Combined aerobic and resistance training significantly improves FEV1, FVC, and MIP in older sarcopenic patients

This systematic review and meta-analysis synthesized evidence from randomized controlled trials on exercise training modalities for older patients with sarcopenia. The analysis included a total sample size of 655 participants. The population consisted of older patients with sarcopenia, though the specific study settings were not reported. The intervention involved different exercise training modalities, specifically aerobic training alone, resistance training, and combined aerobic and resistance training. The comparator was aerobic controls.

The primary outcome was FEV1. For combined training, FEV1 was significantly improved with a mean difference (MD) of 0.28 (95% CI 0.14-0.44, P = 0.0002). When compared directly to aerobic controls, combined training yielded additional benefits for FEV1 with an MD of 0.28 (95% CI 0.22-0.35, P < 0.00001). Resistance training alone did not significantly improve FEV1 (all P > 0.05). Aerobic training alone did not significantly enhance pulmonary function for MIP (MD=9.40, 95% CI -1.09-19.89, P = 0.08).

Key secondary outcomes included FVC, FEV1/FVC, and MIP. For combined training, FVC was significantly improved (MD=0.30, 95% CI 0.09-0.52, P = 0.005), and MIP was significantly improved (MD=9.42, 95% CI 0.85-17.99, P = 0.03). Compared to aerobic controls, combined training showed additional benefits for FVC (MD=0.14, 95% CI 0.06-0.21, P = 0.0003) and FEV1/FVC (MD=8.52, 95% CI 6.57-10.46, P < 0.00001). Resistance training alone significantly improved FEV1/FVC (MD=2.74, 95% CI 0.36-5.13, P = 0.02) but not FVC, FEV1, or MIP (all P > 0.05).

Safety and tolerability findings were not reported in the included studies. The review did not provide data on adverse events, serious adverse events, discontinuations, or overall tolerability of the exercise interventions.

These results compare to prior landmark studies in sarcopenia, which have primarily focused on resistance training for muscle mass and strength. This meta-analysis extends the evidence to pulmonary function outcomes, highlighting the added value of combined training for ventilation metrics. The findings suggest that combined exercise may offer a more comprehensive benefit than single-modality training in this population.

Key methodological limitations include that the test for subgroup difference was non-significant for FEV1 (P = 0.94), indicating consistent effects across reference conditions, while the effect on FEV1/FVC was reference-dependent (P for subgroup difference <0.00001). Subgroup analysis by COPD status showed no significant differences for most outcomes. The setting was not reported, and follow-up duration was not reported, which limits the interpretation of long-term effects.

Clinically, these results suggest that combined aerobic and resistance training should be considered for older sarcopenic patients to improve pulmonary function, particularly FEV1, FVC, and MIP. However, the evidence is observational in nature from a meta-analysis of RCTs, and causality cannot be inferred beyond the reported associations. Practice decisions should integrate these findings with individual patient assessments.

Unanswered questions remain regarding the optimal dose, frequency, and duration of combined training, the long-term sustainability of benefits, and the applicability to sarcopenic patients with specific comorbidities such as COPD. Future primary trials are needed to address these gaps.