Effects of resistance training on balance-related physical performance in older adults with sarcopenic obesity: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND/OBJECTIVE: The objective of this systematic review was to synthesize findings by quantitatively examining the effects of resistance training on balance-related physical performance in older adults with sarcopenic obesity (SO). METHODS: Randomized controlled trials (RCTs) on standalone resistance training interventions for older adults aged 60 years and older with SO were included. Five electronic databases (CENTRAL, PubMed/MEDLINE, Academic Search Premier, CINAHL, and SPORTDiscus) were searched until 2 April 2026. The Physiotherapy Evidence Database and Grading of Recommendation Assessment, Development, and Evaluation were used for assessing the risk of bias (RoB) in studies and certainty of evidence (CoE), respectively. Random-effects models were employed for meta-analyses. RESULTS: Six RCTs (n = 221) were included. Overall, our pooled results with low heterogeneity showed that resistance training improved Timed Up and Go Test (TUGT) (-2.23 s, 95%CI -2.96 to -1.49 s, P < 0.00001, I 2  = 0%) and Short Physical Performance Battery (0.93, 95%CI 0.27 to 1.60, P = 0.006, I 2  = 0%) test performances. The adherence and attrition rates of the included RCTs were 81.0─97.6% and 6.7─27.3%, respectively. No serious adverse events were reported. All RCTs were rated as having low or moderate RoB, whereas the CoE for all outcomes ranged from "low" to "very low". CONCLUSION: Resistance training may be an effective and well-tolerated intervention for older adults with SO. Given low to very low CoE, more high-quality interventional studies with larger sample sizes are imperatively needed. PROTOCOL REGISTRATION NUMBER: PROSPERO CRD420251146059.