Myostatin (MSTN) is regarded as a key factor influencing skeletal muscle strength and function, and elevated circulating levels of MSTN may be closely associated with age-related sarcopenia and frailty. Given the limitations of pharmacological interventions, exercise intervention may emerge as a potential non-pharmacological strategy to regulate MSTN concentration. Therefore, this study aims to systematically evaluate the effect of resistance training (RT) on serum MSTN levels in elderly individuals with sarcopenia/frailty using meta-analysis. In accordance with the PRISMA guidelines, a systematic search was conducted in Chinese and English databases, including PubMed, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure (CNKI), for relevant studies from database inception to November 2025. Two researchers independently performed literature screening, literature searching, data extraction, and assessed the risk of bias of included studies using the original Cochrane risk of bias tool (The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials). Only studies investigating the chronic effects of RT (intervention duration≥8 weeks) were included.Subsequently, to account for the statistical dependency arising from multiple effect sizes reported within single studies, a multilevel meta-analysis was conducted. Analyses were performed using R software (version 4.4.1) with the metafor package (version 4.8.0). The standardized mean difference (SMD) and its 95% confidence interval (95%CI) were calculated for serum MSTN levels. Subgroup analysis was performed based on participants' physical state (sarcopenia vs. frailty). A total of 9 studies (contributing 11 intervention arms, with a total sample size of n= 330) were included. The multilevel meta-analysis showed that RT reduced serum MSTN concentrations in frail/sarcopenic elderly individuals (SMD = -0.23 (95%CI: -0.44 to -0.01), p < 0.001), with negligible heterogeneity (I² = 0%). Subgroup analysis revealed a significant effect of RT in elderly individuals with sarcopenia (SMD = -0.35, 95%CI: -0.65 to -0.06, p < 0.05), but not in those with frailty (SMD = -0.08, 95%CI: -0.40 to 0.23, p = 0.599). The difference between subgroups was statistically significant (p < 0.05). Very low-certainty evidence from this meta-analysis suggests that RT may be associated with a reduction in serum MSTN concentrations in frail or sarcopenic older adults, with a more consistent effect observed in those with sarcopenia. These findings highlight the potential of RT as a non-pharmacological strategy, but further high-quality trials are needed to confirm its efficacy and establish optimal training parameters.
Chu et al. (Thu,) studied this question.