Explore the optimal exercise intervention subtype for sarcopenia: a systematic review and Bayesian network meta-analysis
Meiqi Wei, Shichun He, Xiaoping Zhang, Deyu Meng, Guang Yang, Ziheng Wang
Abstract
PURPOSE: Exercise is the primary choice for managing age-related sarcopenia. However, many exercise intervention subtypes are currently used to manage age-related sarcopenia with little published evidence comparing their efficacy, meaning the optimal exercise intervention subtype for sarcopenia remains unclear. We performed a Bayesian network meta-analysis addressing these uncertainties. METHODS: We searched eight databases for literature through to 5 June 2023 to identify randomized controlled trials (RCTs) of exercise interventions for age-related sarcopenia. Skeletal muscle mass index (SMI), handgrip strength (HGS), knee extension strength (KES), gait speed (GS), chair rise test (CST) and time up and go test (TUGT) were used as outcomes. Effect estimates were expressed as standardized mean differences with 95% confidence intervals. We performed a Bayesian network meta-analysis using a random effects model and the R package gemtc to compare the relative efficacy of various exercise intervention subtypes. We also used surface under the cumulative ranking curve (SUCRA) to estimate relative treatment rankings. This systematic review is registered in PROSPERO, CRD42023474627. RESULTS: We included 37 RCTs with a total of 2322 subjects and 10 unique exercise intervention subtypes. Most RCTs (72.9%) displayed unclear risk of bias. According to the value of SUCRA, whole-body vibration high frequency (WBVH) ranked first in SMI (99.8%), HGS (96.5%) and GS (76.5%), suggesting it is the most comprehensive and effective exercise intervention subtype for managing age-related sarcopenia. Combined training (CT) ranked first in CST (76.5%) and TUGT (75.2%), suggesting it is the most effective exercise intervention subtype for improving muscle function. Resistance training (RT) ranked first in KES (99.3%) and also performed well on TUGT and HGS. CONCLUSION: Our network meta-analysis revealed that certain exercise intervention subtypes are more effective for specific muscle-related outcomes. WBHV, CT and RT are the most promising exercise intervention subtypes for managing sarcopenia, with WBHV providing the most comprehensive improvement in sarcopenia, CT the best improvement in muscle function, and RT the most common exercise intervention subtype for sarcopenia, which remains quite effective in enhancing muscle strength and function. Our meta-analysis provides a valuable reference and guidance for clinicians, researchers and policy makers, but it is limited by the heterogeneity and quality of the included RCTs.