{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T21:17:07Z","timestamp":1793740627705,"version":"4.6.1"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sarcopenic obesity is highly prevalent among older adults and is associated with adverse clinical outcomes. However, direct comparative evidence on the relative efficacy and safety of different exercise-based rehabilitation strategies, with or without nutritional supplementation or high-protein intake, remains limited. This study aimed to compare and rank the effects of diverse rehabilitation interventions using a systematic review and network meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched from database inception to November 1, 2025, without language restrictions. Both Medical Subject Headings and free-text terms were used. Primary outcomes included body mass index (BMI), handgrip strength (GRIP), fat mass (FM), percentage body fat (PBF), and skeletal muscle index (SMI). A systematic review and network meta-analysis were conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB 2) tool, and the certainty of evidence was evaluated using the CINeMA framework. The study protocol was prospectively registered in PROSPERO (CRD420251270452).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-four randomized controlled trials involving 1,298 participants and nine distinct exercise- and nutrition-related rehabilitation strategies were included. For BMI, only multicomponent training (MC) significantly reduced BMI compared with usual care (UC) (MD\u202f=\u202f\u22121.08, 95% CI \u22121.86 to \u22120.29) and ranked highest (SUCRA 85.1%). For handgrip strength, both resistance training (RT) (MD\u202f=\u202f3.96, 95% CI 2.15\u20135.77) and MC (MD\u202f=\u202f2.13, 95% CI 0.25\u20134.01) were superior to UC, with RT ranking first (SUCRA 90.9%). For fat mass, only RT significantly reduced FM compared with UC (MD\u202f=\u202f\u22122.30, 95% CI \u22123.63 to \u22120.98) and achieved the highest ranking (SUCRA 79.0%). For PBF, both MC (MD\u202f=\u202f\u22123.53, 95% CI \u22125.70 to \u22121.36) and RT (MD\u202f=\u202f\u22122.30, 95% CI \u22123.98 to \u22120.62) were effective, with MC ranking highest (SUCRA 77.1%). No intervention demonstrated a statistically significant advantage over UC for SMI; however, MC combined with nutritional supplementation ranked relatively favorably (SUCRA 74.1%). Global consistency testing supported overall network coherence. Sensitivity analyses confirmed the robustness of the findings, and comparison-adjusted funnel plots indicated no clear evidence of publication bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In older adults with sarcopenic obesity, exercise-centered interventions yield clinically meaningful benefits across several key rehabilitation outcomes. Overall, resistance training appears particularly effective for improving muscle strength and reducing adiposity-related measures, whereas multicomponent training shows greater advantages in reducing BMI and PBF. Evidence for improvements in SMI remains limited and uncertain, highlighting the need for larger, well-designed randomized trials with longer follow-up and direct head-to-head comparisons to clarify long-term benefits and identify optimal intervention combinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251270452<\/jats:ext-link>\n                      , PROSPERO: CRD420251270452.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1775783","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T05:27:56Z","timestamp":1771824476000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparative effectiveness of exercise modalities and nutritional supplementation for sarcopenic obesity in older adults: a network meta-analysis based on randomized controlled trials"],"prefix":"10.3389","volume":"14","author":[{"given":"Jiacheng","family":"Yu","sequence":"first","affiliation":[{"name":"School of Physical Education, Ludong University","place":["Yantai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinchun","family":"Li","sequence":"additional","affiliation":[{"name":"School of Physical Education, Ludong University","place":["Yantai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Physical Education, Ludong University","place":["Yantai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Physical Education, Ludong University","place":["Yantai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1007\/s13539-012-0089-z","article-title":"From muscle wasting to sarcopenia and myopenia: update 2012","volume":"3","author":"von Haehling","year":"2012","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1097\/MCO.0b013e328312c37d","article-title":"Sarcopenic obesity: definition, cause and consequences","volume":"11","author":"Stenholm","year":"2008","journal-title":"Curr Opinion Clin Nutr Metab Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older 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