In sarcopenia, it is the training that carries the supplement

Design

Systematic review and meta-analysis of randomised trials with GRADE and RoB 2, PROSPERO registered, search to March 2025

Population

472 older people with sarcopenia across 7 randomised trials

Primary outcome

Body composition, physical performance and biomarkers

Effect

Fat-free mass effect size 0.39, handgrip 1.38, chair stand 0.33, six-minute walk 0.33; whey plus training handgrip 0.49; no significant effect from beta-hydroxy-beta-methylbutyrate plus training

Seven randomised trials with 472 older people with sarcopenia were pooled to separate two things earlier meta-analyses had mixed: strength training with whey protein, and strength training with beta-hydroxy-beta-methylbutyrate.

Across all trials, the combination improved fat-free mass (effect size 0.39), maximal isometric handgrip strength (1.38), the chair stand test (0.33) and the six-minute walk (0.33). The subgroup analyses are where the useful detail sits. Training plus supplementation beat supplementation alone for handgrip strength. Whey protein combined with training improved handgrip (0.49); beta-hydroxy-beta-methylbutyrate combined with training did not produce a significant improvement. Fat mass and knee extension strength did not differ between training with supplement and training alone.

Read together, that says the training is doing the work and the protein is helping it, while the more expensive supplement has not earned its place. The authors are explicit that seven small trials with moderate to high risk of bias make this promising rather than settled, and the internal inconsistency - an overall handgrip effect size of 1.38 against 0.49 in the whey subgroup - is a sign that one or two trials are dominating the pooled figure. For an Indian outpatient conversation this still resolves the practical question: prioritise supervised resistance training and adequate protein, and do not let a supplement budget displace either.

• Prescribe supervised resistance training first; supplementation alone underperformed the combination.
• Use whey or an equivalent protein source rather than beta-hydroxy-beta-methylbutyrate, which showed no clear added effect.
• Measure handgrip strength and the chair stand test at baseline so change is visible.
• Do not expect fat mass or knee extension strength to move; neither did.
• Treat the pooled effect sizes cautiously - seven small trials with moderate to high risk of bias.

The statistics, in plain English

Hedges g effect sizes of about 0.3 to 0.5 are small to moderate and clinically plausible for these outcomes; the overall handgrip figure of 1.38 is implausibly large for this intervention and almost certainly reflects one or two outlying trials rather than a real average. With 472 participants across seven trials, subgroup analyses contain only a handful of studies each, so the absence of an effect for beta-hydroxy-beta-methylbutyrate means not demonstrated rather than disproved. Moderate to high risk of bias applies throughout.

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