Strength training plus whey protein in sarcopenia: real but modest

Design

systematic review and meta-analysis of 7 randomised controlled trials, GRADE-assessed

Population

472 older people with sarcopenia

Primary outcome

body composition and physical performance with strength training plus whey protein or HMB

Effect

fat-free mass ES 0.39; handgrip ES 1.38 overall and 0.49 for whey plus training; no handgrip benefit with HMB

Seven randomised trials with 472 older people with sarcopenia were pooled to test strength training combined with either whey protein or beta-hydroxy-beta-methylbutyrate, against training or supplementation alone. Effect sizes are reported as Hedges' g.

Combined training and supplementation improved fat-free mass (0.39), maximal isometric handgrip strength (1.38), chair stand test (0.33) and six-minute walk (0.33). In subgroups, training plus supplement beat supplement alone for handgrip, and whey protein with training improved handgrip (0.49) while HMB with training did not. Fat mass and knee extension strength showed no difference between combined treatment and either component alone. The authors grade the evidence as promising rather than definitive - seven trials, small samples, moderate to high risk of bias and inconsistent subgroups.

The practical reading is that the training is doing the work and the protein is supporting it. For a patient with sarcopenia, that ordering matters: a supplement without resistance exercise has little to offer, and the common clinical pattern - prescribing a protein powder because exercise is difficult to arrange - gets the priority backwards. Where you can only deliver one, deliver the training. Where both are possible, whey protein has the better supporting data than HMB, and in Indian practice it is worth noting that adequate protein can usually be achieved from food, with cost and lactose tolerance both arguing against a supplement as the default.

• Prescribe supervised resistance training first; supplementation supports it rather than substitutes
• Prefer whey protein over HMB on current evidence, where a supplement is used
• Aim protein intake through food first, and reserve supplements for those who cannot reach it
• Measure handgrip and chair stand at baseline and at 12 weeks to see whether anything changed
• Do not expect fat mass or knee extension strength to shift on this evidence

Why it matters

It separates the component that works from the one that is easier to prescribe.

Don't overread it

Seven small trials with moderate-to-high risk of bias; improvements were in performance tests, not in function, falls or independence.

The statistics, in plain English

A Hedges' g of 0.33 to 0.39 is a small effect, roughly the difference you would need a measured test to detect; the handgrip figure of 1.38 is much larger and, coming from few small trials, likely inflated. Effect sizes on performance tests do not translate directly into independence or falls, which is what patients care about and what these trials were too small to measure. Moderate to high risk of bias across seven trials means the direction is more trustworthy than any of the numbers.

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