Comparative effectiveness of protein or protein-related supplementation combined with resistance or functional exercise for sarcopenia in older adults: a systematic review and network meta-analysis
Abstract
Background: Resistance and functional exercise are core non-pharmacological strategies for sarcopenia management. Protein or protein-related supplementation is commonly used to support exercise-induced adaptations, but the comparative effects of different supplementation strategies when added to exercise remain unclear.
Objective: This systematic review and network meta-analysis compared the additional effects of different protein or protein-related supplementation strategies combined with resistance or functional exercise on grip strength, appendicular skeletal muscle mass index (ASMI), and timed up-and-go (TUG) performance in older adults with sarcopenia or at high risk of sarcopenia.
Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, and SinoMed were searched from inception to March 16, 2026. Randomized controlled trials comparing exercise plus protein or protein-related supplementation with the same or comparable exercise program plus placebo, no additional supplementation, or exercise alone were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Pairwise and frequentist network meta-analyses were conducted, and intervention rankings were assessed using the surface under the cumulative ranking curve (SUCRA).
Results: Eighteen randomized controlled trials involving 1,341 participants and 12 combined intervention strategies were included. Pairwise meta-analysis showed that supplementation added to exercise significantly…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,341 participants or records.
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