Journal of Internal Medicine Concepts & Practice >

2026 , Vol. 21 >Issue 01: 28 - 38

DOI: https://doi.org/10.16138/j.1673-6087.2026.01.04

Effects of exercise combined with nutrition intervention on body composition, physical function and sleep quality in elderly patients with sarcopenia

  • ZHANG Yin ,
  • SHEN Honghua ,
  • XU Yiming ,
  • DU Jingbo ,
  • LIU Jie ,
  • WU Shunjun ,
  • LING Xiaonan ,
  • REN Lei
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  • a. Department of Respiratory Rehabilitation; b. Department of Rehabilitation Therapy and Management, the Fourth Rehabilitation Hospital of Shanghai, Shanghai 200042, China

Received date: 2025-02-24

  Online published: 2026-04-08

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, 2025, Copyright reserved © 2025.
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Abstract

Objective To investigate the effects of combined aerobic and resistance training along with nutritional supplementation on body composition, physical function, and sleep quality in elderly patients with sarcopenia. Methods A total of 83 elderly outpatients and inpatients with sarcopenia from the Department of Respiratory Rehabilitation at the Fourth Rehabilitation Hospital of Shanghai between January and June 2024 were enrolled, and were randomly assigned to a control group (aerobic training only, n=42) or an intervention group [combined aerobic and resistance training + whey protein supplementation containing vitamin D3 and beta-hydroxy-beta-methylbutyrate (HMB), n=41] for a 12-week intervention. Measurements including skeletal muscle index (SMI), 25-hydroxyvitamin D level, grip strength, 6-meter gait speed, and short physical performance battery (SPPB) score were examined before and after treatment. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and Epworth sleepiness scale (ESS). Results After treatment, the intervention group showed significantly greater improvements than the control group in SMI, 25-hydroxyvitamin D level, 6-meter gait speed, and total SPPB score (all P<0.05). The change in 5-time sit-to-stand performance was also significantly greater in the intervention group (P<0.05). Regarding sleep quality, both groups demonstrated significant post-intervention improvements in subjective sleep quality, sleep efficiency, total PSQI score, and ISI score (all P<0.05). Compared with the control group, the intervention group showed more pronounced improvements in subjective sleep quality, sleep duration, sleep disorders, total PSQI score, ISI score, and ESS score (all P<0.05). Logistic regression analysis indicated that the intervention modality [odds ratio (OR)=2.698, P=0.020] and comorbid osteoporosis (OR=2.362, P=0.043) were both associated with the improvement of sleep quality in patients. Conclusions Compared with aerobic training alone, a combined intervention of aerobic and resistance training with nutritional supplementation is more effective in improving muscle function and sleep quality in elderly patients with sarcopenia. The intervention modality and the presence of comorbid osteoporosis are significant factors influencing the efficacy of sleep quality improvement.

Key words： sarcopenia; resistance training; aerobic training; vitamin D3; beta-hydroxy-beta-methylbutyrate; whey-protein

Cite this article

ZHANG Yin , SHEN Honghua , XU Yiming , DU Jingbo , LIU Jie , WU Shunjun , LING Xiaonan , REN Lei . Effects of exercise combined with nutrition intervention on body composition, physical function and sleep quality in elderly patients with sarcopenia[J]. Journal of Internal Medicine Concepts & Practice, 2026 , 21(01) : 28 -38 . DOI: 10.16138/j.1673-6087.2026.01.04

