, SMD, and mALI as predictive factors for OS. Additionally, sarcopenia and SMD were also found to be statistically significant factors in predicting PFS. These biomarkers could potentially help triage patients for active nutritional intervention for better outcomes.

Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people: a pilot randomised controlled trial

BACKGROUND

The effects of dietary intervention in managing sarcopenic obesity are controversial, and behavior change techniques are lacking in previous studies which are important for the success of dietary intervention. This study aimed to evaluate the feasibility and preliminary effects of a dietary behaviour change (DBC) intervention on managing sarcopenic obesity among community-dwelling older people in the community.

METHODS

A two-armed, RCT was conducted. Sixty community-dwelling older adults (≥ 60 years old) with sarcopenic obesity were randomised into either the experimental group (n = 30), receiving a 15-week dietary intervention combined with behaviour change techniques guided by the Health Action Process Approach model, or the control group (n = 30), receiving regular health talks. Individual semi-structured interviews were conducted with 21 experimental group participants to determine the barriers and facilitators of dietary behaviour changes after the intervention.

RESULTS

The feasibility of the DBC intervention was confirmed by an acceptable recruitment rate (57.14%) and a good retention rate (83.33%). Compared with the control group, the experimental group significantly reduced their body weight (p = 0.027, d = 1.22) and improved their dietary quality (p < 0.001, d = 1.31). A positive improvement in handgrip strength (from 15.37 ± 1.08 kg to 18.21 ± 1.68 kg), waist circumference (from 99.28 ± 1.32 cm to 98.42 ± 1.39 cm), and gait speed (from 0.91 ± 0.02 m/s to 0.99 ± 0.03 m/s) was observed only in the experimental group. However, the skeletal muscle mass index in the experimental group decreased. The interview indicated that behaviour change techniques enhanced the partcipants' compliance with their dietary regimen, while cultural contextual factors (e.g., family dining style) led to some barriers.

CONCLUSION

The DBC intervention could reduce body weight, and has positive trends in managing handgrip strength, gait speed, and waist circumference. Interestingly, the subtle difference between the two groups in the change of muscle mass index warrants futures investigation. This study demonstrated the potential for employing dietary behaviour change interventions in community healthcare.

TRIAL REGISTRATION

Registered retrospectively on ClinicalTrailas.gov (31/12/2020, NCT04690985).

Effect of Hypoxia Conditioning on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

The effects of hypoxia conditioning, which involves recurrent exposure to hypoxia combined with exercise training, on improving body composition in the ageing population have not been extensively investigated.

OBJECTIVE

This meta-analysis aimed to determine if hypoxia conditioning, compared to similar training near sea level, maximizes body composition benefits in middle-aged and older adults.

METHODS

A literature search of PubMed, EMBASE, Web of Science, Scopus and CNKI (China National Knowledge Infrastructure) databases (up to 27th November 2022) was performed, including the reference lists of relevant papers. Three independent reviewers extracted study characteristics and health outcome measures. Search results were limited to original studies of the effects of hypoxia conditioning on body composition in middle-aged and older adults.

RESULTS

Twelve studies with a total of 335 participants were included. Hypoxia conditioning induced greater reductions in body mass index (MD = -0.92, 95%CI: -1.28 to -0.55, I2 = 0%, p < 0.00001) and body fat (SMD = -0.38, 95%CI: -0.68 to -0.07, I2 = 49%, p = 0.01) in middle-aged and older adults compared with normoxic conditioning. Hypoxia conditioning improved lean mass with this effect not being larger than equivalent normoxic interventions in either middle-aged or older adults (SMD = 0.07, 95%CI -0.12 to 0.25, I2 = 0%, p = 0.48). Subgroup analysis showed that exercise in moderate hypoxia (FiO2 > 15%) had larger effects than more severe hypoxia (FiO2 ≤ 15%) for improving body mass index in middle-aged and older adults. Hypoxia exposure of at least 60 min per session resulted in larger benefits for both body mass index and body fat.

CONCLUSION

Hypoxia conditioning, compared to equivalent training in normoxia, induced greater body fat and body mass index improvements in middle-aged and older adults. Adding hypoxia exposure to exercise interventions is a viable therapeutic solution to effectively manage body composition in ageing population.

