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Aging and disease
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Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults with Sarcopenia: A Systematic Review and Meta-Analysis
Wangxiao Bao, Yun Sun, Tianfang Zhang, Liliang Zou, Xiaohong Wu, Daming Wang, Zuobing Chen*
Department of Rehabilitation Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Abstract  

Sarcopenia is an age-related condition that is characterized by progressive and generalized loss of muscle mass and function. Exercise treatment has been the most commonly used intervention among elderly populations. We performed a systematic review and meta-analysis to evaluate the available literature related to the effects of exercise interventions/programs on muscle mass, muscle strength and physical performance in older adults with sarcopenia. We searched PubMed, EMBASE, MEDLINE and the Web of Science for randomized controlled trials and controlled clinical trials exploring exercise in older adults with sarcopenia published through July 2019 without any language restrictions. Pooled analyses were conducted using Review Manager 5.3, with standardized mean differences (SMDs) and fixed-effect models. A total of 3898 titles and abstracts were initially identified, and 22 studies (1041 individuals, 80.75% females, mean age ranged from 60.51 to 85.90 years) were included in the meta-analysis. The exercise programs in the studies consisted of 30 to 80 min of training, with 1 to 5 training sessions weekly for 6 to 36 weeks. Muscle strength (grip strength [SMD 0.57, 95 % CI 0.42 to 0.73, P <0.00001] and timed five chair stands [SMD -0.56, 95 % CI -0.85 to -0.28, P < 0.0001]) and physical performance (gait speed [SMD 0.44, 95 % CI 0.26 to 0.61, P < 0.00001] and the timed up and go test [SMD -0.97, 95 % CI -1.22 to -0.72, P < 0.00001]) showed significant improvement following exercise treatment, while no differences in muscle mass (ASM [SMD 0.15, 95 % CI -0.05 to 0.36, P = 0.15] and ASM/height2 [SMD 0.21, 95 % CI -0.05 to 0.48, P = 0.12]) were detected. Exercise programs showed overall significant positive effects on muscle strength and physical performance but not on muscle mass in sarcopenic older adults.

Keywords Sarcopenia      exercise      elderly      meta-analysis      muscle      physical     
Corresponding Authors: Zuobing Chen   
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These authors contributed equally to this work.

