Habitual physical activity and sarcopenia: a systematic review and meta-analysis of prospective cohort studies

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported in abstract; both CIs exclude RR = 1.0, indicating statistical significance at conventional thresholds

• Effect Size: Pooled RR = 0.55 (high HPA vs. low HPA); Pooled RR = 0.73 (moderate HPA vs. low HPA)

• Primary Outcome: Incident sarcopenia: high habitual physical activity vs. low habitual physical activity

• Nnt Or Sensitivity: NNT not calculable from abstract data alone (baseline incidence rate not reported); the 45% relative risk reduction for high HPA is clinically substantial, but absolute risk reduction requires population-specific incidence data. Subgroup consistency by gender and PA guideline compliance reported but specific subgroup RRs not provided in abstract.

• Confidence Interval: High HPA: 95% CI = 0.44–0.67; Moderate HPA: 95% CI = 0.50–0.96

Clinical Application

Habitual physical activity promotion is a low-cost, widely feasible intervention with an established safety profile across age groups. The finding that even moderate HPA confers significant protection (RR 0.73) supports a graduated, accessible approach to PA prescription. However, optimal PA type, intensity, frequency, and duration cannot be determined from this meta-analysis due to heterogeneity in PA measurement across included studies. Sarcopenia is increasingly recognised as a significant public health burden in Australia's ageing population. The RACGP supports physical activity promotion for healthy ageing, and the Australian Physical Activity and Sedentary Behaviour Guidelines recommend ≥150 minutes of moderate-intensity aerobic activity per week for adults, consistent with the international PA guidelines used as a subgroup stratifier in this review. Resistance training, specifically recommended for muscle preservation, is not separately analysed in this meta-analysis. From a PBS perspective, no pharmacological agents are currently listed for sarcopenia prevention in Australia, reinforcing the primacy of lifestyle interventions. The TGA has not approved any sarcopenia-specific pharmacotherapy, making evidence-based PA prescription the cornerstone of prevention. Clinicians should note that sarcopenia diagnostic thresholds differ between AWGS (Asian Working Group for Sarcopenia) and EWGSOP2 criteria, and the predominance of Asian cohort data in this review may affect threshold applicability in non-Asian Australian populations. Community-dwelling adults, particularly older adults (≥60 years) at risk of sarcopenia. Findings are most directly applicable to populations represented in the included cohorts, which appear to include significant Asian populations given the CNKI database inclusion. Applicability to younger adults or those with established sarcopenia is not addressed.

Abstract

BACKGROUND: Habitual physical activity (HPA) has been associated with a lower risk of sarcopenia by enhancing skeletal muscle protein synthesis and suppressing systemic inflammation. However, the evidence for a long-term protective association remains inconclusive. Therefore, we conducted a systematic review and meta-analysis to quantify the association between HPA and sarcopenia. METHODS: We searched PubMed, the Cochrane Library, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and the China National Knowledge Infrastructure for prospective cohort studies on the relationship between physical activity (PA) and sarcopenia. We selected English and Chinese-language literature published before 6 October 2025, and assessed study quality using the Newcastle-Ottawa Scale. Data were statistically synthesised by calculating pooled relative risks (RRs) and 95% confidence intervals (CIs) using a random-effects model with the generic inverse-variance method. RESULTS: This meta-analysis included nine prospective cohort studies involving 21 265 participants. High levels of HPA were associated with a significantly lower risk of sarcopenia compared to the low levels (RR = 0.55; 95% CI = 0.44-0.67). This protective association remained consistent in subgroup analyses stratified by gender and by compliance with international PA guidelines. Furthermore, moderate HPA was also associated with a reduced risk compared to low HPA levels (RR = 0.73; 95% CI = 0.50-0.96). CONCLUSIONS: Our analysis indicates that moderate to high levels of HPA are independently associated with a lower risk of sarcopenia, serving as a significant protective factor. However, given the methodological heterogeneity in PA measurement, further high-quality prospective studies are needed to clarify the optimal PA dose while accounting for potential reverse causality. REGISTRATION: PROSPERO: CRD420251162529.

References

1. 1.Dai, D., Xie, F., Cui, J., Wang, S., Cai, J., Wang, G., & Yao, F. (2026). Habitual physical activity and sarcopenia: a systematic review and meta-analysis of prospective cohort studies. Journal of Global Health, 16, 04095. https://doi.org/10.7189/jogh.16.04095