Effects of Nutrition and Exercise Interventions on Persons with Sarcopenic Obesity: An Umbrella Review of Meta-Analyses of Randomised Controlled Trials

BACKGROUND

Sarcopenic obesity (SO) is an increasing phenomenon and has been linked to several negative health consequences. The aim of this umbrella review is the assessment of effectiveness and certainty of evidence of nutrition and exercise interventions in persons with SO.

METHOD

We searched for meta-analyses of RCTs in PubMed, EMBASE and CENTRAL that had been conducted in the last five years, focusing on studies on the treatment and prevention of SO. The primary endpoints were parameters for SO, such as body fat in %, skeletal muscle mass index (SMMI), gait speed, leg strength and grip strength. The methodological quality was evaluated using AMSTAR and the certainty of evidence was assessed using GRADE.

RESULTS

Four systematic reviews with between 30 to 225 participants were included in the umbrella review. These examined four exercise interventions, two nutrition interventions and four interventions that combined nutrition and exercise. Resistance training was the most frequently studied intervention and was found to improve gait speed by 0.14 m/s to 0.17 m/s and lower leg strength by 9.97 kg. Resistance, aerobic, mixed exercise and hypocaloric diet combined with protein supplementation is not significantly effective on selected outcomes for persons with SO compared to no intervention. The low number of primary studies included in the reviews resulted in moderate to very low certainty of evidence.

CONCLUSION

Despite the lack in certainty of evidence, resistance training may be a suitable intervention for persons with SO, in particular for improving muscle function. Nevertheless, further research is necessary to strengthen the evidence.

Sarcopenic obesity: emerging mechanisms and therapeutic potential

Sarcopenic obesity, or the loss of muscle mass and function associated with excess adiposity, is a largely untreatable medical condition associated with diminished quality of life and increased risk of mortality. To date, it remains somewhat paradoxical and mechanistically undefined as to why a subset of adults with obesity develop muscular decline, an anabolic stimulus generally associated with retention of lean mass. Here, we review evidence surrounding the definition, etiology, and treatment of sarcopenic obesity with an emphasis on emerging regulatory nodes with therapeutic potential. We review the available clinical evidence largely focused on diet, lifestyle, and behavioral interventions to improve quality of life in patients with sarcopenic obesity. Based upon available evidence, relieving consequences of energy burden, such as oxidative stress, myosteatosis, and/or mitochondrial dysfunction, is a promising area for therapeutic development in the treatment and management of sarcopenic obesity.

Mitochondrial Dysfunction and Sarcopenic Obesity: The Role of Exercise

Sarcopenic obesity (SO) constitutes the coexistence of skeletal muscle mass loss (sarcopenia) and excess adiposity (obesity). It is mainly considered as a condition in the elderly with health-threatening impacts ranging from frailty to mortality. Mitochondrial dysfunction consists one of the basic pathophysiological mechanisms leading to the development of SO and its consequences. Indirect indicators of mitochondrial function, such as VO2max and exercise capacity, have been demonstrated to be negatively affected in individuals with SO, while the positive effect of exercise on mitochondrial function has been widely proved; thus, in this review, we aimed at investigating the effects of endurance, resistance, and concurrent exercise training on indexes of mitochondrial dysfunction in SO patients. The results of the clinical trials evaluated reveal positive effects of chronic exercise on VO2max and physical capacity, as well as mitochondrial biogenesis and activity. It has been concluded that utilizing a systematic exercise training program that includes both aerobic and strength exercises can be an effective strategy for managing SO and promoting overall health in these patients.

Effects of non-pharmacological interventions on patients with sarcopenic obesity: A meta-analysis

OBJECTIVE

Systematic evaluation of the improvement effect of non-pharmacological intervention on patients with sarcopenic obesity.

METHODS

Wanfang, VIP, China National Knowledge Infrastructure (CNKI), SinoMed, Web of Science, Cochrane Library, PubMed, and Embase databases were searched systematically for randomized controlled trials (RCTS) and experimental studies of non-pharmacological interventions on patients with sarcopenic obesity. The retrieval period was from the establishment of the databases to October 31, 2022. Meta-analysis was conducted using RevMan 5.4.

RESULTS

A total of 18 studies involving 1,109 patients were included. Meta-analysis results showed that non-pharmacological interventions improved patients' body weight [mean difference, MD = -2.74, 95% CI (-4.79, -0.70), P = 0.009], body fat percentage [MD = -0.67, 95% CI (-0.96, -0.38), P<0.00001], grip strength [MD = 1.29, 95% CI (0.81, 1.77), P<0.00001], gait speed [MD = 0.05, 95% CI (0.03, 0.07), P<0.00001], and knee extension strength [MD = 2.56, 95% CI (1.30, 3.82), P<0.0001].

