Background: Sarcopenia is a geriatric muscle disease characterized by the loss of muscle mass, strength, and physical function. To better reflect the unique characteristics of sarcopenia in Korean older adults, the Korean Working Group on Sarcopenia (KWGS) developed a diagnostic algorithm, including a new category of "functional sarcopenia." This study aimed to establish evidence-based exercise guidelines tailored to the KWGS framework.

Methods: A multidisciplinary expert committee conducted a systematic review of randomized controlled trials (RCTs) published between 2000 and 2024 to assess exercise interventions according exercise interventions by FITT (frequency, intensity, time, type) principles. Five key questions were developed, focusing on optimizing exercise modalities to improve muscle mass, strength, and physical performance in older adults with or without sarcopenia.

Results: A total of 42 RCTs met the inclusion criteria. Resistance training was most effective for improving muscle mass and strength, while combined resistance and aerobic exercise is most effective for enhancing physical function. The guideline recommends individualized exercise prescriptions based on sarcopenia subtypes and specific functional deficits, supported by evidence grades and levels.

Conclusion: This is the first Korean evidence-based exercise guideline developed within the KWGS algorithm, offering clinical and community practitioners specific, actionable strategies for preventing and managing sarcopenia. It supports tailored interventions using FITT principles aligned with individual goals and sarcopenia classification.