Effects of exercise interventions based on American College of Sports Medicine recommendations on physical function, body composition, and quality of life in older adults with sarcopenia: a meta-analysis of randomized controlled trials

Abstract Aging is associated with a progressive decline in skeletal muscle mass and strength, which adversely affects the quality of life in older adults. This study aimed to investigate the effects of different exercise volumes on physical function, body composition, and quality of life in older adults with sarcopenia. Methods Randomized controlled trials (RCTs) published up to February 28,2026 that investigated the effects of exercise interventions on older adults with sarcopenia were systematically retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. Study quality was assessed using the Cochrane Risk of Bias tool, and meta-analyses were conducted using appropriate statistical software. Subgroup analyses were performed to examine the influence of adherence to the American College of Sports Medicine (ACSM) guidelines on outcome measures. In addition, sensitivity analyses were conducted to evaluate the robustness of the pooled results, while publication bias was assessed using funnel plots and Egger’s regression test to ensure the comprehensiveness and reliability of the findings. Results The meta-analysis demonstrated that, compared with the control groups, exercise interventions significantly improved handgrip strength (standardized mean difference (SMD) = 0.47, 95% confidence interval (CI): 0.28, 0.66, P < 0.01), gait speed (SMD = 0.70, 95% CI: 0.45, 0.96, P < 0.01), walking test performance (SMD = −0.73, 95% CI: −1.14, −0.32, P < 0.01), skeletal muscle index (SMD = 0.48, 95% CI: 0.19, 0.77, P < 0.01) and body fat percentage (SMD = −0.62, 95% CI: −1.07, −0.17, P < 0.01). Subgroup analyses indicated that improvements in handgrip strength, gait speed, walking test performance, skeletal muscle index, bone mineral density, and health status and quality of life were significantly greater in the high-adherence group than in the low-adherence group (P <0.05).Overall, appropriately designed exercise programs can significantly enhance physical function and body composition, whereas improvements in health status and quality of life depend on high adherence to ACSM recommendations. Conclusion Compared with patients with low adherence, older adults with sarcopenia who demonstrated high adherence to exercise interventions experienced more pronounced improvements in physical function, body composition, and quality of life. However, these findings should be interpreted with caution and require confirmation through large-scale RCTs with longer follow-up durations. Systematic Review Registration https://www.crd.york.ac.uk , identifier CRD420261297264.