ArticlePDF Available

The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients

Authors:

Abstract

Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises , i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises : these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.
Review Article
The Effectiveness of Physical Exercise on Bone Density in
Osteoporotic Patients
Maria Grazia Benedetti ,1Giulia Furlini,1Alessandro Zati,1and Giulia Letizia Mauro2
1Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
2Rehabilitation Unit, Paolo Giaccone Hospital, Palermo, Italy
Correspondence should be addressed to Maria Grazia Benedetti; benedetti@ior.it
Received 16 July 2018; Revised 28 October 2018; Accepted 4 December 2018; Published 23 December 2018
Guest Editor: ´
Angel Matute-Llorente
Copyright ©  Maria Grazia Benedetti et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Physical exercise is considered an eective means to stimulate bone osteogenesis in osteoporotic patients. e authors reviewed
the current literature to dene the most appropriate features of exercise for increasing bone density in osteoporotic patients.
Two types emerged: () weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not
appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to
be eective, they must reach the mechanical intensity useful to determine an important ground reaction force. () Strength and
resistance exercises: these are carried out with loading (liing weights) or without (swimming, cycling). For this type of exercise
to be eective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined.
ese exercises appear extremely site-specic, able to increase muscle mass and BMD only in the stimulated body regions. Other
suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination
of dierent methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving
bone mass. ese exercises seem particularly indicated in deteriorating elderly patients, oen not able to perform exercises of pure
reinforcement. However, for these protocols to be eective they must always contain a proportion of strengthening and resistance
exercises. Given the variability of the protocols and outcome measures, the results of these methods are dicult to quantify.
Trai n i n g w ith whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have
eect on enhancing musclestrength, controversial ndings on improvement of BMD were reported. WBV seems to provide good
results, especially in improving balance and reducing the risk of falling; in this, WBV appears more ecient than simply walking.
Nevertheless, contraindications typical of senility should be taken into account.
1. Introduction
According to the literature, the level of bone loss in a
postmenopausal woman increases with age, respectively,
with a loss of .%, .%, and .% per year for the -,
-, and> age groups []. More precisely, the loss is
.% per year for the spine and .% - .% for the femoral
neck in the rst - years []. In the following years, the
loss is less rapid as it is the immediate postmenopausal
period characterized by a greater speed and entity of bone
loss []. Although exercise is widely recommended as one
of the primary preventive strategies to reduce the risk of
osteoporosis [], its eects on bone are controversial. In fact,
notalltypesofexercisehavethesamepositiveeectonbone
mineral density (BMD). While there is evidence that exercise
induces an increase in bone mass in younger subjects, this
eect in adults and elderly people remains questionable
[]. In elderly people, the results of the studies indicate that
exercise may increase the thickness and resistance of cortical
bone at loaded skeletal sites []. However, it seems that the
improvement on bone strength induced by exercise in older
adults is likely to be due to a lower loss of endocortical bone
and/or an increase in tissue density, rather than an increase
in bone size (periosteal apposition), typical of young subjects.
Supposing that trabecular bone architecture can adapt to
increased loading, the eects of physical activity on thickness,
number, separation, and orientation of trabecular elements
in human bones are not known due to the limited resolution
Hindawi
BioMed Research International
Volume 2018, Article ID 4840531, 10 pages
https://doi.org/10.1155/2018/4840531
BioMed Research International
of most current commonly used imaging techniques
[].
erefore, there is considerable interest in dening the
adequate dosage and characteristics of exercises to improve
bone strength in osteoporosis, in order to develop appropriate
guidelines, given the fact that economic and social costs
appear to be in a progressive and constant growth in relation
to the aging of the population [, ].
In the past years, many studies [, –] have reported
very consistent results on the benecial eects of exercise
onBMDofthelumbarspineandthefemurinmenopausal
women and, in general, in old age. Various exercises have
been described to stimulate bone growth and preserve the
bone mass; the optimal interventions are those favoring
a mechanical stimulus on bone both through antigravity
loading and the stress exerted on muscles [–]. In general,
therapeutic exercises for osteoporosis can be ranked in two
types of activities:
(i) Weight-bearing aerobic exercises,suchasimpactactiv-
ities or any other exercise in which arms, feet, and legs
are bearing the weight, (i.e., walking, stair climbing,
jogging, volleyball, tennis and similar sports, Tai Chi,
and dancing).
