Effects of three modes of physical activity on physical fitness and hematological parameters in older people with sarcopenic obesity: A systematic review and meta-analysis
Open accessAbstract
Objective: This systematic review and meta-analysis assessed the effects of three modes of physical activity (PA) (aerobic training [AT], resistance training [RT], and aerobic combined with resistance training [MT]) on body composition (body weight [BW], body mass index [BMI] and percentage of body fat [BF%]), muscle mass (skeletal muscle mass [SM], appendicular skeletal muscle mass [ASM] and appendicular skeletal muscle mass index [ASMI]), muscle strength (handgrip strength [HG] and knee extension strength [KES]), physical performance (gait speed [GS]) and hematological parameters (inflammatory markers, insulin-like growth factor 1 [IGF-1] and lipid profiles) in older people with sarcopenic obesity (SO). Methods: We searched all studies for PA effects in older people with SO from six databases published from January 2010 to November 2021. Two researchers independently screened studies, extracted data according to inclusion and exclusion criteria, and assessed the quality of included studies. Pooled analyses for pre-and post- outcome measures were performed by Review Manager 5.4. We calculated a meta-analysis with a 95% confidence interval (95% CI) and the standardized mean differences (SMD). Results: 12 studies were analyzed. There were 614 older people (84.9% female) with SO, aged 58.4 to 88.4 years. Compared with a no-PA control group, AT decreased BW (SMD = −0.64, 95% CI: −1.13 to −0.16, p = 0.009, I 2 = 0%) and BMI (SMD = −0.69, 95% CI: −1.18 to −0.21, p = 0.005, I 2 = 0%); RT improved BF% (SMD = −0.43, 95% CI: −0.63 to −0.22, p < 0.0001, I 2 = 38%), ASMI (SMD = 0.72, 95% CI: 0.24 to 1.21, p = 0.004, I 2 = 0%), ASM (SMD = −0.94, 95% CI: −1.46 to −0.42, p = 0.0004), HG (SMD = 1.06, 95% CI: 0.22 to 1.91, p = 0.01, I 2 = 90%) and KES (SMD = 1.06, 95% CI: 0.73 to 1.39, p < 0.00001, I 2 = 14%); MT improved BMI (SMD = −0.77, 95% CI: −1.26 to −0.28, p = 0.002, I 2 = 0%), BF% (SMD = −0.54, 95% CI: −0.83 to −0.25, p = 0.0003, I 2 = 0%), ASMI (SMD = 0.70, 95% CI: 0.22 to 1.19, p = 0.005, I 2 = 0%) and GS (SMD = 0.71, 95% CI: 0.23 to 1.18, p = 0.004, I 2 = 37%). PA increased IGF-1 (SMD = 0.38, 95% CI: 0.11 to 0.66, p = 0.006, I 2 = 0%), but had no effect on inflammatory markers and lipid profiles. Conclusion: PA is an effective treatment to improve body composition, muscle mass, muscle strength, physical performance, and IGF-1 in older people with SO.
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A recent systematic review and meta-analysis encompassing 11 RCTs on the effects of PA found that all the components of SO are improved.
“A recent systematic review and meta‐analysis encompassing 11 RCTs on the effects of PA found that all the components of SO are improved [24].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [24]
The Conclusion reports improvements across body composition, muscle mass, strength, and physical performance in older people with sarcopenic obesity, but says different exercise modes improve these outcomes selectively—not that every component improves with every mode. The Results (Study selection) report 12 included studies, rather than 11; the Quality assessment table records random allocation for 11 of them. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSO might be influenced by multiple shared factors and pathophysiological pathways that affect both sarcopenia and obesity, including age, sedentary lifestyle, lack of muscle exercise, hormone levels, nutritional status, insulin resistance, systemic inflammation and others.
“SO might be influenced by multiple shared factors and pathophysiological pathways that affect both sarcopenia and obesity, including age, sedentary lifestyle, lack of muscle exercise, hormone levels, nutritional status, insulin resistance, systemic inflammation and others [14, 23, 24, 25, 26, 27].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [24]
The Introduction (page unavailable) links sarcopenic obesity to aging, lower physical activity, and inflammatory and IGF-1 pathways; the Discussion (page unavailable) also describes hormonal changes and reduced activity in relation to body composition. The copy does not establish nutritional status or lack of muscle exercise as distinct contributing factors, and it describes insulin resistance as a risk associated with obesity rather than a pathway influencing sarcopenic obesity. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPrevious studies have shown similar results on lean and fat mass and inconclusive results on the continuous or dose-response effect of protein intake effect on HGS.
“Previous studies have shown similar results on lean and fat mass and inconclusive results on the continuous or dose–response effect of protein intake effect on HGS [20, 23, 24, 39].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [24]
The Results > Outcomes and Discussion (pages unavailable) report findings on skeletal muscle mass and body-fat percentage in older people with sarcopenic obesity, providing some support for the lean- and fat-mass portion of the sentence. The paper examines exercise modes, however, and does not report a continuous or dose–response effect of protein intake on handgrip strength. (LLM, conf=0.82)
Experimental — accuracy not yet measuredZhuang et al. reported favorable SMDs for BMI under aerobic and mixed training.
“Zhuang et al. (17) reported favorable SMDs for BMI under aerobic and mixed training”
Some reviews reported favorable changes in ASM, ASMI, standardized skeletal muscle mass index or fat-free mass.
