JMIR Publications

ABSTRACT

Background:

With the accelerating trend of global population aging, frailty and sarcopenia have emerged as significant public health challenges that are closely associated with geriatric syndromes [1]. Frailty is a multidimensional syndrome characterized by decreased functional reserve and increased vulnerability to stressors [2]. Sarcopenia, defined as the loss of skeletal muscle mass and function, typically precedes frailty, is a core component of frailty [2, 3]. A shared pathophysiological hallmark and a key clinical link between these two conditions is the presence of muscle atrophy and the consequent decline in physical performance [4, 5]. Systematic reviews and meta-analyses indicate that the prevalence of frailty among people aged over 60 is 16%, while the prevalence of pre-frailty is as high as 47% [6].The prevalence of sarcopenia ranges from 10% to 27% [7]. Critically, both of these highly prevalent conditions are important predictors of serious adverse health outcomes [8-10], profoundly impacting older adults’ the function, quality of life, and survival of older adults [5, 11]. Although evidence suggests that resistance exercise is an effective intervention for improving muscle mass and function, its practical implementation often faces multiple real-world challenges, including insufficient rehabilitation resources, economic constraints, transportation difficulties, and declines in patients’ physical performance, all of which reduce patient adherence and motivation [12, 13]. In this context, Digital Health Interventions (DHIs) emerge as a promising alternative, offering the convenience, accessibility, and home-based approach needed to overcome these barriers and support long-term adherence [14]. Recent advances in digital technology have created new opportunities for geriatric rehabilitation. In 2019, the World Health Organization defined DHIs as digital functionalities for health objectives, highlighting features like continuous monitoring and personalized feedback, which improve healthcare quality and accessibility [15]. While some studies have explored DHIs for frailty and sarcopenia, gaps and inconsistencies remain in the evidence [16] . Existing reviews are limited by their focus on single conditions and the absence of comprehensive meta-analyses for older adults with frailty and sarcopenia; for example, meta-analyses on grip strength in frailty show inconsistent results and fail to include sarcopenia populations [17, 18]. Given the rapid advancement of digital technology and shifts in intervention models, along with the importance of managing frailty and sarcopenia in older adults, it is crucial to systematically update and synthesize the evidence on digital solutions for this vulnerable population. Therefore, this systematic review aimed to search, evaluate, and synthesize the existing evidence on the effectiveness of DHIs in improving muscle strength, muscle mass, physical performance, and quality of life among older adults with frailty and sarcopenia.

Objective:

To evaluate the effectiveness of digital health interventions (DHIs) in older adults with frailty and sarcopenia.

Methods:

Data sources, including PubMed, Web of Science, MEDLINE, Embase, and the Cochrane Library, were searched from inception to July 2025 to identify randomized controlled trials. Meta-analyses were conducted using Review Manager 5.3. Trials meeting the eligibility criteria were assessed for risk of bias with the revised Cochrane Risk of Bias tool 2.0 (ROB 2.0). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results:

A total of 12 trials involving 882 elderly individuals with sarcopenia and/or frailty were included. DHIs significantly improved total skeletal muscle mass, gait speed, and balance function. Subgroup analysis indicated that internet-based and exergame-based interventions significantly improved ASMI, while video-based interventions improved 30CST and FTSST. Intervention durations of 4-8 weeks improved 30CST, while those exceeding 8 weeks improved ASMI. Compared with active control, TUGT demonstrated significant improvement; compared with passive control, 30CST showed significant improvement. However, no significant improvements were observed in overall grip strength, the 6-minute walk test, the 2-minute walk test, and quality of life.

Conclusions:

DHIs may be beneficial for older adults with frailty and sarcopenia, particularly in improving specific aspects of muscle mass and physical function, but the overall clinical effectiveness is still uncertain. However, due to limited existing research, further high-quality RCTs and more in-depth assessments of clinical effectiveness are needed to strengthen the current evidence. Clinical Trial: The study protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251135302).