Effects of Aquatic Exercise in Older Adults With Sarcopenia:A Randomized Trial

Sarcopenia is a geriatric syndrome characterized by age-related loss of skeletal muscle mass, strength, and physical performance, leading to increased risk of falls, functional decline, and reduced quality of life. Exercise interventions, particularly resistance training, are effective in managing sarcopenia; however, land-based exercises may be challenging for older adults due to balance impairments, joint problems, and fear of falling. Pool-based exercise programs may offer a safe and feasible alternative, as water buoyancy reduces joint loading while providing resistance to support muscle strengthening. Despite these potential benefits, evidence regarding the effects of aquatic exercise in individuals with sarcopenia remains limited, especially in Türkiye. This study aims to evaluate the effects of a 6-week supervised pool-based exercise program on muscle strength, muscle morphology, physical performance, mood, and quality of life in individuals aged 65 years and older with sarcopenia. Sarcopenia will be identified using the Sonographic Thigh Adjustment Ratio (STAR), based on ultrasound measurements of anterior thigh muscle thickness. In addition, appendicular skeletal muscle mass will be assessed using bioelectrical impedance analysis (ASM/height²). Outcome measures will include ultrasound-based muscle thickness, STAR, muscle strength, functional performance tests, depressive symptoms, and health-related quality of life. Assessments will be performed at baseline, immediately after the intervention, and at 1-month follow-up.

Inclusion Criteria: 1. Age ≥65 years 2. Diagnosis of "definite sarcopenia" according to the ISarcoPRM diagnostic algorithm 3. Not receiving nutritional supplementation and not requiring nutritional support according to the Mini Nutritional Assessment (MNA) 4. Sufficient cognitive ability to understand and follow instructions, including study-related questions and the home exercise program 5. Voluntary participation in the study 6. Ability to ambulate independently (assistive devices such as a cane are allowed; however, fully dependent individuals will be excluded) Exclusion Criteria: 1. Inability to complete assessment tests and questionnaires 2. Presence of severe systemic disease that may contraindicate exercise 3. Severe visual or hearing impairment 4. Presence of a cardiac pacemaker 5. Severe cardiopulmonary disease 6. Uncontrolled hypertension 7. Uncontrolled diabetes mellitus 8. Receiving nutritional supplementation 9. Severe anemia 10. Conditions contraindicating hydrotherapy, including aquaphobia (fear of water), behavioral disorders, dyspnea at rest, urinary or fecal incontinence, known chlorine allergy, open wounds, acute systemic illness, epilepsy, tracheostomy, indwelling drainage devices, and immunodeficiency