Lifting, not supplements, drove muscle gains in older women

Sarcopenic obesity is the double problem of excessive body fat alongside shrinking, weakening muscle, and it carries the combined health risks of both conditions. Those risks, and the potential for physical disability, rise with age, and older women face a steeper challenge than men because muscle loss accelerates after menopause. Despite that, no standardised or clearly effective treatment approach has been established. This review asked which non-pharmacological approaches, from exercise to nutrition, actually improve body composition and physical function in women aged 60 and over with sarcopenic obesity.

The researchers searched PubMed, Web of Science, Embase and the Cochrane Library up to April 2025. Eleven studies made the final analysis: ten randomised controlled trials plus one quasi-experimental study included for its rigorous intervention design and complete data, together covering 532 participants. The primary outcomes were key indicators of body composition and physical function, including body fat percentage, appendicular fat-free mass, skeletal muscle index, handgrip strength and gait speed. Study quality was rated with the Cochrane Risk of Bias 2.0 tool, and the certainty of evidence was assessed with the GRADE approach across five domains.

Pooled across trials, the interventions significantly reduced body fat percentage, by around 1.85 percentage points on average, and significantly improved appendicular fat-free mass, skeletal muscle index and handgrip strength. Gait speed, waist circumference and body mass index did not change significantly. Subgroup analyses added texture: combined interventions beat single ones for reducing body fat, and short-term programmes outperformed long-term ones. For building muscle, resistance training on its own showed the most consistent benefits, and adding nutritional supplementation on top conferred no significant extra advantage.

The analysis supports exercise, and particularly resistance training, as the cornerstone for improving handgrip strength and functional outcomes in this group, while confirming that several non-drug approaches can shift body composition markers. The null result for added supplements complicates a popular assumption that nutrition products are an essential companion to training, though the authors say the possible synergy of combined exercise and nutrition deserves further investigation. They also call for future trials to adopt the latest international consensus definitions of sarcopenia so results can be compared, and for the optimal modality and dosage to be pinned down.

For older women noticing both fat gain and strength loss, this is evidence that structured exercise, with resistance work at its core, can meaningfully shift body fat, muscle and grip strength even after 60. The lack of change in BMI and waist circumference is a useful reframe: the scale and the tape measure can miss improvements happening inside body composition. The finding that supplements added no clear extra muscle benefit is a reason for scepticism toward products marketed as the fix for ageing muscle. What the ideal programme looks like, and for how long, is still being worked out.