References

[1] Damluji AA, Alfaraidhy M, AlHajri N, et al. Sarcopenia and cardiovascular diseases[J]. Circulation, 2023, 147(20):1534-1553.
[2] Tan X, Titova OE, Lindberg E, et al. Association between self-reported sleep duration and body composition in middle-aged and older adults[J]. J Clin Sleep Med, 2019, 15(3):431-435.
[3] Locquet M, Beaudart C, Delandsheere L, et al. Subjective sleep quality among sarcopenic and non-sarcopenic older adults: results from the SarcoPhAge cohort[J]. J Frailty Aging, 2018, 7(3):176-181.
[4] de Sá Souza H, de Melo CM, Piovezan RD, et al. Resistance training improves sleep and anti-inflammatory parameters in sarcopenic older adults: a randomized controlled trial[J]. Int J Environ Res Public Health, 2022, 19(23):16322.
[5] 崔华, 王朝晖, 吴剑卿, 等. 老年人肌少症防控干预中国专家共识（2023）[J]. 中华老年医学杂志, 2023, 42(2):144-153.
  Cui H, Wang ZH, Wu JQ, et al. Chinese expert consensus on prevention and intervention for elderly with sarcopenia (2023)[J]. Chin J Geriatr, 2023, 42(2):144-153.
[6] Shen Y, Shi Q, Nong K, et al. Exercise for sarcopenia in older people: a systematic review and network meta-analysis[J]. J Cachexia Sarcopenia Muscle, 2023, 14(3):1199-1211.
[7] Lu L, Mao L, Feng Y, et al. Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis[J]. BMC Geriatr, 2021, 21(1):708.
[8] Cereda E, Pisati R, Rondanelli M, et al. Whey protein, leucine- and vitamin-D-enriched oral nutritional supplementation for the treatment of sarcopenia[J]. Nutrients, 2022, 14(7):1524.
[9] Peng LN, Cheng YC, Yu PC, et al. Oral nutritional supplement with β-hydroxy-β-methylbutyrate (HMB) improves nutrition, physical performance and ameliorates intramuscular adiposity in pre-frail older adults: a randomized controlled trial[J]. J Nutr Health Aging, 2021, 25(6):767-773.
[10] Cangussu LM, Nahas-Neto J, Orsatti CL, et al. Effect of vitamin D supplementation alone on muscle function in postmenopausal women: a randomized, double-blind, placebo-controlled clinical trial[J]. Osteoporos Int, 2015, 26(10):2413-2421.
[11] Li ML, Zhang F, Luo HY, et al. Improving sarcopenia in older adults: a systematic review and meta-analysis of randomized controlled trials of whey protein supplementation with or without resistance training[J]. J Nutr Health Aging, 2024, 28(4):100184.
[12] Gu WT, Zhang LW, Wu FH, et al. The effects of beta-hydroxy-beta-methylbutyrate supplementation in patients with sarcopenia: a systematic review and meta-analysis[J]. Maturitas, 2025, 195:108219.
[13] Hernández-Lepe MA, Miranda-Gil MI, Valbuena-Gregorio E, et al. Exercise programs combined with diet supplementation improve body composition and physical function in older adults with sarcopenia: a systematic review[J]. Nutrients, 2023, 15(8):1998.
[14] Gao X, Qiao Y, Chen Q, et al. Effects of different types of exercise on sleep quality based on Pittsburgh Sleep Quality Index in middle-aged and older adults: a network meta-analysis[J]. J Clin Sleep Med, 2024, 20(7):1193-1204.
[15] Tseng TH, Chen HC, Wang LY, et al. Effects of exercise training on sleep quality and heart rate variability in middle-aged and older adults with poor sleep quality: a randomized controlled trial[J]. J Clin Sleep Med, 2020, 16(9):1483-1492.
[16] Akbari Kamrani AA, Shams A, Shamsipour Dehkordi P, et al. The effect of low and moderate intensity aerobic exercises on sleep quality in men older adults[J]. Pak J Med Sci, 2014, 30(2):417-421.
[17] Zhou Y, Wu W, Zou Y, et al. Benefits of different combinations of aerobic and resistance exercise for improving plasma glucose and lipid metabolism and sleep quality among elderly patients with metabolic syndrome: a randomized controlled trial[J]. Endocr J, 2022, 69(7):819-830.
[18] Al-Jiffri OH, Abd El-Kader SM. Aerobic versus resistance exercises on systemic inflammation and sleep parameters in obese subjects with chronic insomnia syndrome[J]. Afr Health Sci, 2021, 21(3):1214-1222.
[19] 张艳, 谈玉婷, 黄夕夏, 等. 上海市社区老年人肌少症患病率及相关危险因素分析[J]. 老年医学与保健, 2018, 24(6):608-613.
  Zhang Y, Tan YT, Huang XX, et al. Prevalence of sarcopenia and the associated risk factors in community elderly in Shanghai[J]. Geriatr Health Care, 2018, 24(6):608-613.
[20] 《运动处方中国专家共识(2023)》专家组. 运动处方中国专家共识(2023)[J]. 中国运动医学杂志, 2023, 42(1): 3-13.