CONCLUSIONS

Non-pharmacological interventions can effectively improve the clinical symptoms and signs of patients with sarcopenic obesity. Dissemination of this information will be therapeutically useful.

TRIAL REGISTRATION

Registration. The PROSPERO No. is CRD42023403341.

Nutritional and exercise interventions in individuals with sarcopenic obesity around retirement age: a systematic review and meta-analysis

CONTEXT

Retirement is an opportune time for people to establish new healthy routines. Exercise and nutritional interventions are promising in the prevention and treatment of sarcopenic obesity.

OBJECTIVE

This systematic review aimed.

to assess the effectiveness of nutritional and exercise interventions for the treatment of sarcopenic obesity in persons of retirement age.

DATA SOURCES

PubMed, Embase, CINAHL, and CENTRAL databases were searched in September 2021 for randomized controlled trials; a manual search was also conducted. The search yielded 261 studies, of which 11 were eligible for inclusion.

DATA EXTRACTION

Studies of community-dwelling individuals with sarcopenic obesity receiving any nutritional or exercise intervention ≥ 8 weeks with the mean age  ±  standard deviation between 50 and 70 years were included. Primary endpoint was body composition, and secondary endpoints were body mass index, muscle strength, and physical function. The literature review, study selection, data extraction, and risk-of-bias assessment were performed by two reviewers independently. Data were pooled for meta-analysis when possible.

RESULTS

Meta-analysis was only possible for the exposure "resistance training" and the exposure "training (resistance or aerobic)" in combination with the exposure "added protein" as compared with "no intervention" or "training alone." Resistance training led to a significant body fat reduction of -1.53% (95%CI, -2.91 to -0.15), an increase in muscle mass of 2.72% (95%CI, 1.23-4.22), an increase in muscle strength of 4.42 kg (95%CI, 2.44-6.04), and a slight improvement in gait speed of 0.17 m/s (95%CI, 0.01-0.34). Protein combined with an exercise intervention significantly reduces fat mass (-0.80 kg; 95%CI, -1.32 to -0.28). Some individual studies of dietary or food supplement interventions for which data could not be pooled showed positive effects on body composition.

CONCLUSION

Resistance training is an effective treatment for persons of retirement age with sarcopenic obesity. Increased protein intake combined with exercise may increase reductions in fat mass.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021276461.

Resistance Training and Weight Loss in Older Adults: A Scoping Review

Resistance training (RT) is one of the most effective interventions available to older adults wishing to slow the progressive loss of muscle size and strength known to occur with age. Less is known about the ability of RT to resist the onset of an equally problematic condition related to increased age: obesity. The objective of this scoping review was to characterize current research associated with RT and weight loss in older adults, including protocols, feasibility, and gaps in current knowledge. We searched six databases using variations of the terms "resistance training," "weight loss," and "older adults" for experimental or quasi-experimental studies published in the year 2009 or later. Studies were included if they featured at least one treatment group with a mean age of > 65 years that engaged in an RT-only exercise protocol with no aerobic or high-intensity interval component. Of the 6102 references identified by the initial database search, 24 were retained for analysis. Older women and older adults with obesity or sarcopenic obesity were the most studied groups (n = 13), followed by healthy community-dwelling older adults (n = 11) and studies involving older adults and some aspect of either dietary control or pharmaceutical intervention (n = 8). Significant between-study heterogeneity was observed in the RT characteristics researchers thought optimal for improving body composition measures in older adults. Changes in body composition, rather than total body mass, were found to be the essential variables to consider when evaluating the effectiveness of an RT intervention aimed at reducing chronic disease in older adults. Weight loss alone appears to be an incomplete and problematic outcome measure for older adults, with changes in body composition (ratio of fat mass to lean mass) being the more appropriate variable to emphasize in this population. However, it is important to note that only one study, showing questionably reproducible findings, found a significant lean body mass gain. The lack of abundant high-quality evidence demonstrating combined RT and a healthy diet can lead to significant fat loss and lean body mass gain, coupled with high attrition rates observed in many of the studies reviewed, highlight the need for further rigorous research.