(ii) Strength end/or resistance exercises,inwhichthejoints
are moved against some kind of resistance, in the form
of free weights, machines, tubing, or one's own body
weight [].
However, it is still not clear which exercise is the best suited
and how long it would take to obtain an appropriate result.
For example, the SIOMMS guidelines [] recommend per-
forming a minimum of physical activity, such as walking, for
 minutes every day, despite the lack of available evidence.
Meanwhile the position paper in the American College of
Sports Medicine [] suggests, during adulthood, to carry
out weight-bearing endurance activities (i.e., tennis, stair
climbing, and jogging), activities that involve jumping (vol-
leyball, basketball), and resistance exercise (weight liing)
with moderate or high intensity, - times a week for -
minutes, possibly in combination.
e eects of exercise on bone tissue have gained an
important contribution also from studies on sport athletes.
Numerous publications have linked physical exercise, bone
metabolism markers, and bone mineral density []. While
the isolated exercise (single bout training) seems to give
a eeting osteogenetic stimulation, a longer training, for
example,  times a day for  weeks, seems to provide a
better stimulation. Furthermore, aerobic exercise seems to
be particularly eective in the enzymatic activation of the
osteoblasts. ese observations underscore the importance
of combining aerobic and anaerobic exercises in osteogenetic
protocols. Furthermore, aer a longer period of training (-
 months), the sedentary and untrained individuals obtained
better results in BMD than the already trained individuals
with signicant osteogenetic activity without increasing the
reabsorption indexes. Probably individuals already trained
with the continuation of exercise only maintained the good
bone metabolic level already reached, which can not indef-
initely increase. Regarding the type of exercise, sport shows
us clearly how the activities performed in weight bearing,
including high impact and endurance mechanical compo-
nents, are more eective in increasing the BMD of limited
or nonimpact exercises. In fact, BMD is on average higher
in athletes with sporting activities involving jumping (volley-
ball, basketball ball rugby, soccer, and martial arts) compared
to those who do not have these mechanical characteristics,
such as swimming, rowing, and cycling []. Furthermore
there are evidences that high level of physical activity during
youth, as seen in female athletes, seems to have a benecial
eect on bone mass and helps to prevent bone loss due to
aging [].
In clinical practice, however, the prescription of exer-
cise in the elderly and osteoporotic patient must always
be preceded by a careful evaluation: indeed, it is essential
to dene the type, intensity, and duration of a proposed
program. e decision is based on the subject’s muscle
strength, range of motion, balance, gait, cardiopulmonary
function, comorbidities, bone density, and histor y of previous
fractures, as well as the risk of falling [, , ]. In fact, the
most intense exercises, such as high impact activities, that are
eective in increasing bone mass in young subjects may not
be indicated for some elderly osteoporotic subjects []. e
progression of the exercise must always be respected, and, in
patients with severe osteoporosis, the activities involving the
exion or rotation of the trunk must be avoided.
Regarding aquatic exercise, a recent systematic review
supports the evidence of a trend showing its eectiveness in
maintaining or even improving BMD [].
2. Materials and Methods
2.1. Search Criteria. Main search engines (PubMed,
Cochrane Library, and Pedro) were explored using the
keywords: exercise AND osteoporosis in title, resistance
exercise AND osteoporosis, weight bearing exercise AND
osteoporosis, vibration AND osteoporosis. e following
lters were applied: articles in English language on humans
aged  and over. e research took into account the existing
systematic reviews and meta-analyses, focusing also on the
individual articles included in the reviews. A subsequent
selection regarding only exercise and primary osteoporosis,
based on the titles and abstracts analysis of the articles, was
performed.
2.2. Methodological Problems Emerging from the Studies.
Several critical issues in the evaluation of evidence, limiting
in some way the conclusion of this review, were highlighted in
theCochranereviews[,].Regardingthemethods,among
the several exercises proposed in the literature there were
relevant dierences in the type and in the setting where
the exercises were carried out, the intensity, the duration,
frequency of the sessions, and the total duration of the
program. Furthermore, the sample size, patients’ compliance
or adherence to the study, the presence of a control group,
BioMed Research International
the number of postmenopausal years, and the follow-ups
reported in the studies were very diverse.
