Comparative effectiveness and dose–response relationship of exercise-based interventions for muscle mass in older women with sarcopenia: a systematic review and network meta-analysis

Vollständiger Abstract

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Background Exercise and nutrition are the principal non-pharmacological strategies for sarcopenia, but the relative effects of different exercise combinations and the dose required to improve muscle mass in older women remain uncertain. This study compared exercise-based interventions and examined the dose-response relationship. Methods PubMed, Web of Science, Embase, the Cochrane Library, and EBSCO were searched from inception to 1 July 2026. Eligible trials enrolled women aged ≥ 60 years female with sarcopenia. Risk of bias was assessed using RoB 2. A frequentist random-effects network meta-analysis combined direct and indirect evidence, with effects expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Interventions were ranked using P-scores. Network meta-regression examined control condition, age, intervention duration, weekly frequency, weekly exercise dose, and female proportion. A Bayesian model-based network meta-analysis assessed the dose–response relationship using MET-min/week. Results Twenty-seven controlled trials involving 1,845 participants were included. Heterogeneity was moderate, with no significant global inconsistency. Most interventions improved muscle mass compared with control, although no significant effect was detected for Chinese traditional exercise. Resistance, aerobic, and balance training combined with nutritional supplementation produced the largest effect (SMD = 1.41, 95% CI 0.81–2.01) and ranked first ( P -score = 0.882). Control condition, age, and weekly exercise dose were significant effect modifiers, but covariate adjustment did not materially alter the intervention rankings. The dose–response relationship was positive and nonlinear. Within the central evidence-supported range, the lower 95% credible limit first exceeded zero at 460 MET-min/week (SMD = 0.19, 95% CrI 0.01–0.37). At the upper boundary of this range (1,144 MET-min/week), the predicted SMD was 1.38 (95% CrI 1.08–1.61). Conclusion Resistance-based multicomponent exercise may improve muscle mass in older women with sarcopenia, particularly when combined with nutritional supplementation. Exercise dose should be increased gradually according to individual tolerance. The reported dose values should be interpreted as evidence-supported estimates rather than fixed biological thresholds or universally optimal prescriptions. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261449654 , identifier: PROSPERO (CRD420261449654).