Effect of Exercise Interventions on Sarcopenia-Related Outcomes in Older Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis.

To systematically evaluate the effects of exercise interventions on sarcopenia-related outcomes and glycemic control in older adults with type 2 diabetes (T2DM).

We searched PubMed, Scopus, and Cochrane CENTRAL (January 2020-October 2025) for RCTs in adults with T2DM (mean age ≥ 65 years) comparing structured exercise (≥ 4 weeks) with nonexercise control. Co-primary outcomes were lean/appendicular lean mass, muscle strength, and physical performance; secondary outcomes were HbA1c, FPG, and HOMA-IR. Random-effects meta-analyses used Hedges' g for sarcopenia outcomes and mean differences for metabolic outcomes from pre-post changes.

Eleven RCTs (≈740 participants) were included. Exercise produced a small, nonsignificant effect on lean mass (6 trials; g = 0.14, 95% CI -0.09 to 0.37; I2 = 0%). Significant moderate-to-large improvements were found in muscle strength (nine trials; g = 0.67, 95% CI 0.46-0.88; I2 = 11.7%) and physical performance (nine trials; g = 0.74, 95% CI 0.44-1.03; I2 = 64.4%). HbA1c was reduced by 0.32 percentage points (seven trials; I2 = 0%), HOMA-IR improved by 0.51 units (three trials; I2 = 0%), while FPG changes were small and nonsignificant. Adverse events were rare and no serious exercise-related complications occurred.

In older adults with T2DM, structured exercise training yields meaningful gains in muscle strength, physical performance, and glycemic control despite only modest effects on lean mass. These findings support resistance-based or multicomponent programs as a core component of care to address both sarcopenia-related impairments and metabolic abnormalities in this high-risk population.