BACKGROUND: Sarcopenia is closely associated with a poor quality of life and mortality, and its prevention and treatment represent a critical area of research. Resistance training is an effective treatment for older adults with sarcopenia. However, they often face challenges when receiving traditional rehabilitation treatments at hospitals. OBJECTIVE: We aimed to compare the effects of a digital rehabilitation program with those of traditional therapist-supervised rehabilitation training on older adults with sarcopenia. METHODS: In total, 58 older adults with sarcopenia were recruited offline and randomized (1:1) into 2 groups: the telerehabilitation group (TRG, n = 29, 50%) and the in-person rehabilitation group (IRG, n = 29, 50%). Both groups underwent 4-week resistance training targeting 6 major muscle groups. The TRG received exercise guidance via a mobile app, while the IRG received in-person training from a therapist. Offline assessments of body composition, grip strength, and balance using the 30-Second Arm Curl Test (30SACT), 30-Second Sitting-to-Rising Test (30SSRT), quadriceps femoris extension peak torque (EPT) and extension total power (ETP), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), 6-Minute Walk Test (6MWT), and Instrumental Activities of Daily Living (IADL) scale, were conducted before and after the intervention. RESULTS: Of the 58 patients, 51 (88%; TRG: n = 24, 47%; IRG: n = 27, 53%) completed the trial. After 4 weeks of intervention, the mean grip strength increased from 18.10 (SD 5.56) to 19.92 (SD 5.90) kg in the TRG (p = 0.02) and from 18.59 (SD 5.95) to 19.59 (SD 6.11) kg in the IRG (p = 0.01). The 30SACT and 30SSRT scores increased from 12.48 (SD 2.68) to 14.94 (SD 3.68) times (p = 0.01) and from 15.16 (SD 7.23) to 16.58 (SD 8.42) times (p = 0.045), respectively, in the TRG and from 12.25 (SD 4.19) to 14.68 (SD 4.36) times (p = 0.003) and from 14.31 (SD 4.04) to 16.25 (SD 4.91) times (p = 0.01), respectively, in the IRG. The quadriceps femoris EPT increased from 26.19 (SD 10.26) to 35.00 (SD 13.74) Nm (p = 0.004) in the TRG and from 26.95 (SD 11.81) to 32.74 (SD 12.33) Nm (p = 0.003) in the IRG. The BBS scores significantly improved in both groups (p < 0.0001), with the mean TRG score increasing by 3.19 (SD 2.86) points and the mean IRG score by 3.06 (SD 2.44) points. Neither group exhibited significant within-group changes on the TUGT or the 6MWT. Both groups reported significant improvements in the IADL (TRG: p = 0.04; IRG: p = 0.02). Between-group comparisons revealed no significant differences in changes in all indicators. CONCLUSIONS: A 4-week remote resistance training program is effective in improving strength, balance, and the IADL in older adults with sarcopenia, with effects comparable to rehabilitation supervised by a physical therapist. Telerehabilitation may be a convenient and effective alternative for older adults with sarcopenia who have limited access to rehabilitation resources. TRIAL REGISTRATION: ChiCTR 2300071648; https://www.chictr.org.cn/showprojEN.html?proj=196313.

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