Resistance training for sarcopenia: a 24-trial meta-analysis on dose and clinical benefit

Sarcopenia is the age-related progressive loss of muscle mass, strength and physical function, and it is associated with falls, fractures and loss of independence ^[4]. Resistance training is widely recommended for managing it, but evidence on the best prescription, including type, frequency, setting and dose, has been limited ^[1]. A 2025 systematic review and meta-analysis in Aging Clinical and Experimental Research pooled randomized trials in older adults with a sarcopenia diagnosis to address that gap ^[1].

What was studied

The authors searched PubMed, Embase, Web of Science and CENTRAL through June 2025 ^[1]. Eligible studies were randomized controlled trials (RCTs) in adults aged 60 or older with sarcopenia that compared resistance training with usual care or no intervention and reported strength, physical function or muscle mass outcomes ^[1]. Risk of bias was assessed with the RoB 2 tool, conventional meta-analyses were run with the meta package in R, and Bayesian dose-response models were fitted with the brms package ^[1]. Training dose in those models was expressed in MET-min/week ^[1].

Who was included

Twenty-four RCTs with a combined 951 participants met the criteria ^[1]. The abstract does not report participants' sex distribution, countries, sarcopenia diagnostic criteria or trial durations ^[1]. That omission matters because doctors and researchers use different definitions and ways of diagnosing sarcopenia ^[5].

What was found

In random-effects models, resistance training significantly improved handgrip strength, gait speed, knee extension strength, the timed up and go test (TUG) and the five-times sit-to-stand test (5STS) ^[1]. Handgrip strength is measured by squeezing a dynamometer, gait speed is typically timed over about 4 meters, and the TUG times rising from a chair, walking 3 meters, returning and sitting down ^[4][5].

No significant improvements were observed in the short physical performance battery (SPPB), appendicular skeletal muscle mass index or appendicular skeletal muscle mass ^[1]. The SPPB combines three timed tests: standing from a chair, standing balance and walking speed ^[5]. In sarcopenia assessment more generally, muscle mass can be measured with imaging tests such as dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) ^[4][5].

Subgroup analyses showed significant differences by resistance type, training frequency and setting, although meta-regression identified no significant sources of heterogeneity ^[1]. The authors nonetheless concluded that resistance type and training frequency were key effect modifiers ^[1].

A nonlinear Bayesian random-effects model suggested an optimal dose of 1220 MET-min/week for handgrip strength and a minimal effective dose of 600 MET-min/week that may suffice for clinically meaningful improvement in gait speed ^[1].

The authors' central qualification concerns clinical relevance ^[1]. They reported that improvements in grip strength, gait speed, TUG, 5STS and SPPB did not exceed their minimal important difference (MID) thresholds, indicating little to no clinical benefit ^[1]. Their overall conclusion was that resistance training probably improves muscle strength and physical function in this population ^[1].

How it fits with other recent evidence

A separate 2025 meta-analysis in BMC Geriatrics pooled 12 RCTs with 538 sarcopenic older adults ^[3]. Compared with controls, resistance training had a moderate effect on grip strength (SMD 0.63, 95% CI 0.43 to 0.83) and SPPB (SMD 0.56, 95% CI 0.18 to 0.94), but not on skeletal muscle mass index (SMD 0.24, 95% CI -0.05 to 0.53) ^[3]. Unlike the larger review, its meta-regression identified training frequency (p < 0.0001) and intensity (p = 0.0019) as significant predictors of grip strength improvement, and its authors described moderate-intensity training twice a week as a promising strategy ^[3]. The two reviews agree on muscle mass but differ on SPPB and on whether heterogeneity was explained ^[1][3].

A 24-week RCT in Chengdu, China, randomized 90 adults aged 60 to 77 with primary sarcopenia (13 men, 77 women) to supervised Baduanjin, a qigong practice combining gentle exercise, breathing and meditation, or to supervised resistance training ^[2]. Between-group differences favored Baduanjin for SPPB (B = 1.94, 95% CI 1.20 to 2.68) and skeletal muscle index (B = 0.37, 95% CI 0.25 to 0.50), with no significant differences in arm muscle mass, left handgrip strength or the 6-m walk test ^[2]. That trial compared two active exercise programs rather than exercise against no intervention ^[2].

Limitations

• The abstract reports statistical significance but not pooled effect sizes, confidence intervals or the MID values used, so the magnitude of each effect cannot be assessed from it ^[1].
• The RoB 2 results and any certainty-of-evidence ratings are not reported in the abstract ^[1].
• Subgroup differences by type, frequency and setting were not supported by meta-regression, so the effect-modifier conclusions rest on subgroup comparisons alone ^[1].
• The dose estimates come from a modeled dose-response curve, and the 600 MET-min/week estimate for meaningful gait-speed change is reported alongside a pooled gait-speed improvement that did not exceed its MID ^[1].
• Comparators were usual care or no intervention, so the review does not address resistance training relative to other exercise forms ^[1][2].
• Doctors and researchers use different definitions and ways of diagnosing sarcopenia, so populations labeled sarcopenic may differ across studies ^[5].