Effects of exercise on body composition, physical function, and metabolic health in older adults with sarcopenic obesity: A systematic review and meta-analysis

Abstract

Exercise interventions benefit body composition, physical function, and metabolic health in older adults with sarcopenic obesity (SO), but the comparative effects of different types of exercise remain unclear. This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate overall and type-specific effects. Six databases were systematically searched up to December 2025. Twenty RCTs with a total of 917 participants (mean age 64.1-81.4 years) were included. Overall, exercise significantly reduced body mass index (BMI; MD = -0.51; 95%CI: -0.76 to -0.25), body fat mass (BFM; MD = -1.74; 95%CI: -2.67 to -0.81), body fat percentage (PBF; MD = -2.64; 95%CI: -3.27 to -2.00), and low-density lipoprotein cholesterol (LDL-C; MD = -7.17; 95%CI: -13.62 to -0.71), and increased appendicular skeletal muscle (ASM; MD = 0.34; 95%CI: 0.13 to 0.55), skeletal muscle index (SMI; MD = 0.21; 95%CI: 0.10 to 0.32), handgrip strength (HG; SMD = 0.97; 95%CI: 0.47 to 1.47), gait speed (GS; MD = 0.14; 95%CI: 0.07 to 0.21), knee extension strength (KES; SMD = 0.36; 95%CI: 0.06 to 0.65), and insulin-like growth factor 1 (IGF-1; SMD = 0.65; 95%CI: 0.30 to 1.00). Subgroup analyses demonstrated that resistance training (RT) significantly reduced PBF, and significantly increased ASM, SMI, HG, KES, and IGF-1. Combined training (CT) significantly reduced BMI and PBF, and improved SMI, HG, GS, and IGF-1. Our systematic review and meta-analysis of studies of older adults with SO indicates that the beneficial effect of exercise is not supported by high-quality evidence. Moderate-certainty evidence does suggest statistically significant benefits for body composition and physical function, while low-certainty evidence suggests trivial effects for metabolic health. Future high-quality RCTs addressing methodological issues are needed to improve the certainty of the evidence and to further investigate the optimal type of exercise for this population.

Keywords: Body composition; Exercise; Metabolic health; Physical function; Sarcopenic obesity.