Currently submitted to: Journal of Medical Internet Research
Date Submitted: Oct 11, 2026
Open Peer Review Period: Oct 12, 2026 - Dec 7, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Comparative effectiveness of digitally delivered interventions for sarcopenia: systematic review with network and component network meta-analyses of randomised controlled trials
ABSTRACT
Background:
Sarcopenia is characterized by declines in muscle strength, muscle mass, and physical function. Exercise and nutrition are key to its management, and digital delivery may enhance the accessibility of these interventions.
Objective:
To compare and rank digitally delivered exercise and nutritional strategies and estimate the incremental effects of intervention components using component network meta-analysis (CNMA).
Methods:
We searched comprehensive electronic databases from inception to July 27, 2026. Randomized controlled trials evaluating digitally delivered exercise and/or nutritional interventions in patients with sarcopenia were included. Risk of bias was assessed using RoB 2. Bayesian network meta-analysis was used to compare and rank different intervention strategies. Intervention components were prespecified and coded for CNMA, with incremental mean differences (iMDs) estimating the added benefit or harm of each component.
Methods:
We searched comprehensive electronic databases from inception to July 27, 2026. Randomized controlled trials evaluating digitally delivered exercise and/or nutritional interventions in patients with sarcopenia were included. Risk of bias was assessed using RoB 2. Bayesian network meta-analysis was used to compare and rank different intervention strategies. Intervention components were prespecified and coded for CNMA, with incremental mean differences (iMDs) estimating the added benefit or harm of each component.
Results:
Sixteen studies involving 1,355 participants were included. In the Bayesian NMA, digital exercise, digital nutrition, and combined digital exercise plus nutrition significantly improved handgrip strength (HGS) versus usual care, with MDs of 1.35 kg (95% CrI, 0.33 to 2.54), 2.07 kg (95% CrI, 0.06 to 4.27), and 2.21 kg (95% CrI, 1.15 to 3.56), respectively. In the additive CNMA, automated reminders/prompts had a positive incremental effect on appendicular skeletal muscle mass index (ASMI) (iMD, 1.71 kg/m²; 95% CI, 0.19 to 3.23; P = .027), whereas digital nutrition had a negative incremental effect (iMD, −0.97 kg/m²; 95% CI, −1.74 to −0.19; P = .015). Self-monitoring had a positive incremental effect on gait speed (iMD, 0.38 m/s; 95% CI, 0.16 to 0.60; P < .001).
Conclusions:
Digitally delivered exercise and nutrition, particularly in combination, may improve handgrip strength in patients with sarcopenia. Automated reminders/prompts and self-monitoring showed positive incremental effects on ASMI and gait speed, respectively, whereas digital nutrition showed an unexpected negative effect on ASMI.
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