Supplementary file 1_Effects of non-pharmacological interventions on body composition and physical function in older women with sarcopenic obesity: a meta-analysis.doc

BackgroundSarcopenic obesity is characterized by excessive fat mass accompanied by sarcopenia, resulting in combined health risks associated with both conditions. Currently, no standardized or effective treatment approach has been established. The health risks and potential for physical disability associated with sarcopenia increase with age, and older women face greater challenges than men due to the accelerated muscle loss following menopause.
ObjectiveGiven the absence of standardized or effective treatments, this systematic review aimed to evaluate which non-pharmacological interventions can effectively improve body composition and physical function in older women (aged ≥60 years) with sarcopenic obesity.
DesignSystematic review and meta-analysis.
Setting and participantsOlder women aged 60 years and above.
MethodsA comprehensive search of four electronic databases (PubMed, Web of Science, Embase, and the Cochrane Library) was conducted up to April 2025. A total of 11 studies were included in the meta-analysis, comprising 10 randomized controlled trials (RCTs) and one quasi-experimental study. Although the latter did not employ random allocation, it was included due to the rigor of its intervention design, the completeness of its data, and its relevance to the research question. The primary outcomes measured included key indicators of body composition and physical function. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool. To determine the certainty of evidence for the main outcomes, the GRADE approach was applied, evaluating five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias.
ResultsA total of 11 studies (10 randomized controlled trials and 1 non-randomized controlled trial) involving 532 participants were included. Meta-analysis revealed that exercise and other non-pharmacological interventions significantly reduced body fat percentage (WMD = −1.85, 95% CI: −3.35 to −0.36, p < 0.05) and significantly improved appendicular free fat mass (WMD = 0.64, 95% CI: 0.60–0.68, p < 0.001), skeletal muscle index (WMD = 0.64, 95% CI: 0.43–0.86, p < 0.001), and handgrip strength (WMD = 2.96, 95% CI: 1.76–4.16, p < 0.001). No significant differences were observed in gait speed, waist circumference, or body mass index (all p > 0.05). Subgroup analyses suggested that combined interventions were more effective than single interventions in reducing body fat, and short-term programs were superior to long-term ones. For muscle mass outcomes, single resistance training showed more consistent benefits in improving Appendicular Free Fat Mass, whereas the addition of nutritional supplementation conferred no significant extra advantage.
ConclusionFuture studies on sarcopenic obesity should adopt the latest international consensus criteria (e.g., European Working Group on Sarcopenia in Older People 2, Asian Working Group for Sarcopenia 2019) to enhance the comparability and clinical applicability of findings. Current evidence indicates that exercise interventions, particularly resistance training, serve as the cornerstone for improving handgrip strength and functional outcomes such as gait speed. Various non-pharmacological approaches have also been validated in improving body composition indicators (Body Fat Percentage, Appendicular Free Fat Mass, and Skeletal Muscle Index). The synergistic effects of combined exercise and nutritional interventions on muscle mass and strength warrant further investigation, especially to determine the optimal modality and dosage in women with sarcopenic obesity. Future intervention strategies should be systematically designed to integrate short-term intensive programs with long-term maintenance, thereby maximizing therapeutic benefits and improving clinical feasibility.