With regard to the criteria used to evaluate and mea-
sure the eectiveness of the exercises, the studies generally
referred to the measurement of BMD detected at the femur
(the whole hip, neck, trochanteric and intertrochanteric
region, and the Ward’s triangle), lumbar spine, distal radius,
forearm, tibia, ankle, and total body. In addition to BMD,
other studies had also considered aspects such as bone
quality, fracture risk reduction, BMC, cortical bone den-
sity, body mass, and muscle strength. Although BMD is
a relatively good predictor of fracture risk in the elderly
population, current research indicates that up to % of low-
impact trauma fractures occur in individuals who are not
osteoporotic but have a normal or slightly reduced BMD,
resulting in osteopenia. is discovery highlights the limits of
bone densitometry (DXA) in providing accurate BMD mea-
surements or its ability to provide relevant information about
the main determinants of bone strength, such as size, shape,
and bone structure. Minor changes in bone mass distribution,
cortical and trabecular structure, and bone geometry can lead
to large increases in bone strength dependent on changes in
BMD []. e most advanced studies now are focusing on
the use of some noninvasive bone imaging techniques, such
as quantitative peripheral computed tomography (pQCT),
magnetic resonance imaging (MRI), and DXA-based hip
structural analysis (HSA) [, ].
3. Results and Discussion
Forty-four systematic reviews were retrieved in PubMed
using the keywords “exercise AND osteoporosis”,  using
the keywords “resistance exercise AND osteoporosis”, 
with “weight bearing exercise AND osteoporosis”, and 
using “vibration AND osteoporosis”. irty-three systematic
reviews were retrieved from Pedro and  Cochrane review
from Cochran Library using the keywords “exercise AND
osteoporosis”. Of these, once eliminated duplicates and
papers not primarily focused on exercise and osteoporosis, 
systematic reviews and meta-analyses were considered with
respect to dierent type of exercise (Table ) and  with
respect to whole body vibration (Table ).
3.1. Weight-Bearing Aerobic Exercise. One of the most com-
mon forms of aerobic training is walking, an exercise very
well accepted by the older people, because it is harmless,
self-managed, and easily practicable. e eects of walking
on BMD have been widely considered, although the results
are not always consistent in the various studies [–, ].
e meta-analyses showed the absence of signicant eects
on the lumbar spine or on the femoral neck attempted by
the only walking [, ]. Likewise, from the studies analysed
by Gomez Cabello et al. [], there is no evidence of a
close correlation between BMD increasing and gait exercise.
However, the eectiveness of walking in maintaining the level
ofBMDandinpreventingitslossisalreadyanexcellentresult
of this simple type of exercise.
Furthermore, it is important to consider some parameters
that can inuence the eects of walking, such as walking
speedily/slowly or strongly/weekly. Actually, there is evidence
that an intervention of more than  months in duration can
provide signicant and positive eects on femoral neck BMD
in peri- and postmenopausal women [].
Some studies show how a brisk walking or jogging can
have positive eects on hip and column BMD in women of
menopausal age []. Certainly, some low-impact activities,
such as jogging combined with stair climbing and walking,
favor minor loss of BMD in both the hip and the spine
in menopausal women. Hence, walking/jogging must reach
a sucient high level of mechanical stress determining an
important ground reaction force able to stimulate bone mass
[,,,].
In comparing dierent types of physical exercises with
controls, Howe [] found a signicant eect in BMD for
bipodalic or monopodalic static exercises and on spine and
wrist for dynamic low-impact exercises (including walking
and Tai Chi).
Regarding Tai Chi, the issue is in increasing debate; recent
literature [, , –] suggests a positive eect on attenu-
ating BMD loss at the lumbar spine and the proximal femoral
neck and on biomarkers of bone metabolism. However, in
order to be eective, this activity has to last  months as
minimum [].
In summary:
(i) Walking, as an isolated intervention, is not able to
modify the loss of BMD. However, in the context of a
health maintenance program in general it is advisable
to walk for at least 30 minutes a day.
