Nonlinear dose-response effects of exercise modalities on handgrip strength and functional mobility in middle-aged and older adults with sarcopenia: A Bayesian network meta-analysis.

Objective To examine the non-linear dose-response effects of different exercise modalities on handgrip strength and functional mobility in middle-aged and older adults with sarcopenia, and whether modality-dose combinations produce outcome-specific functional responses. Methods Cochrane Library, Web of Science, PubMed, Embase, and SPORTDiscus were searched through 5 February 2026 for eligible randomized controlled trials. Exercise interventions were standardized using metabolic equivalents. Bayesian model-based network meta-analysis was performed in R to model non-linear dose-response relationships for handgrip strength and functional mobility and compare modality-specific effects across dose ranges. Results Twenty-nine randomized controlled trials were included. Overall exercise dose showed an inverted U-shaped association with both outcomes. Handgrip strength improved from a dose of 140 metabolic equivalent-minutes, with the largest effect at 690 and an optimal range of 560–830 metabolic equivalent-minutes. Functional mobility showed a similar non-linear pattern, improving from 140 and peaking at 830. When disaggregated by modality, the largest effect for handgrip strength was observed with whole-body vibration at 280, and a stable peak for functional mobility occurred only under resistance training at 580 metabolic equivalent-minutes. Conclusions In middle-aged and older adults with sarcopenia, exercise prescription should consider both dose and modality rather than total volume alone. Handgrip strength and functional mobility may require different modality-dose strategies, supporting outcome-targeted exercise planning. For geriatric nursing practice, these findings may help nurses guide individualized exercise recommendations according to patients’ primary functional limitations, such as reduced grip strength or impaired mobility. © 2026 Elsevier Inc.