“Some reviews reported favorable changes in ASM, ASMI, standardized skeletal muscle mass index or fat-free mass, including Hita-Contreras et al. (14), Yin et al. (13), Zhuang et al. (17) and Qiu et al. (21).”
Zhuang et al. reported SMD +0.71 for mixed or combined training for gait speed/mobility.
“SMD + 0.71 for mixed or combined training in Zhuang et al. (17)”
Zhuang et al. and Chen et al. reported favorable IGF-1 findings.
“Zhuang et al. (17) and Chen et al. (18) reported favorable IGF-1 findings”
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Sorted by citations
Training modalities for elder sarcopenic obesity: a systematic review and network meta-analysis
Qiu, H., Zheng, W., Zhou, X., Liu, Q., & Zhao, X. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1537291 · Cited by 17 · see citing works
Exercise-induced inflammatory and metabolic adaptations in ageing: A meta-analytic compendium
Sheldon, R., Gan, A., Tasong, J., Yap, A., Ahmad, M., Júnior, P. R. H., Viswanathan, K., Setti, N. S. M., Jarman, O., Hoque-Uddin, M. S., et al. (2025) · Ageing Research Reviews · doi:10.1016/j.arr.2025.102974 · Cited by 16 · see citing works
Fico, B. G., Maharaj, A., Pena, G. S., & Huang, C. (2023) · Biology · doi:10.3390/biology12060865 · Cited by 14 · see citing works
Effects of non-pharmacological interventions on patients with sarcopenic obesity: A meta-analysis
Xu, J., Hu, Q., Li, J., Zhou, Y., & Chu, T. (2023) · PLoS ONE · doi:10.1371/journal.pone.0290085 · Cited by 10 · see citing works
Cao, X., Yang, B., & Zhou, J. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1166341 · Cited by 10 · see citing works
Araújo, E. M., Coelho‐Júnior, H. J., Sousa, C. V., Rosa, T. D. S., Neto, I. V. D. S., Marzetti, E., Franco, O. L., & Aguiar, S. D. S. (2024) · Experimental Gerontology · doi:10.1016/j.exger.2024.112662 · Cited by 7 · see citing works
Xu, J., Hu, Q., Ding, J., Ren, Y., & Chu, T. (2024) · Clinical Interventions in Aging · doi:10.2147/cia.s455849 · Cited by 7 · see citing works
Zhuang, M., Shi, J., Liu, J., He, X., & Chen, N. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04592-9 · Cited by 7 · see citing works
Self-citationWiedmaier-Barros, J., Higueras‐Fresnillo, S., Sadarangani, K. P., & Martínez-Gómez, D. (2024) · Experimental Gerontology · doi:10.1016/j.exger.2024.112511 · Cited by 4 · see citing works
Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study
Benz, E., Pinel, A., Guillet, C., Capel, F., Pereira, B., Rizopoulos, D., Cruz‐Jentoft, A. J., Eglseer, D., Topinkova, E., Barazzoni, R., et al. (2025) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.70099 · Cited by 2 · see citing works
Liu, Y., Mao, S., Xie, W., Qian, G., Wu, X., Xu, H., & Ossowski, Z. M. (2026) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1677087 · Cited by 2 · see citing works
Self-citationSarcopenia, obesity, and their association with selected behavioral factors in active older adults
Teraž, K., Kalc, M., Peskar, M., Pišot, S., Šimunič, B., Pišot, R., & Pori, P. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1129034 · Cited by 1 · see citing works
Ma, X., Sun, G., Liu, C., Yan, X., Liang, W., & Ma, Z. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1859967
“The strict main pool comprised seven pairwise meta-analyses and one network meta-analysis published between 2018 and 2025 (13, 14, 17–22).”
Zhuang, M., Shi, J., Liu, J., He, X., & Chen, N. (2023) · Figshare · doi:10.6084/m9.figshare.24873103
Self-citationLin, J., Zhu, Z., & Zhang, Y. (2026) · Medicine · doi:10.1097/md.0000000000049003
Shang, Y., & Shang, Y. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1819905
Leung, W. K. C., Yau, C. Y. C., Chan, B. C. L., Wong, Y. Y. Y., Chow, J. N. L., Lam, S. C., & Suen, L. K. P. (2026) · Journal of Exercise Science & Fitness · doi:10.1016/j.jesf.2026.200514
Mummadi, M. K., Gavaravarapu, S. M., Reddy, S. N., Ramanujam, K., Prakash, R., Reddy, V., Raghavendra, P., Bansal, P. G., Chowdhury, R., & Kulkarni, B. (2026) · Obesity Pillars · doi:10.1016/j.obpill.2026.100324
- Authors
- Zhuang, M., Jin, M., Lu, T., Lu, L., Ainsworth, B. E., Liu, Y., & Chen, N.
- Affiliations
- Shanghai University of Sport (CN)
- XinHua Hospital (CN)
- Corresponding author
- Liu, Yu
- Chen, Nan
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2022-08-25
- Volume
- 13
- Pages
- 917525-917525
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC9458075
- OpenAlex
- W4295519592
- Cited by
- 18
- References
- 72
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 3 · 2023: 6
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China
- Shanghai Municipal Health Commission
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- sarcopenic obesity, older adults, physical activity, aerobic exercise, resistance training, concurrent training, body composition, muscle mass, muscle strength, physical performance, walking speed, hematological parameters, inflammatory markers, insulin-like growth factor I, lipid profile, sarcopenia, obesity, grip strength, quadriceps strength, body fat percentage
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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