Sarcopenia is the age-related, progressive loss of muscle mass, strength and physical function, and it raises the risk of falls, fractures and loss of independence [4]. Resistance training is widely recommended for the condition, yet the authors of a 2025 systematic review in Frontiers in Public Health note that evidence specific to older women remains limited [1]. Their meta-analysis pooled randomized controlled trials in that population to estimate effects on muscle mass, strength and physical function [1].
What was studied
Four databases were searched through February 2025: PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials [1]. The protocol was registered in PROSPERO (CRD420251066233) [1]. Twelve randomized controlled trials, together enrolling 518 older women with sarcopenia, were included [1]. Pooling used a random-effects model fitted by restricted maximum likelihood with the "meta" package in R [1]. Risk of bias was judged with RoB 2 and certainty of evidence with GRADE [1].
How the outcomes are measured
Clinicians generally define sarcopenia by one or more of three features: low muscle mass, low muscle strength and low physical performance [4]. The review's outcomes correspond to these features [1, 4]:
- Handgrip strength is the force of a hand squeeze and serves as a marker of overall muscle weakness [4].
- Gait speed is assessed by timing a 4-meter walk at a usual pace [4].
- The Timed Up and Go (TUG) test times rising from a chair, walking 3 meters away and back, and sitting down again [4].
- The 30-Second Chair Stand counts sit-to-stand repetitions completed without arm use in 30 seconds [4].
- Muscle mass is commonly estimated with dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) [4].
What was found
Effects were reported as standardized mean differences (SMD) with 95% confidence intervals (CI) [1]. Relative to control conditions, resistance training improved two strength measures and three functional measures to a statistically significant degree [1]:
- Knee extension strength showed the largest pooled effect, an SMD of 0.85 (95% CI, 0.37 to 1.33) [1].
- For handgrip strength the pooled SMD was 0.43 (95% CI, 0.11 to 0.74) [1].
- On the 30-Second Chair Stand, the estimate was 0.52 (95% CI, 0.19 to 0.86) [1].
- Gait speed had the smallest significant effect, 0.37 (95% CI, 0.09 to 0.64) [1].
- TUG improved with an SMD of −0.68 (95% CI, −0.95 to −0.41); because TUG is a timed test, the negative sign corresponds to faster completion [1, 4].
No significant effect on skeletal muscle mass index was found, and the abstract gives no pooled estimate for that outcome [1]. Of the reported outcomes, knee extension strength had the widest confidence interval [1]. The authors conclude that resistance training improves strength and physical function in older women with sarcopenia, but that its effect on muscle mass is still uncertain [1].
Subgroup findings
Sarcopenic obesity refers to sarcopenia occurring together with a higher body mass index [4]. In the subgroup analyses, knee extension strength rose more among women with sarcopenic obesity, whereas gait speed rose more among women with sarcopenia only [1]. Mixed resistance training was reported to have a significant advantage for gait speed, though the abstract neither defines the term nor gives subgroup effect sizes [1].
Context from other studies
A 12-week randomized trial in older adults with type 2 diabetes and sarcopenia compared combined aerobic and resistance exercise with health education, and reported increases in grip strength and appendicular skeletal muscle mass index in the exercise group; its abstract does not state the sample size [2]. A separate meta-analysis of 9 randomized trials in 513 hemodialysis patients with sarcopenia found that exercise combined with nutritional intervention, compared with either alone, improved skeletal muscle index (weighted mean difference 0.82, 95% CI 0.62 to 1.03) [3]. Those populations and interventions differ from the women-only resistance training trials in the 2025 review, so the findings are not directly comparable [1, 2, 3].
Limitations
- The evidence base is small, at 12 trials and 518 participants, and the authors call for large-scale, long-term studies to confirm the findings and refine intervention protocols [1].
- The abstract does not report the GRADE certainty ratings, the RoB 2 judgments, between-trial heterogeneity, or the duration, frequency and intensity of the training programs [1].
- The authors describe the effect on muscle mass as uncertain, and the abstract provides no pooled estimate for skeletal muscle mass index [1].
- Results are reported as SMDs, and the abstract does not convert them into clinical units such as seconds, kilograms or repetitions [1].
- The abstract does not specify which diagnostic criteria the included trials used, and published estimates of sarcopenia vary partly because definitions and diagnostic methods differ [1, 5].
- The review was restricted to older women with sarcopenia, so its pooled estimates describe that population only [1].
References
- Zhou Y, Wen K, Zhang X, Sun Y. Effects of resistance training on muscle mass, strength, and physical function in older women with sarcopenia: a systematic review and meta-analysis. Front Public Health. 2025;13:1735899. doi:10.3389/fpubh.2025.1735899. PMID: 41668861. https://pubmed.ncbi.nlm.nih.gov/41668861/
- Ma Y, Zheng J, Yu M, Zheng Z, Yang F, Liu Y. Effects of combined aerobic and resistance exercise on sarcopenia in elderly patients with type 2 diabetes mellitus. J Endocrinol. 2025;267(3). doi:10.1530/JOE-25-0275. PMID: 41342363. https://pubmed.ncbi.nlm.nih.gov/41342363/
- Zhang L, Yang L, Wang X, Zhang D. Effect of nutritional intervention combined with resistance exercise on clinical indicators of patients with sarcopenia in maintenance hemodialysis: a systematic review and meta-analysis. Ren Fail. 2025;47(1):2492365. doi:10.1080/0886022X.2025.2492365. PMID: 40456518. https://pubmed.ncbi.nlm.nih.gov/40456518/
- Cleveland Clinic. Sarcopenia (Muscle Loss): Symptoms & Causes. Accessed October 11, 2026. https://my.clevelandclinic.org/health/diseases/23167-sarcopenia
- WebMD. Sarcopenia (Muscle Loss With Aging): Causes, and Treatments. Accessed October 11, 2026. https://www.webmd.com/healthy-aging/sarcopenia-with-aging