(ii) Aerobic training and in particular the path with high
intensity and speed, interspersed with jogging, climbing
scales, and stepping, is able to limit the reduction of
BMD.
3.2. Strength and Resistance Exercises. Strength and resis-
tance training are the most studied techniques to increase
bone mass in the elderly. e rationale of these exercises lies
in the mechanical stimulus indirectly produced on the bone
[, , ]. Like weight-bearing exercises, the strength exercise
determines a joint reaction force and muscle strengthening,
producing an important clinical benet on the BMD, in the
lumbar spine and, to a greater extent, in the femoral neck [].
is type of activity is also dened as “nonimpacting” and
can be carried out with loading (liing weights) or without
loading (swimming, cycling) [].
Studies have examined the eect of strengthening the
muscles of the upper limb and lower limb, rather than sp ecic
groups such as iliopsoas and spinal extensors. From the
evidence gathered by Zehnacker et al. [] the eectiveness
of strength training in the hip and spine sites is related to
the intensity of the training; the exercise requires high loads
(-% of a maximum repetition) for - repetitions of -
 sets performed at least for  year,  times a week for -
 minutes per session. In particular some types of exercise
wouldbeabletoincreasebonemineraldensity:()weighted
squats, hack squats, leg press, hip extension, hip adduction,
BioMed Research International
T : Systematic reviews and meta-analyses on Exercise and Osteoporosis.
Authors/Title/Source Main conclusions
omez-Cabello A, Ara I, Gonz´alez-Ag¨uero A, Casaj´us
JA, Vicente-Rodr´ıguez G. Eects of training on bone
mass in older adults: a systematic review. Sports Med.
;;():-.[]
Walking provides a modest increase in the loads on the skeleton above gravity
and, therefore, this type of exercise has proved to be less eective in osteoporosis
prevention. Strength exercise seems to be a powerful stimulus to improve and
maintain bone mass during the ageing process. Multi-component exercise
programmes of strength, aerobic, high impact and/or weight-bearing training, as
well as whole-body vibration (WBV) alone or in combination with exercise, may
help to increase or at least prevent decline in bone mass with ageing, especially in
postmenopausal women.
Nikander R, Siev¨anen H, Heinonen A, Daly RM,
Uusi-Rasi K, Kannus P. Targeted exercise against
osteoporosis: A systematic review and meta-analysis for
optimising bone strength throughout life. BMC Med.
 Jul ;:. []
Epidemiological evidence suggests that moderate to vigorous physical activity
performed three to four times per week is associated with considerably lower
incidence of fragility fractures in both women and men. e ndings from these
studies also suggest that exercise regimens that include moderate- to
high-magnitude impacts from varying loading directions may represent the
optimal mode to enhance bone structure and strength.
Zehnacker CH, Bemis-Dougherty A. Eect of weighted
exercises on bone mineral density in post-menopausal
women. A systematic review. J Geriatr Phys er.
;():-. []
Weighted exercises can help in maintaining BMD in postmenopausal women
and increasing BMD of the spine and hip in women with osteopenia and
osteoporosis. e exercise program must be incorporated into a lifestyle change
and be lifelong due to the chronic nature of bone loss in older women.
McMahon M. What impact does aquatic therapy have
on bone density in postmenopausal women? If it has a
positive or maintenance eect, what are the programme
parameters that facilitate these outcomes? Aqualines
;():-.[]
e majority of the studies reviewed support a trend showing that exercising in
water can be useful in at least maintaining, or improving, various measures of
bone mineral density (BMD).
Howe T, Shea B, Dawson LJ, Downie F, Murray A, Ross
C, Harbour RT, Caldwell LM, Creed G. Exercise for
preventing and treating osteoporosis in
postmenopausal women. Cochrane Database Syst Rev.
 Jul ;():CD. []
e most eective type of exercise intervention on bone mineral density (BMD)
for the neck of femur appears to be non-weight bearing high force exercise such
as progressive resistance strength training for the lower limbs. e most eective
intervention for BMD at the spine was combination exercise programmes
compared with control groups. Our results suggest a relatively small statistically
signicant, but possibly important, eect of exercise on bone density compared
with control groups.
