Sarcopenia is a condition involving loss of muscle mass and strength that can make walking and other daily activities more difficult. This study will compare a modified seven-form Yijinjing exercise program with resistance training in 240 adults aged 50 years or older with sarcopenia at six hospitals in Beijing. Yijinjing is a traditional Chinese exercise that combines movements, breathing and focused attention.
For the first 6 months, participants will be randomly assigned to Yijinjing or resistance training. Exercise is scheduled at least three times per week, with one supervised group session and two remotely supervised home sessions. Both groups will receive the same dietary counseling and health education. The main question is whether Yijinjing improves physical performance at 6 months by an amount that is not meaningfully worse than resistance training. Physical performance will be measured using the Short Physical Performance Battery, which includes balance, walking and repeated chair stands.
After the 6-month assessment, participants in the resistance training group will switch to standard-duration Yijinjing. Eligible participants originally assigned to Yijinjing will be randomly assigned again to standard-duration or longer-duration Yijinjing for another 6 months. Participants who are not eligible for this second random assignment may continue standard-duration Yijinjing when clinically appropriate. Assessments at baseline, 6 months and 12 months will examine muscle mass and strength, physical function, quality of life and other health measures. Exercise-related adverse events will be monitored throughout the 12-month intervention.
Adults aged 50 years or older, of either sex.
Confirmed sarcopenia with both low muscle mass and low handgrip strength according to the protocol. For ages 50-64: ASMI <7.6 kg/m² in men or <5.7 kg/m² in women, and grip strength <34 kg in men or <20 kg in women. For ages 65 or older: ASMI <7.0 kg/m² in men or <5.7 kg/m² in women, and grip strength <28 kg in men or <18 kg in women. ASMI is appendicular skeletal muscle mass measured by multifrequency bioelectrical impedance analysis divided by height squared.
Clinically stable, with no acute illness, infection, major surgery or hospitalization within the preceding 4 weeks.
Physician assessment confirms ability to tolerate moderate-intensity exercise and safely undertake Yijinjing and resistance training.
Severe cardiopulmonary disease, including unstable angina, myocardial infarction within the preceding 3 months, severe heart failure or severe ventilatory impairment.
Severe hepatic, renal or endocrine disease, including cirrhosis, renal failure, uncontrolled diabetes or severe thyroid dysfunction.
Parkinson disease, residual deficits after stroke, severe joint deformity or persistent back or leg pain preventing completion of the prescribed exercise.
Severe cognitive decline, Alzheimer disease, uncontrolled psychiatric illness or severe depression preventing adequate cooperation.
Sequential
Modified Yijinjing Exercise
BehavioralModified seven-form traditional Chinese exercise adapted for adults with sarcopenia, combining movement, breathing and attention. Three sessions weekly: one supervised group session and two remotely supervised home sessions. Stage 1 sessions last 40-45 minutes including warm-up and cool-down; stage 2 standard-duration sessions last 40 minutes and extended-duration sessions progressively increase to 50-60 minutes, maximum 65 minutes. Target Borg RPE is 11-13 on the 6-20 scale. Duration and movement intensity are adjusted for tolerance and safety.
Progressive Resistance Training
BehavioralSix months of progressive resistance training at least three times weekly, approximately 40 minutes per session: 5 minutes of warm-up, 30 minutes of exercise and 5 minutes of cool-down. Five functional exercises target major muscle groups: wall squats, wall push-ups, forward lunges, reverse arm flexion/extension and supported heel raises. Each exercise is performed for two sets of 6-8 repetitions, with 1 minute of rest between sets. One session is supervised in person and two are remotely supervised at home each week. Exercise intensity and technique are adjusted for tolerance and safety. Participants switch to standard-duration modified Yijinjing after the 6-month assessment.
Dietary Counseling and Health Education
BehavioralProvided to all treatment pathways. Dietary advice targets total daily protein intake of 1.2-1.5 g/kg through ordinary food, using the lower of ideal or actual body weight. The study does not supply protein supplements. Three-day food diaries, including two weekdays and one non-working day, are reviewed at baseline, 6 months and 12 months with individualized advice. Standardized health education is delivered weekly for the first three weeks, approximately 30 minutes plus 5-10 minutes of questions per session, covering sarcopenia, nutrition, exercise safety and health management. Content and contact time are identical across groups.
Change From Baseline in Short Physical Performance Battery Total Score at 6 Months
The Short Physical Performance Battery (SPPB) assesses standing balance, 4-meter walking performance and five repeated chair stands. Total scores range from 0 to 12; higher scores indicate better physical performance. The primary endpoint is the 6-month total score minus the baseline total score. Noninferiority is concluded if the lower bound of the 95% confidence interval for the difference in change (Yijinjing minus resistance training) exceeds -0.5 points.
Appendicular Skeletal Muscle Mass Index
Appendicular skeletal muscle mass measured by multifrequency bioelectrical impedance analysis divided by height squared, expressed in kg/m².
Handgrip Strength
Maximum dominant-hand grip strength from two dynamometer measurements, expressed in kg.
Usual Walking Performance Over 6 Meters
Time required to walk 6 meters at usual pace, averaged over two trials.
Five-Repetition Chair Stand Performance
Performance on five repeated chair stands as a measure of lower-limb function.
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