From Bibliometrics To Meta-Analysis: the Effects of Exercise and/or Nutritional Interventions on Older Adults with Sarcopenic Obesity

Sarcopenic obesity (SO) in older adults is associated with increased risks of metabolic disorders and mortality. Exercise and/or nutritional interventions are commonly employed for SO management, yet their effectiveness remains uncertain, and whether combined strategies offer superior benefits over single-component approaches is still under debate.

This study aimed to identify research trends and evaluate the effects of exercise and/or nutritional interventions on body composition and physical function in older adults with SO.

Literature published between 1998 and 2025 was retrieved from the Web of Science Core Collection. Bibliometric analyses were conducted using CiteSpace and VOSviewer, and a meta-analysis was performed with RevMan.

Among the 202 included studies, analysis of keywords revealed recent hot topics such as myokines, gut microbiota, and osteoporosis. Meta-analysis of 19 trials showed: (1) Exercise alone: Resistance exercise (RE) reduced body mass index (BMI) (SMD = –0.51, P = 0.0008) with small effect size, improved body fat (BF%) (SMD = –0.79, P < 0.00001) and gait speed (GS) (SMD = 0.96, P = 0.0008) with a moderate effect size, and improved handgrip strength (HGS) with a small effect size (SMD = 0.49, P = 0.002). Combined exercise (CE) reduced BF% (SMD = –0.56, P = 0.0001) and BMI (SMD = –0.51, P = 0.02) and improved GS moderately (SMD = 0.53, P = 0.04) with small effect size, but did not significantly affect HGS (P = 0.21). No exercise intervention significantly affected appendicular skeletal muscle mass (ASM) (P = 0.18). (2) Nutrition alone or combined with exercise showed no significant effects on BF% (P = 0.12), ASM (P = 0.42), or HGS (P = 0.4).

This study suggests that RE should be the preferred intervention for SO in older adults, effectively improving body composition and physical function. CE also show utility, achieving comparable fat reduction and improving GS, though its effect on HGS remains limited, indicating room for protocol optimization. Current evidence falls short of supporting nutrition-only or synergistic exercise-nutrition approaches as first-line therapies, highlighting the necessity for stringent monitoring of energy intake and expenditure in future protocols. Moreover, multicenter RCTs are warranted to decode the mechanisms of these interventions—such as the gut-muscle axis and related signaling pathways—while fostering cross-disciplinary collaboration and extending evaluative frameworks to encompass broader comorbid phenotypes.