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Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a systematic review and meta-analysis
Open accessAbstract
Background: Overweight and obese older people face a high risk of muscle loss and impaired physical function, which may contribute to sarcopenic obesity. Resistance exercise training (RET) has a beneficial effect on muscle protein synthesis and can be augmented by protein supplementation (PS). However, whether body weight affects the augmentation of muscular and functional performance in response to PS in older people undergoing RET remains unclear.Objective: This study was conducted to identify the effects of PS on the body composition and physical function of older people undergoing RET.Design: We performed a comprehensive search of online databases to identify randomized controlled trials (RCTs) reporting the efficacy of PS for lean mass gain, strength gain, and physical mobility improvements in older people undergoing RET.Results: We included 17 RCTs; the overall mean ± SD age and body mass index (BMI; in kg/m 2) in these RCTs were 73.4 ± 8.1 y and 29.7 ± 5.5, respectively. The participants had substantially greater lean mass and leg strength gains when PS and RET were used than with RET alone, with the standard mean differences (SMDs) being 0.58 (95% CI: 0.32, 0.84) and 0.69 (95% CI: 0.39, 0.98), respectively. The subgroup of studies with a mean BMI ≥30 exhibited substantially greater lean mass (SMD: 0.53; 95% CI: 0.19, 0.87) and leg strength (SMD: 0.88; 95% CI: 0.42, 1.34) gains in response to PS. The subgroup of studies with a mean BMI <30 also exhibited relevant gains in response to PS.Conclusions: Compared with RET alone, PS combined with RET may have a stronger effect in preventing aging-related muscle mass attenuation and leg strength loss in older people, which was found in studies with a mean BMI ≥30 and in studies with a mean BMI <30. Clinicians could use nutrition supplement and exercise strategies, especially PS plus RET, to effectively improve the physical activity and health status of all older patients.
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“Of note, Liao et al. 106 compared the effect of additional protein ingestion and RE with no intervention as a control group; therefore, it is reasonable to suggest that the RE was the primary intervention leading to the main findings.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [106]
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In the citing paper
“The claimed superior effects of multi-ingredients compared to the intake of each ingredient in isolation are based on their synergistic interaction or amplification effect once the included ingredients are ingested as a component of a special formulation (Liao et al. 2017).”
From Effect of a Multi-Ingredient Post-Workout Dietary Supplement on Body Composition and Muscle Strength – A Randomized Controlled Trial (2025) · cites this paper as Liao et al. 2017
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“The insertion of clinical trials testing multi‐ingredient supplements, 106 including energy‐restricted weight‐loss diets, 13 or using different cut‐off points for age sub‐groups likely explain the differences in main effects and conclusions when comparing studies. 14 , 21 , 22 , 23”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [106]
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In the citing paper
“In contrast, Liao et al. 106 found additive significant main effects for additional protein (but included numerous other supplement ingredients) ingestion and RE in the performance of physical function tests in older overweight or obese subjects.”
From Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (2022) · cites this paper as [106]
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“Because protein supplementation mainly induces muscular adaptations such as muscle hypertrophy, contributions of neural and muscular factors to training-induced adaptation would not be coincidence between resistance training interventions with and without protein supplementation.”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
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“There has been growing recognition that increases in muscle mass and strength following resistance training is elicited by protein supplementation in older adults (10,11).”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In most of the previous studies, casein, whey, and/or milk protein have been used as protein supplementations to test the effect of its combination with resistance training (10,11)”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
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In the citing paper
“On the other hand, amount of CAS supplementation used in this study is relatively low in comparison with those used in the previous studies (10–63 g/d or 0.3 g/kg/d) (10,11).”
From Modulation of Neural and Muscular Adaptation Processes During Resistance Training by Fish Protein Ingestions in Older Adults (2020) · cites this paper as [11]
Experimental — accuracy not yet measuredIn the citing paper
“PS in combination with resistance-type MSE has been identified as an efficient intervention for LM and strength gain in elderly individuals [11,13,15,19,59,64].”
In the citing paper
“Previous systemic reviews have shown nonsignificant effects on changes in muscle mass [20,69], muscle strength [20], and physical mobility [19] in response to PS + MSE for elderly adults who mostly were healthy or not frail.”
In the citing paper
“Furthermore, we identified that an increase of >2.0% to 3.0% in muscle mass predicts a positive effect of PS + MSE on leg strength and walking capability, which may explain the inconsistencies with other authors who reported conflicting results of such synergetic improvements in muscle mass and function [13,17,18,19,20].”
In the citing paper
“Recent systematic reviews have summarized the synergistic effects of PS and ET on body composition and strength in older individuals [15,17,18,19,20], most of which included healthy participants [18,19,20,21] and included trials using RET only [18,19,20,21].”
From Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults (2018) · cites this paper as [20]
In the citing paper
“there may have been sex differences for changes in body composition in response to PS plus exercise training [20,91,92,93]”
From Effects of Protein Supplementation Combined with Exercise Intervention on Frailty Indices, Body Composition, and Physical Function in Frail Older Adults (2018) · cites this paper as [20]
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“Previous trials have claimed that aging-related type II myofiber atrophy was alleviated by resistance exercise training (RET) because it increased the rate of MPS (9–11) and resulted in lean mass gain in older adults (12).”
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BackgroundCan Dietary Supplements Support Muscle Function and Physical Activity? A Narrative Review
Brough, L., Rees, G., Drummond‐Clarke, L., McCallum, J. E., Taylor, E., Kozhevnikov, O., & Walker, S. (2025) · Nutrients · doi:10.3390/nu17213495 · Cited by 5
“Indeed, the combination of RET with nutritional intervention provides a better stimulus for maintaining muscle strength and mass than RET alone [75].”
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Effects of milk proteins supplementation on muscle protein synthesis
Casagranda, M., Zanella, P. B., Vieira, A., & Macedo, R. C. O. (2019) · Nutrition & Food Science · doi:10.1108/nfs-11-2018-0328 · Cited by 5
Sarcopenic Obesity as a Risk Factor for Cardiovascular Disease: An Underrecognized Clinical Entity
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“It is recommended that it consist of resistance exercises such as use of weights, squats and elastic band, divided into 3 phases: 1) warm-up (5–10 min); 2) main phase or physical conditioning (20–60 min) and 3) cool down and stretching (10 min) [20,21].”
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BackgroundResistance Exercise in Prostate Cancer Patients: a Short Review
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“Konsistent mit diesen Resultaten berichtete Meng et al. (53) in einer Kohorte von 862 postmenopausalen Frauen (Durchschnittalter 75 Jahre) nach fünf Jahren 5,3 % höhere Gesamtmuskelmasse bei Frauen mit höherer Einnahme (1,6 ± 0,4 g/kg KG/Tag) verglichen mit jener mit tieferer Einnahme (0,8 ± 0,2 g/kg KG/ Tag) bei Base…”
BackgroundIntérêts de l’activité physique chez les sujets âgés
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“These results are in line with those of a meta-analysis, which revealed a greater fat mass loss and lean mass increase when combining protein supplementation and resistance training [14].”
ResultImpaired Muscle Performance in Older Adults
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Beta-hydroxy-beta-methylbutyrateの摂取と筋力運動の併用が閉経後女性の骨格筋量および筋力に及ぼす効果に関する予備的研究：ランダム化クロスオーバー試験
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“…revisión sistemática concluyó que el aporte de proteínas más ejercicios de fuerza fue significa-tivamente más efectivo en prevenir la pérdida de masa muscular relacionada con la edad que el grupo que utilizó solamente ejercicios de fuerza sin aporte de suplementos de proteínas (Liao et al., 2017).”
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“The combination of resistance exercise with protein supplementation (including whey protein) has been found more effective than resistance exercise alone at preventing muscle mass loss [38].”
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Metadata
- Authors
- Liao, C.-D., Tsauo, J.-Y., Wu, Y.-T., Cheng, C.-P., Chen, H.-C., Huang, Y.-C., Chen, H.-C., & Liou, T.-H.
- Affiliations
- National Taiwan University (TW)
- National Taiwan University Hospital (TW)
- National Taipei University of Nursing and Health Science (TW)
- Taipei Medical University (TW)
- Corresponding author
- Liou, Tsan-Hon
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 106
- Issue
- 4
- Pages
- 1078-1091
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2747357561
- Cited by
- 317
- References
- 63
- Citations by year
- 2026: 21 · 2025: 35 · 2024: 28 · 2023: 32 · 2022: 40 · 2021: 37 · 2020: 49 · 2019: 38 · 2018: 35 · 2017: 1
- FWCI
- 4.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Health and Welfare
- National Science Council
- Ministry of Science and Technology, Taiwan (053-MY3, 2314-B-038)
- Health Promotion Administration, Ministry of Health and Welfare
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Muscle metabolism and nutrition
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Keywords
- protein supplementation, resistance training, older adults, sarcopenic obesity, body composition, lean mass gain, leg strength, physical function, physical mobility, body mass index, muscle protein synthesis, muscle mass loss
- MeSH terms
- Aged, Aged, 80 and over, Body Composition, Dietary Proteins, Female, Humans, Male, Middle Aged, Muscles, Obesity, Physical Fitness, Dietary Supplements, Muscle Strength, Resistance Training, Sarcopenia
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