Polidoulis I, Beyene J, Cheung AM. e eect of
exercise on pQCT parameters of bone structure and
strength in postmenopausal women – a systematic
review and meta-analysis of randomized controlled
trials. Osteoporos Int. ;():-. []
We conclude that exercise in postmenopausal women may decrease bone loss by
maintaining cortical and trabecular volumetric BMD.
Martyn-St James M, Carroll S. Meta-analysis of
walking for preservation of bone mineral density in
postmenopausal women. Plos one. ;():-.
[]
We conclude that regular walking has no signicant eect on preser vation of
BMD at the spine in postmenopausal women, whilst signicant positive eects at
femoral neck are evident. However, diverse methodological and reporting
discrepancies are apparent in the published trials on which these conclusions are
based. Other forms of exercise that provide greater targeted skeletal loading may
be required to preserve bone mineral density in this population.
Ma D, Wu L, He Z. Eects of walking on the
preservation of bone mineral density in
perimenopausal and postmenopausal women: a
systematic review and meta-analysis. Menopause.
;():-. []
Walking as a singular exercise therapy has no signicant eects on BMD at the
lumbar spine, at the radius, or for the whole body in perimenopausal and
postmenopausal women, although signicant and positive eects on femoral
neck BMD in this population are evident with interventions more than  months
in duration.
Bolam KA, van Uelen JG, Taae DR. e eect of
physical exercise on bone density in middle-aged and
older men: a systematic review. Osteop Int.
;():-. []
Regular resistance training and impact-loading activities should be considered as
a strategy to prevent osteoporosis in middle-aged and older men.
Kelley GA, Kelley KS, Kohrt WM. Eects of ground and
joint reaction force exercise on lumbar spine and
femoral neck bone mineral density in postmenopausal
women: a meta-analysis of randomized controlled
trials. BMC Musculoskelet Disord. ; ;:. []
e overall ndings suggest that exercise may result in clinically relevant benets
to FN and LS BMD in postmenopausal women.
Chow TH, Lee BY, Ang ABF, Cheung VYK, Ho MMC,
Takemura S. e eect of Chinese martial arts Tai Chi
Chuan on prevention of osteoporosis: A systematic
review. J Orthop Translat. ; ;:-. []
TCC is benecial to BMD and may be a cost-eective and preventive measure of
osteoporosis. is benecial eect is better observed in long-term TCC practice.
BioMed Research International
T  : C o n t i nu ed.
Authors/Title/Source Main conclusions
SunZ,ChenH,BergerMR,ZhangL,GuoH,HuangY.
Eects of tai chi exercise on bone health in
perimenopausal and postmenopausal women: a
systematic review and meta-analysis. Osteoporos Int.
 Oct;():-. []
Tai chi exercise may have benets on bone health in perimenopausal and
postmenopausal women, but the evidence is sometimes weak, poor, and
inconsistent.
de Kam D, Smulders E, Weerdesteyn V,
Smits-Engelsman BC. Exercise interventions to reduce
fall-related fractures and their risk fac tors in individuals
with low bone density: a systematic review of
randomized controlled trials. Osteoporos Int.
;():-. []
Exercise interventions for patients with osteoporosis should include
weight-bearing activities, balance exercise, and strengthening exercises to reduce
fall and fracture risk.
Martyn-St James M, Carroll S. A meta-analysis of
impact exercise on postmenopausal bone loss: the case
for mixed loading exercise programmes. Br J Sports
Med. ; ():-. []
Mixed loading exercise programmes combining jogging with other low-impact
loading activity and programmes mixing impact activity with high-magnitude
exercise as resistance training appear eective in reducing postmenopausal bone
loss at the hip and spine. Other forms of impact exercise appear less eective at
preserving BMD in this population. However, diverse methodological and
reporting discrepancies are evident in current published trials.
Varahra A, Rodrigues IB, MacDermid JC, Bryant D,
Birmingham T. Exercise to improve functional
outcomes in persons with osteoporosis: a systematic
review and meta-analysis. Osteoporos Int.