  Writing Group of Chinese expert consensus on exercise prescription (2023). Chinese expert consensus on exercise prescription (2023)[J]. Chin J Sports Med, 2023, 42(1):3-13.
[21] 方蔓倩, 葛烨培, 杨黎明, 等. 解郁安神方加减联合西药治疗肝郁化火型失眠的临床观察[J]. 现代中医临床, 2016, 23(4):16-20.
  Fang MQ, Ge YP, Yang LM, et al. Clinical observation of modified Jieyu Anshen Formula combined with western medicine on the treatment of liver stagnation transforming into fire type insomnia[J]. Modern Chinese Clinical Medicine, 2016, 23(4):16-20.
[22] Wang H, Huang WY, Zhao Y. Efficacy of exercise on muscle function and physical performance in older adults with sarcopenia: an updated systematic review and meta-analysis[J]. Int J Environ Res Public Health, 2022, 19(13):8212.
[23] Grgic J, Mcllvenna LC, Fyfe JJ, et al. Does aerobic training promote the same skeletal muscle hypertrophy as resistance training?[J]. Sports Med, 2019, 49(2):233-254.
[24] Song Z, Moore DR, Hodson N, et al. Resistance exercise initiates mechanistic target of rapamycin (mTOR) translocation and protein complex co-localisation in human skeletal muscle[J]. Sci Rep, 2017, 7(1):5028.
[25] Kakigi R, Yoshihara T, Ozaki H, et al. Whey protein intake after resistance exercise activates mTOR signaling in a dose-dependent manner in human skeletal muscle[J]. Eur J Appl Physiol, 2014, 114(4):735-742.
[26] Kaczka P, Michalczyk MM, Jastrz?b R, et al. Mechanism of action and the effect of beta-hydroxy-beta-methylbutyrate (HMB) supplementation on different types of physical performance - a systematic review[J]. J Hum Kinet, 2019, 68:211-222.
[27] Mendes MM, Botelho PB, Ribeiro H. Vitamin D and musculoskeletal health: outstanding aspects to be considered in the light of current evidence[J]. Endocr Connect, 2022, 11(10):e210596.
[28] Choi M, Park H, Cho S, et al. Vitamin D3 supplementation modulates inflammatory responses from the muscle damage induced by high-intensity exercise in SD rats[J]. Cytokine, 2013, 63(1):27-35.
[29] Roldán-Jiménez C, Bennett P, Cuesta-Vargas AI. Muscular activity and fatigue in lower-limb and trunk muscles during different sit-to-stand tests[J]. PLoS One, 2015, 10(10):e0141675.
[30] Anan M, Hattori H, Tanimoto K, et al. The coordination of joint movements during sit-to-stand motion in old adults: the uncontrolled manifold analysis[J]. Phys Ther Res, 2017, 20(2):44-50.
[31] Miyazaki R, Ayabe M, Kumahara H, et al. Effects of light-to-moderate intensity aerobic exercise on objectively measured sleep parameters among community-dwelling older people[J]. Arch Gerontol Geriatr, 2021, 94:104336.
[32] Hasan F, Tu YK, Lin CM, et al. Comparative efficacy of exercise regimens on sleep quality in older adults: a systematic review and network meta-analysis[J]. Sleep Med Rev, 2022, 65:101673.
[33] Gupta S, Bansal K, Saxena P. A clinical trial to compare the effects of aerobic training and resistance training on sleep quality and quality of life in older adults with sleep disturbance[J]. Sleep Sci, 2022, 15(2):188-195.
[34] Bonardi JMT, Lima LG, Campos GO, et al. Effect of different types of exercise on sleep quality of elderly subjects[J]. Sleep Med, 2016, 25:122-129.
[35] Maric D, Ficarra S, Di Bartolo L, et al. Effects of resistance training on sleep quality and disorders among individuals diagnosed with cancer: a systematic review and meta-analysis of randomized controlled trials[J]. Cancer Med, 2024, 13(8):e7179.
[36] Karandikar-Agashe G, Agrawal R. Comparative study of the effect of resistance exercises versus aerobic exercises in postmenopausal women suffering from insomnia[J]. J Midlife Health, 2020, 11(1):2-5.
[37] Yu X, Sun S, Zhang S, et al. A pooled analysis of the association between sarcopenia and osteoporosis[J]. Medicine (Baltimore), 2022, 101(46):e31692.
[38] Chen S, Xu X, Gong H, et al. Global epidemiological features and impact of osteosarcopenia: a comprehensive meta-analysis and systematic review[J]. J Cachexia Sarcopenia Muscle, 2024, 15(1):8-20.
[39] 王亮, 陶天遵, 杨惠林, 等. 中国老年骨质疏松症诊疗指南（2023）[J]. 中华骨与关节外科杂志, 2023, 16(10):865-885.
  Wang L, Tao TZ, Yang HL, et al. China guideline for diagnosis and treatment of senile osteoporosis (2023)[J]. Chin J Bone Joint Surg, 2023, 16(10):865-885.
[40] Abboud M. Vitamin D supplementation and sleep: a systematic review and meta-analysis of intervention studies[J]. Nutrients, 2022, 14(5):1076.
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