Sarcopenia, characterized by the progressive loss/gradual decline of skeletal muscle mass, muscle strength, and functional performance, is a common syndrome associated with aging [1]. This condition not only increases the risk of disability and functional impairment but also has a significant impact on mortality rates and overall quality of life [1]. Interestingly, recent evidence suggests a close relationship between sarcopenia and non-alcoholic fatty liver disease (NAFLD). Sarcopenia has been found to be highly prevalent among individuals with NAFLD, and it has been identified as a crucial risk factor for the development and progression of the disease [2], [3]. Additionally, the findings of previous studies showed a relationship between sarcopenia and negative effects in individuals suffering from cirrhosis, including hepatic decompensation, and those awaiting a liver transplant [2], [4].

Regular exercise is widely recognized as an effective strategy to prevent or delay the onset of sarcopenia [5]. Among the various exercise modalities, Nordic walking (NW) has emerged as a promising form of aerobic exercise with numerous benefits. Nordic walking is a safe, accessible, and adequate exercise involving striding with specially designed poles to improve posture and strengthen the back, shoulders, and hips [6], [7], [8], [9]. Studies have demonstrated NW as a therapeutic intervention for individuals with diverse health conditions and its positive effects in individuals with cardiovascular disease [10], including improvements in cardiovascular fitness, blood pressure, and lipid profiles [11], [12], [13], including improvements in gait, balance, and overall physical function [14], supportive for breast cancer patients to improve physical fitness, quality of life, and shoulder mobility [15], [16]. However, despite the potential advantages of NW, there is a paucity of research investigating its effects specifically on sarcopenia in patients with NAFLD [17].

In recent meta-analyses, Hejazi and Hackett, and Liu et al. showed the analytical results that exercise therapies that improve liver biomarkers benefit NAFLD [18], [19]. On the other hand, earlier research adopting intervention periods ranging from 6 to 12 months evaluated the impact of exercise treatments on sarcopenia-related outcomes [20]. As NW is an alternate form of exercise to conventional aerobics, NW is a promising therapeutic approach for improving sarcopenia-related parameters through aerobic exercise and upper-body muscle engagement, with multifaceted and synergistic effects on muscular strength, mitochondrial function, and oxidative capacity of skeletal muscle [21], [22]. The effects of Nordic walking (NW) on muscle strength in postmenopausal women with pre-diabetes and NAFLD are largely unknown, and more long-term interventions evidence are urged to investigate the sarcopenia-related metrics [23], [24].

Therefore, the objective of this study was to evaluate the effects of an 8.6-month NW intervention on parameters related to sarcopenia, including skeletal muscle mass, muscular strength, and physical performance, in postmenopausal women with NAFLD and pre-diabetes.