Just Accepted Date: 23 October 2019  
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Wangxiao Bao
Yun Sun
Tianfang Zhang
Liliang Zou
Xiaohong Wu
Daming Wang
Zuobing Chen
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Wangxiao Bao,Yun Sun,Tianfang Zhang, et al. Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults with Sarcopenia: A Systematic Review and Meta-Analysis[J]. Aging and disease, 10.14336/AD.2019.1012
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http://www.aginganddisease.org/EN/10.14336/AD.2019.1012     OR     http://www.aginganddisease.org/EN/Y/V/I/0
RefsNAgeSex (F, %)BMIDiagnostic CriteriaPeriodWeekly (times)Intervention
ExeCon
[27]141668.47±2.780.00%23.37±1.91ASM/Height2 < 10.75 kg.m-28w310 min warm-up, 45 min resistance training.
[23]8884.30±5.3758.93%21.90±3.01AWGS12w25 min warm-up, 20 min resistance exercise program and 5 min cool down.
[26]403773.39±6.9275.32%18.85±2.04AWGS24w15-10 min warm up and cool down routine,
20-30 min chair-based resistance exercises using Thera-Bands, and 20-min aerobic exercises.
[33]353769.95±2.73100.00%24.80±0.91EWGSOP36w25 min warm-up, 20 min muscular districts with low weight loads
[18]333179.90±7.8050.00%25.00±3.39SMM/Weight < 37.15% for men and < 32.26% for women12w260-min warm-up, muscle resistance training
and relaxation stage.
[25]111781.75±6.9630.72%31.28±6.44SMM/Weight ≤ 0.93 for men and ≤ 0.57 for women12w35 min warm-up, 20-30 min resistance exercises with workload and 5 min cool down.
[34]361872.87±7.0287.30%22.72±2.45EWGSOP12w260 min comprehensive progressive group exercise
program or home therapeutic exercises
[17]171667.48±4.29100.00%N.A.AWGS8w260 min progressive resistance training
[36]332367.35±5.23100.00%28.05±3.77SMM/Weight < 27.6 %12w310 min warm up, 40 min elastic resistance exercises and 5 min cool down.
[22]252574.10±6.15100.00%27.30±1.74SMM/Weight < 25.1 %24w550-80 min of combined aerobic and resistance
exercises
[32]252167.32±5.20100.00%27.72±3.30EWGSOP12w35 min warm up, 35-40 min resistance training exercises and cool down routine.
[24]151568.83±3.3683.33%27.83±3.80SMM/Weight ≤ 32.5% for men and
≤25.7% for women
8w260 min progressive resistance load training using weight-training equipment at 60-70% of one repetition maximum.
[35]602075.75±5.4270.00%23.84±3.01ASM/Height2 < 8.87 kg.m-2 for men and 6.42 kg.m-2 for women12w3Whole-body vibration training with 14,400 vertical vibrations
[31]7860.51±2.40100.00%19.47±1.52EWGSOP6w260 min training program comprised five exercises (squats, front lunges, side lunges, calf raises, and toe raises).
[38]181769.20±4.94100.00%28.11±3.66SMM/Weight < 27.6 %12w310 min warm up, 40 min elastic resistance exercises and 5 min cool down.
[37]141472.00±4.05100.00%32.50±2.62Handgrip strength≤21 kg10w260 min progressive resistance exercise program
[21]353481.25±4.68100.00%25.20±2.63SMM/Height2 < 5.67 kg.m-212w260 min warm-up, weight/machine training, stationary bicycle aerobic exercise, and chair/standing exercise.
[29]202185.90±7.5064.44%29.09±4.52EWGSOP24w260 min progressive resistance and balance training.
[30]261468.96±5.7655.77%20.09±1.81AWGS24wvaryinghome exercise programs, combining walking with lower limb resistance exercises.
[28]191679.90±4.9227.69%24.92±3.55ASM/Height2 < 10.75 kg.m-2 for men and 6.75 kg.m-2 for women12w210 min warm up, 30 min resistance exercises using Thera-Bands, and 10 min cool-down.
[20]323268.60±5.54100.00%N.A.ASM/Height2 < 6.42 kg/m212w260 min of stretching, muscle strengthening,
balance and gait training.
[19]393978.85±2.84100.00%18.85±1.85ASM/Height2 < 6.42 kg/m212w25 min warm up, 30 min strengthening exercise, 20 min balance and gait training and 5 min cool down.
Table 1  Characteristics of the included studies.
Figure 1.  Flow diagram of studies search, selection and inclusion process.
Figure 2.  Effects of exercise programs on the muscle mass in older adults with sarcopenia. Forest plot of difference in mean change from baseline in ASM (A) and ASM/height2 (B) after the intervention. ASM, Appendicular skeletal muscle mass. CI confidence interval, IV, inverse variance, Std, standardized.
Figure 3.  Effects of exercise programs on the muscle strength in older adults with sarcopenia. Forest plot of difference in mean change from baseline in grip strength (A) and five chair stands time (B) after the intervention. CI confidence interval, IV, inverse variance, Std, standardized.
Figure 4.  Effects of different exercise programs on the grip strength in older adults with sarcopenia. Forest Forest plot of difference in mean change from baseline for grip strength in sarcopenic individuals after (A) resistance training, (B) weight training, (C) aerobic training. CI confidence interval, IV, inverse variance, Std, standardized.
Figure 5.  Effects of exercise programs on the physical performance in older adults with sarcopenia. Forest plot of difference in mean change from baseline in gait speed (A) and TUG test (B) after the intervention. CI confidence interval, IV, inverse variance, Std, standardized.
Figure 6.  Assessment of risk of bias based on the Cochrane risk-of-bias tool. (A) Risk of bias graph; (B) risk of bias summary.
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