Optimal Exercise Dose for Improving Body Composition in Sarcopenic Obesity: A Bayesian Meta-Analysis of Dose-Response Relationships
Description
Sarcopenic obesity, characterized by the coexistence of low muscle mass/strength and excess adiposity, is a growing geriatric syndrome associated with increased risks of physical disability, metabolic disorders, cardiovascular disease, and mortality. Despite exercise being the cornerstone of non‑pharmacological management, the optimal exercise prescription—particularly the dose‑response relationships between exercise volume and improvements in body composition and muscle strength—remains poorly defined for this specific population. Existing guidelines are largely extrapolated from general older adult populations and lack evidence tailored to sarcopenic obesity. This systematic review and Bayesian network meta‑analysis, combined with dose‑response meta‑analysis, aims to: (1) compare and rank the relative efficacy of four exercise modalities—aerobic training (AT), resistance training (RT), combined training (CT), and multicomponent exercise (MCEx)—on body composition outcomes (ASMI, SMI, BF%, BMI) and grip strength in adults with sarcopenic obesity; (2) quantify overall and modality‑specific dose‑response relationships between weekly exercise volume (MET·min/week) and each outcome; (3) identify the optimal weekly exercise dose (peak SMD) and dose range for each outcome; and (4) determine the minimum dose required to achieve clinically meaningful improvement (MCID, SMD ≥ 0.5). A comprehensive literature search will be conducted across multiple databases (PubMed, Web of Science, Cochrane Library, EMBASE, Scopus, CNKI, and Wanfang) from inception to January 2026. Only randomized controlled trials (RCTs) involving adults (≥18 years) with sarcopenic obesity, comparing structured exercise interventions versus control or different exercise modalities, and reporting at least one body composition outcome or grip strength will be included. Study screening, data extraction, and risk of bias assessment (Cochrane RoB 1) will be performed independently by two reviewers. Data will be synthesized using: (1) pairwise random‑effects meta‑analysis for direct comparisons; (2) Bayesian random‑effects network meta‑analysis (MCMC, JAGS) for direct and indirect evidence with SUCRA ranking; and (3) restricted cubic spline dose‑response meta‑analysis for overall and modality‑specific relationships. Certainty of evidence will be assessed using the GRADE framework. This review will provide an evidence‑based, quantifiable framework for personalized exercise prescription in sarcopenic obesity, informing clinical practice guidelines and public health recommendations. The findings will help clinicians and exercise physiologists prescribe optimal, dose‑specific exercise interventions tailored to individual patient profiles, ultimately improving clinical outcomes and quality of life in this high‑risk population.