Effects of different exercise modalities on pulmonary function in older patients with sarcopenia:A systematic review and meta-analysis

• Combined aerobic-resistance training significantly improves FVC, FEV 1 and MIP in older patients with sarcopenia. • Standalone aerobic or resistance training shows limited efficacy on pulmonary function in sarcopenia. • First meta-analysis on different exercise modalities for pulmonary function in older patients with sarcopenia. To evaluate the effects of different exercise training modalities on pulmonary function in older sarcopenic patients. Two independent reviewers systematically searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wan Fang Database from inception to November 2025. Randomized controlled trials assessing pulmonary function in this population post-exercise training. Data were extracted independently by two authors; disagreements were resolved via a third author. 11 RCTs involving 655 patients were included. Aerobic training alone did not significantly enhance pulmonary function (MIP: MD=9.40, 95 % CI=-1.09–19.89, P = 0.08). Resistance training improved FEV₁/FVC (MD=2.74, 95 % CI=0.36–5.13, P = 0.02) but not FVC, FEV₁, or MIP (all P > 0.05). In contrast, combined training significantly improved FVC (MD=0.30, 95 % CI=0.09–0.52, P = 0.005), the primary outcome FEV₁ (MD=0.28, 95 % CI=0.14–0.44, P = 0.0002), and MIP (MD=9.42, 95 % CI=0.85–17.99, P = 0.03). When compared against aerobic controls, combined training provided additional benefits for FVC (MD=0.14, 95 % CI=0.06–0.21, P = 0.0003), FEV₁ (MD=0.28, 95 % CI=0.22–0.35, P < 0.00001), and FEV₁/FVC (MD=8.52, 95 % CI=6.57–10.46, P < 0.00001). The test for subgroup difference was non-significant for FEV₁ ( P = 0.94), indicating consistent effects across reference conditions, while the effect on FEV₁/FVC was reference-dependent (P for subgroup difference <0.00001). Subgroup analysis by COPD status showed no significant differences for most outcomes. Combined training (aerobic plus resistance) yields more comprehensive and significant pulmonary function benefits in older sarcopenic patients than standalone aerobic or resistance training, particularly for core ventilation metrics and maximal inspiratory pressure.