ABSTRACT Objective To compare the relative effects of exercise and nutritional interventions on muscle strength, physical performance, muscle mass, and body composition‐related outcomes in older adults with sarcopenia or pre‐sarcopenia using network meta‐analysis. Methods PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to August 8, 2026. Randomized controlled trials (RCTs) comparing exercise, nutritional, or combined interventions with control strategies in older adults with sarcopenia or pre‐sarcopenia were included. A frequentist network meta‐analysis compared four intervention nodes (Control, Exercise, Nutrition, and Combined). Risk of bias was assessed with RoB 2, and certainty of evidence with CINeMA. Results Sixty‐five reports representing 57 RCTs and 6017 participants were included. Compared with Control, Combined, Nutrition, and Exercise improved handgrip strength, with the largest estimate for Combined (mean difference [MD] 4.29 kg, 95% confidence interval [CI], 2.50–6.07; p ‐score 0.877). For physical function, Exercise improved the Timed Up and Go test (TUG; MD 1.19 s, 95% CI, 0.72–1.66) and ranked highly for gait speed (MD 0.11 m/s, 95% CI, 0.06–0.17). For appendicular skeletal muscle mass index (ASMI), Combined, Exercise, and Nutrition increased ASMI, with Combined ranked highest (MD 0.32 kg/m 2 , 95% CI, 0.17–0.48; p ‐score 0.831). Overall certainty of evidence was limited according to CINeMA. Conclusions Exercise and nutritional strategies showed different relative effects across clinical outcomes in older adults with sarcopenia or pre‐sarcopenia. Combined exercise and nutrition ranked more favorably for selected muscle‐related outcomes, whereas exercise showed a more consistent pattern of benefit for physical performance. These findings require confirmation in high‐quality trials because the overall certainty of evidence was limited.
ABSTRACT Aim This study aims to examine the multidimensional nature of well‐being in old age by investigating the structural interrelations among joy of life, psychological well‐being, and life satisfaction in individuals aged 55 and over. Method Designed within a relational survey model, the research was conducted with 389 participants (207 males, 182 females) selected through convenience sampling (59.9% face‐to‐face interviews, 40.1% online surveys). Data were collected using a Personal Information Form, the Joy of Life in Old Age Scale, the Psychological Well‐Being Scale, and the Life Satisfaction Scale. Construct validity was evaluated using Confirmatory Factor Analysis (CFA), confirming acceptable model fit across scales. The structural relationships were examined using covariate‐adjusted multiple linear regression and controlled Bootstrap mediation models (5000 resamples, 95% CI). Results After statistically controlling for sociodemographic covariates, psychological well‐being remained the single strongest direct predictor of life satisfaction ( β = 0.395, p < 0.001). In sociodemographic analyses, a paradoxical finding revealed that individuals with chronic illnesses and lower education levels reported higher joy of life scores. Controlled mediation analyses confirmed that psychological well‐being plays a robust partial mediating role in the relationship between external support dimensions (social and institutional support) and life satisfaction. Conclusion These results demonstrate that external support provided to the surveyed older adults is indirectly associated with life satisfaction primarily by nourishing eudaimonic psychological well‐being (autonomy and purpose in life), independently of sociodemographic variations. This highlights the necessity of holistic social policies targeting psychological empowerment alongside resource distribution in aging populations.
ABSTRACT Objective To systematically evaluate the effects of mind–body exercise (MBE) on cognitive function and peripheral blood brain‐derived neurotrophic factor (BDNF) levels in older adults with mild cognitive impairment (MCI), and to explore its intervention effects and potential biological mechanisms. Methods PubMed, Web of Science, EMBASE, and the Cochrane Library were searched from database inception to March 2026 for randomized controlled trials (RCTs) investigating various MBE interventions, including Tai Chi, Baduanjin, yoga, and mindfulness/meditation, in older adults with MCI. The primary outcomes included cognitive function (global cognitive function, verbal fluency, executive function, episodic memory, short‐term memory, working memory, and processing speed and attention) and peripheral blood BDNF levels. Effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs) and pooled using fixed‐ or random‐effects models according to heterogeneity. Sensitivity analyses and funnel plots were used to assess robustness and publication bias. Results Seventeen randomized controlled trials involving 1251 participants were included. MBE significantly improved global cognitive function (SMD = 0.82, 95% CI: 0.55 to 1.09, p < 0.001), verbal fluency (SMD = 0.58, 95% CI: 0.25 to 0.91, p = 0.001), executive function (SMD = 0.39, 95% CI: 0.12 to 0.67, p = 0.005), episodic memory (SMD = 0.59, 95% CI: 0.26 to 0.92, p < 0.001), and short‐term memory (SMD = 0.54, 95% CI: 0.27 to 0.81, p < 0.001) in older adults with MCI. Working memory showed a potential improvement, but the result was not robust in sensitivity analysis. No significant effects were observed for processing speed/attention (SMD = 0.12; 95% CI: −0.04 to 0.28; p = 0.131) or peripheral blood BDNF (SMD = 0.89; 95% CI: −0.12 to 1.89; p = 0.085). Subgroup analyses suggested greater benefits for Tai Chi–based interventions and for verbal fluency when intervention duration exceeded 12 weeks. Conclusions Mind–body exercise is beneficial for improving global cognitive function, verbal fluency, executive function, episodic memory, and short‐term memory in older adults with MCI; however, evidence remains insufficient regarding its effects on processing speed and attention and peripheral blood BDNF levels. Tai Chi‐based mind–body exercise and longer intervention durations may yield greater benefits. These findings support the use of mind–body exercise as an important adjunctive strategy for comprehensive intervention in older adults with MCI and provide a reference for optimizing exercise‐based intervention programs in clinical and practical settings.
ABSTRACT Aim The benefit of mechanical thrombectomy (MT) for acute ischemic stroke in patients with pre‐stroke moderate‐to‐severe disability is difficult to evaluate using the modified Rankin Scale (mRS) alone. We developed and evaluated the SMILE‐Stroke score as a patient‐centered outcome measure. Methods We conducted a retrospective cohort study of 31 patients with pre‐stroke mRS scores of 3–5 who underwent MT. The 10‐point SMILE‐Stroke score, comprising Speech, Mobility, Ingestion, Lavatory, and Engagement domains, was assessed at discharge; a score ≥ 4 was prespecified as favorable. Interrater reliability, convergent validity with the Barthel Index, associations with discharge disposition and mRS, and pre‐stroke SMILE‐Stroke scores were evaluated. Results Twelve patients (38.7%) achieved a favorable SMILE‐Stroke outcome. Interrater reliability was excellent for the total score (single‐rater intraclass correlation coefficient = 0.957) and dichotomized outcome (Fleiss' κ = 0.863). The score correlated strongly with the discharge Barthel Index (Spearman's ρ = 0.86, p < 0.001) and showed a graded association with discharge disposition (Kruskal–Wallis p = 0.0012). For distinguishing discharge to home/original residence or rehabilitation hospital from long‐term care hospital or death, the SMILE‐Stroke score yielded an AUC of 0.82. Notably, 6 of 19 patients (31.6%) with 90‐day mRS scores of 4–5 achieved a favorable SMILE‐Stroke outcome. Conclusions The SMILE‐Stroke score was feasible, reproducible, and associated with established functional and discharge outcomes in selected MT‐treated patients with pre‐stroke disability. It may complement the mRS by identifying preserved or regained patient‐centered functional domains within poor mRS categories.
