Frailty in older adults is a common aging-related syndrome that can lead to adverse health outcomes. Although physical exercise and nutritional interventions have been widely recognized as beneficial for managing frailty, the comparative effectiveness of various intervention approaches remains uncertain. We systematically evaluated the effects of multicomponent exercise, nutritional supplementation, and combined interventions on frailty status and functional outcomes in older adults using network meta-analysis. Randomized controlled trials (RCTs) published between 2006 and 2025 were searched to include studies assessing the effects of multicomponent exercise, nutritional supplements (including amino acids and proteins, etc.), combined interventions, or standard care on frailty status in older adults aged ≥ 60 years. Changes in frailty scores constituted the primary outcome. Secondary outcomes comprised gait speed, the Short Physical Performance Battery (SPPB), and the Timed Up-and-Go test (TUG). Effect sizes were calculated using Standardized Mean Difference (SMD) and 95% Confidence Interval (CI), and ranked using network meta-analysis. Ultimately, 22 RCTs involving 2,055 participants were included, with comparable baseline characteristics among participants. Regarding the improvement in frailty scores, combined interventions demonstrated the greatest improvement (SMD = -0.92, 95% CI: -1.43 to -0.40), followed by multicomponent exercise (SMD = -0.78, 95% CI: -1.15 to -0.43), while nutritional supplementation showed a trend toward improvement that did not reach statistical significance (SMD = -0.69, 95% CI: -1.67 to 0.27). For gait speed, nutritional supplementation (SMD = + 0.37, 95% CI: +0.06 to + 0.68) yielded the greatest improvement, while multicomponent exercise (SMD = + 0.09, 95% CI: -0.04 to + 0.22) showed minimal benefit. Significant improvement in SPPB scores was observed only after multicomponent exercise (SMD = + 1.85, 95% CI: +0.33 to + 3.50). In the TUG test, combined interventions (SMD = -4.61, 95% CI: -9.36 to + 0.25) tended to reduce completion time (non-significant); conversely, multicomponent exercise alone significantly increased time (SMD = + 3.96 s, 95% CI: +0.91 to + 7.07). Low heterogeneity was observed across outcomes with no evidence of publication bias. The impacts of different interventions on frailty in older adults exhibited outcome-specific variations. Combined interventions were most effective in improving frailty scores, demonstrating potential synergistic effects between physical exercise and nutrition, while nutritional supplementation showed the most significant benefit for gait speed. Multicomponent exercise alone also produced significant improvements in frailty scores and physical performance. These findings suggest that clinicians should consider combined approaches for overall frailty improvement while tailoring interventions based on specific functional objectives when developing management strategies for frailty in older adults. CRD420251038055.
Yang et al. (Mon,) studied this question.
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