BACKGROUND: The aim of this systematic review was to summarize the results of trials evaluating interventions for the reduction of sarcopenia in patients undergoing surgery. METHODS: Searches were conducted using the Cochrane Central Register of Controlled Trials, Medline and Embase. RCTs evaluating exercise, dietary or pharmacological interventions to address sarcopenia in the perioperative period were included. Treatment effect estimates were expressed as standardized mean differences (MDs) with confidence intervals, and heterogeneity was expressed as I2 values. RESULTS: Seventy trials including 3,402 participants were selected for the data synthesis. Exercise interventions significantly increased muscle mass (MD 0.62, 95% CI 0.34 to 0.90; p < 0.001), muscle strength (MD 0.55, 0.39 to 0.71; p < 0.001), measures of gait speed (MD 0.42, 0.05 to 0.79; p = 0.03), and reduced time for completion of set exercises (MD -0.76, -1.12 to -0.40; p < 0.001) compared with controls. Subgroup analysis showed that interventions in the early postoperative period were more likely to have a positive effect on muscle mass (MD 0.71, 0.35 to 1.07; p < 0.001) and timed tests (MD -0.70, -1.10 to -0.30; p = 0.005) than preoperative interventions. Treatment effects on muscle mass (MD 0.09, -0.31 to 0.49; p = 0.66) and strength (MD 0.46, -0.01 to 0.92; p = 0.05) were attenuated by the presence of cancer. Results of analyses restricted to nine trials at low risk of allocation concealment bias and fourteen trials at low risk of attrition bias were comparable to those of the primary analysis. Risk-of-bias assessment showed that most trials were at high risk of incomplete outcome and attrition bias, thus reducing the estimate of certainty of the evidence according to the GRADE assessment tool. CONCLUSION: Exercise interventions appear beneficial in reducing the impact of sarcopenia. Because of the high risk of bias and low certainty of the current evidence, large RCTs using standardized measures of muscle mass should be undertaken.

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