Comparative effectiveness of exercise modalities and nutritional supplementation for sarcopenic obesity in older adults: a network meta-analysis based on randomized controlled trials.

Multicomponent training was the only intervention that significantly reduced BMI compared with usual care and ranked highest for this outcome.

• Multicomponent training (MC) significantly reduced BMI compared with usual care (MD = -1.08, 95% CI -1.86 to -0.29).
• MC achieved the highest SUCRA ranking for BMI at 85.1%.
• No other intervention demonstrated a statistically significant reduction in BMI versus usual care.
• The analysis was based on 24 RCTs involving 1,298 participants and nine distinct exercise- and nutrition-related rehabilitation strategies.

Both resistance training and multicomponent training significantly improved handgrip strength compared with usual care, with resistance training ranking first.

• Resistance training (RT) improved handgrip strength compared with usual care (MD = 3.96, 95% CI 2.15–5.77).
• Multicomponent training (MC) also improved handgrip strength compared with usual care (MD = 2.13, 95% CI 0.25–4.01).
• RT ranked highest for handgrip strength with a SUCRA of 90.9%.
• These were the only two interventions demonstrating statistically significant advantages over usual care for this outcome.

Resistance training was the only intervention that significantly reduced fat mass compared with usual care and achieved the highest ranking for this outcome.

• RT significantly reduced fat mass (FM) compared with usual care (MD = -2.30, 95% CI -3.63 to -0.98).
• RT achieved the highest SUCRA ranking for fat mass at 79.0%.
• No other intervention demonstrated a statistically significant reduction in fat mass versus usual care.

Both multicomponent training and resistance training significantly reduced percentage body fat compared with usual care, with multicomponent training ranking highest.

• MC significantly reduced percentage body fat (PBF) compared with usual care (MD = -3.53, 95% CI -5.70 to -1.36).
• RT also significantly reduced PBF compared with usual care (MD = -2.30, 95% CI -3.98 to -0.62).
• MC ranked highest for PBF with a SUCRA of 77.1%.

No intervention demonstrated a statistically significant advantage over usual care for skeletal muscle index, though multicomponent training combined with nutritional supplementation ranked relatively favorably.

• No intervention achieved a statistically significant improvement in skeletal muscle index (SMI) versus usual care.
• MC combined with nutritional supplementation ranked relatively favorably for SMI with a SUCRA of 74.1%.
• The authors noted that evidence for improvements in SMI remains limited and uncertain.

The network meta-analysis included 24 randomized controlled trials with 1,298 participants and nine distinct rehabilitation strategy categories.

• Databases searched included PubMed, Embase, the Cochrane Library, and Web of Science from inception to November 1, 2025.
• Both Medical Subject Headings and free-text terms were used without language restrictions.
• Primary outcomes included BMI, handgrip strength, fat mass, percentage body fat, and skeletal muscle index.
• Risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB 2) tool, and evidence certainty was evaluated using the CINeMA framework.
• The study protocol was prospectively registered in PROSPERO (CRD420251270452).

Global consistency testing supported overall network coherence, sensitivity analyses confirmed robustness, and comparison-adjusted funnel plots indicated no clear evidence of publication bias.

• Global consistency testing supported overall network coherence across comparisons.
• Sensitivity analyses confirmed the robustness of the primary findings.
• Comparison-adjusted funnel plots indicated no clear evidence of publication bias.