Effectiveness of different modes of digital health interventions for sarcopenia in older adults: a systematic review and network meta-analysis.

BACKGROUND AND

objectiveSarcopenia-related disability in older adults has emerged as a serious public health challenge; however, the relative efficacy of digital health interventions delivered through different technological pathways in this population remains unclear. This study aimed to compare the clinical effectiveness of different digital modalities in older adults with confirmed sarcopenia through network meta-analysis (NMA), with equal attention given to three core outcome measures: muscle strength (handgrip strength), muscle mass (skeletal muscle mass index, SMI), and physical function (Timed Up and Go Test, TUGT).

methodsA systematic search was conducted in PubMed, Web of Science, the Cochrane Library, Scopus, Embase, CINAHL, and CNKI for randomized controlled trials (RCTs) on digital health interventions for sarcopenia in older adults published up to February 13, 2026. Intervention nodes were pre-specified according to the core interaction mechanisms of digital interventions and classified into three categories: Real-time Feedback, mHealth Management, and Hardware-driven Monitoring. This classification scheme was pre-specified in the PROSPERO registration protocol. Two researchers independently screened the literature and assessed risk of bias using RoB 2.0. A random-effects model was applied for network synthesis and SUCRA probability ranking.

resultsA total of 8 RCTs involving 611 participants were included. Network meta-analysis showed that among digital interventions, Real-time Feedback ranked highest in improving handgrip strength (SUCRA = 80.8%) and SMI (SUCRA = 78.3%); however, it should be noted that these rankings were primarily based on indirect comparisons with a limited evidence base, and the results should be interpreted with caution. Compared with conventional health education, Real-time Feedback demonstrated a statistically significant effect on handgrip strength improvement [SMD = 0.92, 95% CI (0.40, 1.44)]; compared with habitual activities, it showed a significant effect on SMI improvement [SMD = 1.45, 95% CI (0.55, 2.35)]. Offline traditional training ranked highest for physical mobility function (TUGT, SUCRA = 98.7%), outperforming mHealth management [SMD = 0.93, 95% CI (0.39, 1.47)]; however, only 4 studies reported TUGT outcomes and related conclusions should be interpreted with particular caution. Exploratory meta-regression suggested a positive distribution trend in intervention effects with increasing duration, though this finding is for reference only given the limited number of studies. CINeMA evidence certainty was overall rated as "low" to "moderate."

conclusionDigital health interventions are effective means of improving muscle mass and strength in patients with sarcopenia. Among them, Real-time Feedback ranked highest within the current limited evidence base and shows promising potential; however, it is insufficient as a definitive recommendation for the optimal intervention and warrants further validation through more high-quality RCTs. For rehabilitation involving complex mobility functions, offline traditional training retains a relative advantage, and a hybrid management model combining "online real-time feedback with offline physical guidance" may be considered in clinical practice.