Inclusion Criteria:  patients older than 65 years patients who meet criteria for the Asian Working Group for Sarcopenia (AWGS) 2019 patients who had metabolic syndrome  Exclusion Criteria:  patients with less than estimated glomerular filtration rate (eGFR) 30 patients with musculoskeletal or chronic lung disease incapable of exercise patients with untreated or uncontrolled cardiovascular disease which may affect muscle mass or performing exercise patients less than 5 years after treatment of malignant tumor patients with liver cirrhosis, diabetes and other chronic disease patients who cannot perform combined exercise nutrition intervention for other reasons