With global population ageing, sarcopenic obesity has become a common and serious condition in older adults. Exercise guidelines issued by the American College of Sports Medicine (ACSM) are authoritative in exercise science. For older adults with sarcopenic obesity, these guidelines provide multidimensional recommendations on exercise dose, including intensity, frequency, and duration for aerobic and resistance training.

To compare the effects of exercise doses with high adherence to ACSM recommendations versus those with low or uncertain adherence on body composition [body fat percentage, BMI, body weight, appendicular skeletal muscle mass (ASM) ] and physical function (grip strength and walking speed) in older adults with sarcopenic obesity.

Relevant studies on exercise interventions for older adults with sarcopenic obesity were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, Ovid, and China National Knowledge Infrastructure (CNKI). The search period was from database inception to 2023-12-26 for the first four databases, and from database inception to 2024-01-14 for Ovid and CNKI. Two investigators independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Study quality was evaluated using the risk-of-bias tool for randomized controlled trials, and Meta-analysis was performed using RevMan 5.4. Based on whether the intervention group's exercise dose adhered to ACSM recommendations, studies were classified as high adherence or low/uncertain adherence. The effects of these two exercise-dose categories on body fat percentage, BMI, body weight, ASM, grip strength, and walking speed were analyzed. Higgins I² was used to assess heterogeneity among studies, and sensitivity analysis was performed by omitting one study at a time.

A total of 15 studies involving 810 participants were included, of which 7 studies had high adherence to ACSM recommendations and 8 had low or uncertain adherence. Eleven studies reported body fat percentage as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in body fat percentage (MD=-3.54, 95%CI= -5.65 to -1.44, P<0.05), whereas the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=-0.94, 95%CI=-2.54 to 0.67, P>0.05). Five studies reported BMI as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in BMI (MD=-1.98, 95%CI=-3.02 to -0.93, P<0.05). The low/uncertain-adherence intervention group also showed a reduction in BMI, but the difference was not statistically significant (MD=-1.72, 95%CI=-3.42 to -0.03, P=0.05). Five studies reported body weight as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in body weight (MD=-4.85, 95%CI=-7.84 to -1.86, P<0.05), while the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=-1.56, 95%CI=-5.94 to 2.81, P>0.05). Four studies reported ASM as an outcome. For both high-adherence and low/uncertain-adherence exercise doses, no statistically significant differences were observed in ASM compared with the control group (MD=-0.18, 95%CI=-1.03 to 0.67; MD=-0.05, 95%CI=-0.85 to 0.76, P>0.05). Eight studies reported grip strength as an outcome. Compared with the control group, the high-adherence intervention group showed a greater increase in grip strength (MD=2.86, 95%CI=0.76 to 4.97, P<0.05), whereas the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=3.04, 95%CI=-0.26 to 6.34, P>0.05). Seven studies reported walking speed as an outcome. The high-adherence intervention group improved walking speed more than the control group (MD=0.32, 95%CI=0.23 to 0.41, P<0.05), while the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=0.05, 95%CI=-0.01 to 0.11, P>0.05).

High-adherence exercise interventions had significant effects on improving body fat percentage, BMI, body weight, grip strength, and walking speed in patients with sarcopenic obesity. However, exercise intervention had no effect on ASM. Further studies are needed to verify these findings.

随着全球人口老龄化，老年肌肉减少性肥胖成为常见且危害严重的疾病。美国运动医学学会（ACSM）制定的运动指南，是运动领域的权威指引，就老年肌肉减少性肥胖患者而言，该指南涵盖了心肺运动、抗阻运动的运动强度、频率、持续时间等多维度的运动剂量建议。

分析ACSM建议依从性高的运动剂量与ACSM建议依从性低或不确定的运动剂量对老年肌肉减少性肥胖患者身体成分[体脂率、BMI、体质量、四肢骨骼肌质量（ASM）]和身体功能（握力、步速）的影响。

系统检索PubMed、Embase、Web of Science、Cochrane Library、Ovid和中国知网中运动对老年肌肉减少性肥胖患者影响的相关研究，前4个数据库检索时间为建库至2023-12-26，Ovid、中国知网检索时间为建库至2024-01-14。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险，采用随机对照试验偏倚风险评估工具评价研究质量，采用RevMan 5.4软件进行Meta分析。依据纳入研究干预组运动剂量是否依从ACSM建议，分为ACSM建议依从性高和ACSM建议依从性低或不确定，分析两类运动剂量对体脂率、BMI、体质量、ASM、握力、步速的影响。使用Higgins I²统计评估各研究之间的异质性，逐一排除每项研究进行敏感性分析。

共纳入15项研究，包含810名参与者，其中有7项研究对ACSM建议依从性高，8项研究对ACSM建议依从性低或不确定。共11项研究以体脂率为结局指标，干预组ACSM建议依从性高对体脂率的降低效果优于对照组（MD=-3.54，95%CI=-5.65~-1.44，P<0.05），干预组ACSM建议依从性低或不确定对体脂率的降低效果与对照组比较，差异无统计学意义（MD=-0.94，95%CI=-2.54~0.67，P>0.05）。共5项研究以BMI为结局指标，干预组ACSM建议依从性高对BMI的降低效果优于对照组（MD=-1.98，95%CI=-3.02~-0.93，P<0.05），干预组ACSM建议依从性低或不确定降低BMI的效果与对照组比较，差异无统计学意义（MD=-1.72，95%CI=-3.42~-0.03，P=0.05）。共5项研究以体质量为结局指标，干预组ACSM建议依从性高对体质量的降低效果优于对照组（MD=-4.85，95%CI=-7.84~-1.86，P<0.05），干预组ACSM建议依从性低或不确定对体质量的降低效果与对照组比较，差异无统计学意义（MD=-1.56，95%CI=-5.94~2.81，P>0.05）。共4项研究以ASM为结局指标，干预组ACSM建议依从性高和依从性低或不确定对ASM的影响分别与对照组比较，差异均无统计学意义（MD=-0.18，95%CI=-1.03~0.67；MD=-0.05，95%CI=-0.85~0.76；P>0.05）。共8项研究以握力为结局指标，干预组ACSM建议依从性高增加握力的效果优于对照组（MD=2.86，95%CI=0.76~4.97，P<0.05），干预组ACSM建议依从性低或不确定增加握力的效果与对照组比较，差异无统计学意义（MD=3.04，95%CI=-0.26~6.34，P>0.05）。共7项研究以步速为结局指标，ACSM建议依从性高提高步速的效果优于对照组（MD=0.32，95%CI=0.23~0.41，P<0.05），ACSM建议依从性低或不确定对步速的影响与对照组比较，差异无统计学意义（MD=0.05，95%CI=-0.01~0.11，P>0.05）。

对ACSM建议依从性高的运动措施对改善肌肉减少性肥胖患者的体脂率、BMI、体质量、握力、步速具有显著的效果，运动干预对于ASM没有显著影响，需要进一步的研究来验证这些发现。