Traditional Chinese sports intervene in sarcopenia and its complications in the elderly: a meta-analysis on improving muscle strength, mass, and physical function

Abstract

OBJECTIVE: Muscle function decline and physical impairment caused by sarcopenia and its complications increase the risk of adverse health outcomes in the elderly. However, systematic evidence on the efficacy of traditional Chinese sport interventions for these conditions remains insufficient. Therefore, this study employs meta-analysis to systematically evaluate the effectiveness of traditional Chinese sports in treating sarcopenia and its complications. METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang databases to choose randomized controlled trials evaluating traditional Chinese sport interventions for sarcopenia and its complications. Experimental group received one or more traditional Chinese sports, including Yijinjing, Tai Chi, and Baduanjin, while control group received health education, usual care, or remote Tai Chi instruction. Outcome measures included handgrip strength, knee muscle strength, appendicular skeletal muscle mass index, sit-to-stand test, gait speed, timed up-and-go test, and short physical performance battery. Meta-analysis was performed using Revman 5.4 and Stata 15.1 software, and subgroup analyses were conducted to identify optimal intervention parameters. RESULTS: A total of 21 studies (n=1,313) were included. Meta-analysis showed that traditional Chinese sports significantly improved handgrip strength (MD=1.83, 95%CI: 1.65, 2.01, P < 0.00001), knee muscle strength (MD=5.98, 95%CI: 3.85, 8.11, P < 0.00001), appendicular skeletal muscle mass index (MD=0.22, 95%CI: 0.10, 0.34, P=0.0004), gait speed (MD=0.12, 95%CI: 0.09, 0.16, P < 0.00001), sit-to-stand test performance (MD=1.92, 95%CI: 1.41, 2.43, P < 0.00001), timed up-and-go test performance (SMD=-1.00, 95%CI: -1.25, -0.74, P < 0.00001), and short physical performance battery score (MD=1.12, 95%CI: 0.77, 1.46, P < 0.00001). Subgroup analyses revealed that for improving handgrip strength, Yijinjing (intervention >12 weeks, >3 times/week, ≤30 min/session) was most effective; for improving appendicular skeletal muscle mass index, Baduanjin (12 weeks, ≤3 times/week, >30 min/session) was optimal; for improving gait speed, both Tai Chi (>12 weeks, >3 times/week, ≤30 min/session) and Baduanjin (12 weeks, 3 times/week, >30 min/session) were effective; for improving sit-to-stand test performance, Yijinjing (8 weeks, 5 times/week, ≤40 min/session) was best; and for improving timed up-and-go test performance, Baduanjin (>12 weeks, ≤3 times/week, >30 and ≤40 min/session) was most significant. CONCLUSION: Traditional Chinese sports can effectively improve handgrip strength, knee muscle strength, appendicular skeletal muscle mass, and physical function in elderly patients with sarcopenia and its complications, with specific effects under different intervention parameters. It is recommended to prescribe personalized exercise programs based on target outcomes.

1. Introduction

Sarcopenia is an age-related degenerative systemic skeletal muscle disorder characterized by decreased muscle strength, reduced muscle mass, and impaired physical function [1]. In 2016, the World Health Organization officially classified sarcopenia as a disease in the International Classification of Diseases [2], highlighting its medical importance. Epidemiological data indicate that the prevalence of sarcopenia in people aged 60 and above ranges from 10% to 27% [3], and it increases significantly with age, exceeding 50% in those aged 80 and older [4], making it a major health threat to the elderly population.

From the perspective of pathological mechanisms and therapeutic targets, sarcopenia often coexists with other metabolic diseases. Among these, sarcopenia combined with osteoporosis (osteosarcopenia), sarcopenia combined with obesity (sarcopenic obesity), and the simultaneous presence of osteoporosis and obesity (osteosarcopenic obesity) are collectively referred to as sarcopenia and its complications [5-7]. This complex disease state not only increases the difficulty of clinical diagnosis and treatment but is also closely related to adverse health outcomes such as increased fall risk, progression of chronic diseases, cognitive decline, and increased all-cause mortality in the elderly [8-10]. Currently, there is no specific drug for the treatment of sarcopenia and its complications. Although some hormonal drugs may benefit muscle, they carry certain risks of adverse effects [11]. Therefore, controlling underlying diseases, physical exercise, and nutritional supplementation are considered the gold standard for the prevention and treatment of sarcopenia and its complications [12]. Among these, exercise intervention has been supported by a large body of evidence-based medicine; various exercise modalities, including resistance training and aerobic training, have been proven to effectively improve muscle strength, mass, and physical function in patients with sarcopenia and its complications [13-15].

Traditional Chinese sports are exercise interventions based on traditional Chinese medicine theory, encompassing forms such as Tai Chi, Baduanjin, Yijinjing, and Wuqinxi, with a history dating back more than 3,000 years [16]. Traditional Chinese sports combine therapeutic and aerobic exercise characteristics, emphasizing the coordination of mind and body, with gentle and slow movements, and are classified as low-to-moderate intensity aerobic exercise.