PROSPERO

International prospective register of systematic reviews

Citation

Graziela Tavares, Anne Tiedemann, Maria Gottlieb, Simon Rosenbaum, Catherine Sherrington. The effect of
physical activity on muscle mass in older people: a systematic review of randomised controlled trials.
PROSPERO 2014 CRD42014014513 Available from:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42014014513

Review question
1) What is the effect of physical activity on muscle mass in people aged 60 years and older?
2) Does resistance training have a greater impact on muscle mass than other forms of physical activity in
people aged 60 years and older?
3) What is the effect of physical activity on muscle mass in people aged 60 years and older with sarcopenia,
as defined by the European Working Group on Sarcopenia in Older People?
4) What is the effect of physical activity on muscle strength in people aged 60 years and older with
sarcopenia, as defined by the European Working Group on Sarcopenia in Older People?
5) What is the effect of physical activity on physical mobility in people aged 60 years and older with
sarcopenia, as defined by the European Working Group on Sarcopenia in Older People?
6) Is there evidence of a differential impact of physical activity on muscle mass in people aged 60 years and
older on the basis of program or population characteristics?

Searches
We will search the following electronic bibliographic databases: MEDLINE, EMBASE, Cochrane Central
Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature
(CINAHL), SportDiscus, the Physiotherapy Evidence Database (PEDro) and Lilacs.
The search strategy will include terms relating to physical activity interventions, combined with terms
describing the outcome of interest (muscle mass) and terms describing randomised trials. The search
strategy for MEDLINE is supplied with this registration. The search terms will be adapted for use with other
bibliographic databases. We will not have language restrictions. There will be no restrictions on date of
publication.

Search strategy
http://www.crd.york.ac.uk/PROSPEROFILES/14513_STRATEGY_20140927.pdf

Types of study to be included

We will include randomised controlled trials and quasi randomised controlled trials.

Condition or domain being studied

We will include studies recruiting participants aged 60 years and older with and without a formal diagnosis of
sarcopenia. Age-associated muscle loss is a significant clinical issue facing older adults. Age-associated
muscle loss results in a loss of strength and functional ability and is often accompanied by an increase in fat
mass. Whilst the causes of sarcopenia are multifactorial, physical activity has been identified as a potential
strategy to slow the loss of skeletal muscle and function, with evidence suggesting that resistance training
may be the most effective modality of physical activity.
The term sarcopenia was first used by Rosemberg in 1989, to describe loss of muscle mass. Recently the
European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition
and consensus diagnostic criteria for age-related sarcopenia. For the clinical diagnosis of sarcopenia the
older person must have the presence of both low muscle mass and low muscle function (strength or
performance). Thus, diagnosis requires documentation of criterion low muscle mass, plus documentation of
either criterion low muscle strength or criterion low physical performance.

Participants/population
Inclusion: trials that included people aged 60 years or older with and without a diagnosis of sarcopenia.
Sarcopenia diagnosis will be defined by the cut-points for average muscle mass, hand grip strength and gait
speed in accordance the European Consensus of Sarcopenia (2010).
Exclusion criteria: trials in which participants had an average age of less than 60 years.

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Intervention(s), exposure(s)
The interventions to be included will be exercise or physical activity more broadly. Physical activity
represents activity where energy expenditure is increased above resting levels, e.g. walking, housework and
daily chores. Exercise is a sub-set of physical activity and refers to a structured, formal and premeditated
form of physical activity. Examples include attending a gymnasium, group exercise training, resistance
training, running, swimming, jogging etc..
Resistance training is defined a type of strength-building exercise program that requires the body muscle to
exert a force against some form of resistance, such as weight, stretch bands, water, or immovable objects.
Resistance exercise is a combination of static and dynamic contractions involving shortening and
lengthening of skeletal muscles.
Group exercise sessions including dancing, physical yoga, sports and games will also be included.
Interventions where the exercise component makes up less than approximately 50% of the total intervention
will be excluded. Laughing or chanting based yoga interventions will be excluded, as will dietary interventions
with a brief exercise component (equivalent to less than 50% of the total intervention).
We will include studies with a minimum intervention length of 4 weeks.

Comparator(s)/control
Usual care, wait-list or no-treatment controls will be included. Trials incorporating a placebo-based physical
activity program (sham exercises) will also be included. Trials that compare resistance training to another
form of physical activity intervention will also be included.
We will include trials that compare:
1) Physical activity intervention versus non- physical activity control intervention;
2) Resistance training versus another type of physical activity;
We will exclude trials that compare:
1) Physical activity intervention versus drug therapy;
2) Physical activity intervention versus nutritional supplementation;
3) Two types of physical activity where one is not resistance training

Context
Inclusion:
No restriction will be placed on the setting or context of the included studies. Studies utilising hospital
inpatient services, outpatient programs, community-based facilities, home-based programs and other
settings will all be included. The process of referral to the study and location where the intervention was
delivered will be recorded and reported accordingly within the review.
Exclusion:
-Studies that are not randomised controlled trials or quasi randomised controlled trials
-Studies with interventions of less than 4 weeks duration

Main outcome(s)
Muscle mass.
Measures of effect
Pre and post intervention scores will be utilised where available. If baseline values are not reported, groups
will be compared at follow-up. If multiple follow-up data points are provided, the scores obtained as close to
the completion of the intervention as possible will be utilised.
Trials that include muscle mass measured with the following methods will be included: Dual energy X-ray
absorptiometry (DEXA), Computed tomography (CT), BIA Magnetic resonance imaging (MRI).
We will exclude trials that measured muscle mass with anthropometric measures (calculations based on
circumferences and skin fold thickness).

