Frontiers in nutrition · 2026
Exercise-based interventions for sarcopenic obesity in middle-aged and older adults: an umbrella review of systematic reviews with pairwise meta-analyses and network meta-analyses.
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Ma Xiaoge, Sun Guanping, Liu Chuannan, Yan Xujie, Liang Weibao, Ma Zhengda
Аннотация
INTRODUCTION: Sarcopenic obesity (SO) is an increasingly important nutrition- and exercise-relevant phenotype in middle-aged and older adults, but the secondary evidence base is complicated by heterogeneous SO definitions, mixed exercise and nutrition interventions, and repeated use of the same primary trials across reviews.
METHODS: We conducted an umbrella review of systematic reviews with pairwise meta-analysis or network meta-analysis. PubMed, Web of Science, SPORTDiscus, Cochrane Library, Embase and Scopus were searched from inception to 1 March 2026. Eligible reviews focused on middle-aged and/or older adults with SO and reported quantitative syntheses for body composition and/or physical function. Broader non-pharmacological reviews were retained only when exercise-related quantitative syntheses were separately reported and extractable. Two reviewers independently screened records, extracted review-level data and assessed methodological quality with AMSTAR-2; disagreements were resolved by discussion and, where necessary, third-reviewer adjudication. Primary-study overlap was quantified using the corrected covered area (CCA).
RESULTS: Eight reviews met strict exercise-based eligibility criteria, including seven pairwise meta-analyses and one network meta-analysis. They represented 33 unique primary-study units and 88 review-level primary-study occurrences. Primary-study overlap was very high (CCA = 0.238). AMSTAR-2 confidence was low in seven reviews and critically low in one, and umbrella-level outcome certainty was judged low or very low. Adiposity outcomes were directionally favorable across all eight reviews, and physical-function outcomes were generally favorable, particularly for grip strength and gait- or mobility-related performance. Muscle-mass outcomes were mixed, while metabolic and inflammatory outcomes were sparse and inconsistent. Resistance training showed the most consistent strength-related signal, whereas combined or multicomponent exercise provided hypothesis-supporting, not definitive, signals when adiposity and mobility targets were considered together.
DISCUSSION: Exercise-centered interventions may be associated with improvements in adiposity and functional outcomes in middle-aged and older adults with SO; however, clinical, modality-ranking and comparative-effectiveness claims should remain cautious because the review corpus is methodologically weak and highly overlapping.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420261370155, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261370155.
METHODS: We conducted an umbrella review of systematic reviews with pairwise meta-analysis or network meta-analysis. PubMed, Web of Science, SPORTDiscus, Cochrane Library, Embase and Scopus were searched from inception to 1 March 2026. Eligible reviews focused on middle-aged and/or older adults with SO and reported quantitative syntheses for body composition and/or physical function. Broader non-pharmacological reviews were retained only when exercise-related quantitative syntheses were separately reported and extractable. Two reviewers independently screened records, extracted review-level data and assessed methodological quality with AMSTAR-2; disagreements were resolved by discussion and, where necessary, third-reviewer adjudication. Primary-study overlap was quantified using the corrected covered area (CCA).
RESULTS: Eight reviews met strict exercise-based eligibility criteria, including seven pairwise meta-analyses and one network meta-analysis. They represented 33 unique primary-study units and 88 review-level primary-study occurrences. Primary-study overlap was very high (CCA = 0.238). AMSTAR-2 confidence was low in seven reviews and critically low in one, and umbrella-level outcome certainty was judged low or very low. Adiposity outcomes were directionally favorable across all eight reviews, and physical-function outcomes were generally favorable, particularly for grip strength and gait- or mobility-related performance. Muscle-mass outcomes were mixed, while metabolic and inflammatory outcomes were sparse and inconsistent. Resistance training showed the most consistent strength-related signal, whereas combined or multicomponent exercise provided hypothesis-supporting, not definitive, signals when adiposity and mobility targets were considered together.
DISCUSSION: Exercise-centered interventions may be associated with improvements in adiposity and functional outcomes in middle-aged and older adults with SO; however, clinical, modality-ranking and comparative-effectiveness claims should remain cautious because the review corpus is methodologically weak and highly overlapping.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420261370155, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261370155.