Effect of multicomponent exercise and nutrition intervention on frailty status in older adults: a network meta-analysis.

Combined interventions demonstrated the greatest improvement in frailty scores among all intervention types.

• SMD = -0.92, 95% CI: -1.43 to -0.40 for combined interventions
• 22 RCTs involving 2,055 participants were included in the network meta-analysis
• RCTs published between 2006 and 2025 were searched, including older adults aged ≥ 60 years
• Effect sizes were calculated using Standardized Mean Difference (SMD) and 95% Confidence Interval (CI), and ranked using network meta-analysis

Multicomponent exercise produced significant improvements in frailty scores as a standalone intervention.

• SMD = -0.78, 95% CI: -1.15 to -0.43 for multicomponent exercise
• This was the second most effective intervention for frailty score improvement after combined interventions
• Multicomponent exercise also produced significant improvements in physical performance outcomes

Nutritional supplementation showed a trend toward improvement in frailty scores that did not reach statistical significance.

• SMD = -0.69, 95% CI: -1.67 to 0.27 for nutritional supplementation on frailty scores
• Nutritional supplements included amino acids, proteins, and other supplements
• The wide confidence interval crossing zero indicates non-significant improvement in frailty scores

Nutritional supplementation yielded the greatest improvement in gait speed among all intervention types.

• SMD = +0.37, 95% CI: +0.06 to +0.68 for nutritional supplementation on gait speed
• Multicomponent exercise showed minimal benefit for gait speed (SMD = +0.09, 95% CI: -0.04 to +0.22)
• The confidence interval for multicomponent exercise on gait speed crossed zero, indicating non-significant benefit

Significant improvement in SPPB scores was observed only after multicomponent exercise.

• SMD = +1.85, 95% CI: +0.33 to +3.50 for multicomponent exercise on Short Physical Performance Battery (SPPB) scores
• SPPB was one of three secondary outcomes assessed alongside gait speed and the Timed Up-and-Go (TUG) test
• No other intervention showed statistically significant improvement in SPPB scores

Combined interventions tended to reduce TUG test completion time while multicomponent exercise alone significantly increased completion time.

• Combined interventions: SMD = -4.61, 95% CI: -9.36 to +0.25 (non-significant trend toward reduction in TUG time)
• Multicomponent exercise alone: SMD = +3.96 s, 95% CI: +0.91 to +7.07 (statistically significant increase in TUG completion time)
• The TUG result for multicomponent exercise alone was paradoxical, as longer TUG times indicate worse performance

Low heterogeneity was observed across outcomes with no evidence of publication bias.

• The analysis included 22 RCTs with 2,055 participants with comparable baseline characteristics
• The study was registered with PROSPERO (CRD420251038055)
• Low heterogeneity supports the reliability and consistency of the pooled effect estimates across the included trials