Abstract
<title>Abstract</title> <p>Objective Muscle loss frequently occurs in patients with cancer and age-related chronic degenerative diseases. Acute infection-induced inflammatory stress further worsens the prognosis for these individuals. Considering the uncertainty surrounding the effectiveness of exercise and anti-inflammatory diets, this study seeks to assess the impact of four distinct interventions on inflammatory status and sarcopenia-related indices in hospitalized older patients with sarcopenia who are experiencing acute infections. Methods A prospective, parallel-group randomized controlled trial was conducted involving 1,800 hospitalized patients with acute infections. Among these, 200 older sarcopenic patients were screened and subsequently randomized (1:1:1:1) into four groups for a 12-week intervention: Anti-inflammatory Diet (AID), Exercise (Ex), Exercise combined with Anti-inflammatory Diet (Ex + AID), and Exercise combined with High-Protein Diet (Ex + HPD). The primary outcomes included changes (Δ) from baseline to follow-up in inflammatory status, muscle mass, and muscle function, which was assessed through grip strength, gait speed, and the SARC-F score. Results A total of 193 patients completed the trial. Significant inter-group differences were noted in the changes (Δ) of seven indicators: monocyte percentage, monocyte count, eosinophil count, mean corpuscular volume (MCV), Platelet-to-Albumin Ratio (PAR), Monocyte-to-Albumin Ratio Index (MARI), and SARC-F score. Pairwise comparisons indicated that the Ex-group significantly surpassed the AID group in enhancing Δmonocytes and ΔMARI. The Ex + HPD group exhibited significant differences in Δeosinophil count when compared to the Ex-group. Furthermore, the Ex + AID group demonstrated greater improvement in ΔPAR relative to both the Ex + HPD and AID groups. In terms of the ΔSARC-F score, all three exercise-inclusive groups (Ex, Ex + AID, and Ex + HPD) significantly outperformed the AID group (P < 0.001). Conclusion Synergistic interventions that integrate diet and exercise demonstrate greater efficacy than monotherapy. Exercise functions as the primary intervention for modulating inflammation and reversing frailty linked to sarcopenia. This study offers essential evidence-based support for clinical interventions targeting older patients with sarcopenia.</p>