Additional outcome(s)
- Muscle strength.
- Physical mobility.
Measures of effect
- Muscle strength.
Trials that include muscle strength measured with the following methods will be included: dynamometry of
the lower limb muscles or 1 repetition maximum.

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Trials that measured muscle strength with peak expiratory flow will be excluded.
- Physical mobility.
Trials that include physical mobility measures with the following methods will be included: gait speed,
mobility scales, other mobility tests.

Data extraction (selection and coding)

Two reviewers will independently screen titles and abstracts and then, if necessary, the full text of studies
identified by the search strategy using an electronic screening form designed to assess eligibility criteria. A
reason for exclusion will be provided for the exclusion of all full-text studies screened.
Data will be extracted independently by the two reviewers. Data will be extracted according to the PRISMA
Statement ensuring that all checklist items are satisfied.
The following data will be extracted:
• Author, year of publication, country
• Study design
• Sample characteristics (sample size, age and sex of participants)
• Intervention description (country, type, setting, who implemented the intervention, level of supervision)
• Intervention characteristics (session length and frequency, physical activity intensity, overall program
duration)
• Outcome data collected at baseline and at first follow-up, or only at follow-up will include:
- muscle mass;
- muscle strength;
- physical mobility.
Both the electronic screening form and the data extraction form will be specially created for the review and
will be piloted before use. All disagreements regarding the selection of included studies or data extraction will
be solved by discussion and, if necessary, arbitration will occur with a third reviewer.
We will include a PRISMA study flow diagram to document the screening process.
Authors of the included studies will be contacted if the study reports are incomplete or missing data. If the
author does not reply within two weeks, a second email will be sent as a reminder. If, at the end of the fourth
week, a reply has not been received, we will use the available data.

Risk of bias (quality) assessment

The Physiotherapy Evidence Database (PEDro) scale will be used to rate the methodological quality of
included trials.

Strategy for data synthesis

For each included trial, we will calculate treatment effects measured by continuous variables using
standardised mean differences (SMD) with 95% confidence intervals (CI), for either between-group
differences in point estimates at the follow-up time points, or for between-group differences in change
scores, according to available data. Effect sizes will be categorized as small (0.2), medium (0.5) or larger
(0.8 or greater). Treatment effects measured by dichotomous variables will be assessed using risk rations
and 95% CIs.
If sufficient data are available and the studies are not overly heterogeneous, meta-analyses will be
conducted using random effects models. Statistical heterogeneity will be determined by visual inspection of
the forest plots and with consideration of the I-squared and Chi-squared tests. Clinical heterogeneity will be
determined by consensus between the investigators on the basis of collective experience in the field.

Analysis of subgroups or subsets

Exploratory meta-regression analyses will be undertaken to establish whether there is evidence of a
differential impact of physical activity on muscle mass, on the basis of intervention or population
characteristics, if there are sufficient trials.

Contact details for further information

Miss Tavares
gtavares@geortgeinstitute.org.au

Organisational affiliation of the review

The George Institute for Global Health, Sydney Medical School, The University of Sydney and Pontifícia
Universidade Católica do Rio Grande do Sul (PUCRS) – Post Graduate Programm in Biomedical

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Gerontology
http://www.georgeinstitute.org/ and http://www.pucrs.br/igg/

Review team members and their organisational affiliations

Miss Graziela Tavares. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) and The George
Institute for Global Health, Sydney Medical School, The University of Sydney
Dr Anne Tiedemann. The George Institute for Global Health, Sydney Medical School, The University of
Sydney.
Dr Maria Gottlieb. Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
Dr Simon Rosenbaum. The University of New South Wales, School of Psychiatry; The George Institute for
Global Health, Sydney Medical School, The University of Sydney
Professor Catherine Sherrington. The George Institute for Global Health, Sydney Medical School, The
University of Sydney.

Anticipated or actual start date

30 September 2014

Anticipated completion date

16 February 2015

Funding sources/sponsors
Professor Catherine Sherrington is funded by a Fellowship from the National Health and Medical Research
Council of Australia.
Graziela Morgana Silva Tavares has been awarded a Post Graduate Scholarship from the CAPES
Foundation, an agency under the Ministry of Education of Brazil, process number: BEX 3113/14-0.

Conflicts of interest
None known

Language
English

Country
Australia, Brazil

Stage of review
Review Ongoing

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Aged; Exercise; Humans; Muscles

Date of registration in PROSPERO

27 October 2014

Date of first submission

Details of any existing review of the same topic by the same authors
None known.

Stage of review at time of this submission

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Stage Started Completed

Preliminary searches Yes No
Piloting of the study selection process Yes No

Formal screening of search results against eligibility criteria Yes No

Data extraction No No
Risk of bias (quality) assessment No No

Data analysis No No

The record owner confirms that the information they have supplied for this submission is accurate and
complete and they understand that deliberate provision of inaccurate information or omission of data may be
construed as scientific misconduct.
The record owner confirms that they will update the status of the review when it is completed and will add
publication details in due course.

Versions
27 October 2014

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