Background <p>Digital health exercise interventions are emerging as scalable solutions for sarcopenia in older adults, but their efficacy remains unclear.</p> Main body <p>This systematic review and meta-analysis evaluated their effects on muscle strength, mass, and physical performance in older adults with possible, confirmed, or severe sarcopenia. Eleven databases were searched up to 1st October 2025 for randomized and controlled clinical trials. Sixteen studies (<i>n</i> = 1,607 participants) were included. Meta-analysis revealed that, overall, digital interventions showed no significant benefit on appendicular skeletal muscle mass index (MD = 0.16&#xa0;kg/m², 95% CI [-0.03, 0.36]), the timed up-and-go test (SMD=-0.02, 95% CI [-0.40, 0.37]), or gait speed (SMD = 0.06, 95% CI [-0.44, 0.56]) compared to control conditions. Crucially, subgroup analyses revealed significant differential effects: combined digital health interventions (exercise plus nutrition) demonstrated superior improvements in handgrip strength (MD = 2.21&#xa0;kg, 95% CI [1.33, 3.09]) and quality of life (SMD = 0.65, 95% CI [0.29, 1.01]) compared to controls. Furthermore, opposing effects on BMI were observed between exercise-focused and nutrition-focused interventions. The certainty of evidence for most outcomes was rated as low or very low.</p> Conclusion <p>Standalone digital health exercise interventions confer limited benefit on core sarcopenia outcomes. In contrast, comprehensive digital interventions that combine exercise with nutritional support show significant promise for improving muscle strength, muscle mass, and quality of life, representing the most promising avenue. The current evidence base is characterized by low certainty, underscoring the need for more methodologically rigorous trials with longer-term follow-up to confirm these findings and identify the most effective intervention components and target populations.</p> Trial registration <p>CRD42024516930</p>