**4. Combined ketogenic diet and walking exercise interventions in the older community skeletal muscle sarcopenia**

Skeletal muscle has a resistance and strength training ability to adapt and regenerate, which should be done at least twice a week in combination with ketogenic diet interventions to the response. However, there are no approved medications to treat obesity sarcopenia or obese sarcopenia and new drugs. Many health professionals have little knowledge of obesity sarcopenia or obese sarcopenia, they necessarily consider to treat aging-, foods diet-, or drug-related muscle wasting. Exercise physiological programs for older people are best positioned to with chronic diseases including sarcopenia. Combined ketogenic diet with walking exercise interventions is one of the most effective ways to reduce the risk of aging-related diseases in the older community groups [62]. The ketogenic diet and walking exercise are both important for optimal health. Both ketogenic diet and walking exercise interventions in the older community groups can help to reduce aging-related heart, brain, vascular, stomach, muscle, lung, liver, kidney, and large intestine injury (**Figure 3**). While old men may be tempted to pick one over the other, a ketogenic diet and walking exercise training work hand in hand, and combining both will optimize health and quality of life [63]. Cardiac physiological functions are associated with walking exercise training intervention. After 1 year of progressive walking exercise training intervention was confirming physiological cardiac remodeling with walking exercise intervention in the community older people. The influence of walking exercise interventions on aging-related cardiovascular diseases demonstrates in older men than young. In older community groups exhibited myocardial fatty acid metabolism response to beta-adrenergic stimulation after 12 months of walking exercise training [64]. The well-established ketogenic diet promotes the older man's health. The ketogenic diet interventions are high in healthy unsaturated fats from undergoing walking exercise interventions in later life [65, 66]. Ketogenic diets among nonpharmacological treatments for those with exercise intolerance are available to the brain, muscle, and heart, where they generate energy for cells in the mitochondria (**Figure 2**) [67]. The major aging-related heart disease pathophysiological conditions—left ventricular hypertrophy, chronic heart failure, atrial fibrillation, arterial structural remodeling [68]. Pathophysiology is related to multifactorial interventions other than diet or supplementation. In the community older human groups treated with difficult-to-control syndromes are those requiring a lot of energy, such as heart, brain, and muscle [69]. The brain in a carbohydrate-rich diet usually relies on glucose as the preferred substrate for an energy source. The ketogenic diet is a special case of a high-fat diet, about adopting saturated fat in the diet as a cause of heart disease in the community older groups, the long-term ketogenic diet might decrease mitochondrial functions [70]. Glucose is initially the context of a low carbohydrate catabolized in the cytoplasm through the process of glycolysis which produces ATP and NADH [71]. The ketogenic diet reduces hyperglycemia and hyperinsulinemia. Amino acids of threonine, isoleucine, leucine, and lysine were observed for ketogenic amino acids is not true for the heart, conversely, the anoxic heart experiences the greatest [72]. Combined ketogenic diet and exercise interventions in community older groups are high in healthy unsaturated fats from olive oil manipulate nutrient-sensing pathways, particularly heart infarction, diabetes mellitus, and also liver, lung, and kidney disease varieties and antioxidants that help to fight harmful molecules free radicals. Gains in muscle mass of 5–10% and improvements in muscle strength power of 30–150% have been observed after 12 weeks of the combined ketogenic diet and walking exercise interventions in the older community skeletal muscle sarcopenia.