;():-. []
A multicomponent exercise program of high-speed training combined with
simulated functional tasks is promising to enhance functional outcomes. Due to
substantial clinical heterogeneity of the target groups and specic demands of
exercise modes, it is unclear which exercise program is optimal.
Zhao R, Zhao M, Xu Z. e eects of diering
resistance training modes on the preservation of bone
mineral density in postmenopausal women: a
meta-analysis. Osteoporos Int. ; ():-. []
Combined resistance exercise protocols appear eective in preserving femoral
neck and lumbar spine BMD in postmenopausal women, whereas
resistance-alone protocols only produced a nonsignicant positive eect.
Martyn-St James M, Carroll S. Eects of dierent
impact exercise modalities on bone mineral density in
premenopausal women: a meta-analysis. J Bone Miner
Metab. ;():-.[]
Exercise programmes that combine odd- or high-impact activity with
high-magnitude resistance training appear eective in augmenting BMD in
premenopausal women at the hip and spine. High-impact-alone protocols are
eective only on hip BMD in this group. However, diverse methodological and
reporting discrepancies are evident in published trials.
Xu J, Lombardi G, Jiao W, Ban G. Eects of Exercise
on Bone Status in Female Subjects, from Young Girls to
Postmenopausal Women: An Overview of Systematic
Reviews and Meta-Analyses. Sports Med.
;():-. []
Combined-impact exercise protocols (impact exercise with resistance training)
are the best choice to preserve/improve bone mineral density in pre- and
postmenopausal women. Whole-body vibration exercises have no benecial
eects on bone in postmenopausal or elderly women.
knee extension, and hamstring curls; () stair-climbing/step
boxes with weighted vests, power cleans with weighted
vests, and beverage boxes; () military press, latissimus pull
down, seated rowing, and rotary torso; () back extension
exercises with weighted backpack, leg press, bench press,
trunk extension, elbow exion, wrist curl, reverse wrist curl,
triceps extension, and forearm pronation and supination.
In relation to the hip, the exercise is eective on the
greater trochanter if it involves the buttocks, on the lesser
trochanter if it involves the iliopsoas, and on the Ward’s
triangle if it involves the adductors and the hip extensors,
according to the studies of Kerr et al. []. Here, the authors
concluded that there are several possible explanations for
the dierent eectiveness of site-specic exercises: various
muscle insertions, dierent weight or type of contraction, and
duration and nature of the exercise.
Similarly, Sinaki et al. [] have shown that the strength
of the back muscles in osteoporotic women is signi-
cantly reduced compared to healthy subjects; therefore,
the strengthening of these muscles can reduce the risk
of vertebral fractures with simple programs of antigravity
extension in the prone position. Aer two years of exercise,
there was a signicant reduction in the loss of BMD in the
subjects being treated. is signicant dierence, compared
to controls, was maintained eight years aer, despite the
decrement of both BMD and muscle strength.
In opposite opinion are Bemben et al. [] who investi-
gated the dose-response eects of resistance training on BMD
in elderly women and concluded that the gain in BMD at the
proximal femur and lumbar spine is independent of intensity
and frequency of isotonic exercise (with Cybex) of the
upper and lower limbs. In particular, there was no dierence
between men and women at the femur level, while in women
the eect is greater at the spine. In fact, it seems that the bone
in menopausal age can be signicantly increased by a regime
of strengthening exercises with “high-load low repetitions”
but not by a regime of resistance exercises with “low-load
high repetitions” []. e peak load exerted seems to be
therefore more important than the number of repetitions on
theincreaseinbonemassinmenopausalwomen[].Other
BioMed Research International
T : Systematic reviews and meta-analyses on Whole Body Vibration.
Authors/Title/Source Main conclusions
Slatkovska L, Alibhai SM, Beyene J, Cheung AM. Eect
of whole-body vibration on BMD: a systematic review
and meta-analysis. Osteoporos Int.
;():-.[]
We found signicant but small improvements in BMD in postmenopausal
women and children and adolescents, but not in young adults.
MaC,LiuA,SunM,ZhuH,WuH.Eectofwhole-body
vibration on reduction of bone loss and fall prevention
in postmenopausal women: a meta-analysis and
systematic review. J Orthop Surg Res. ; ;:. []
Low-magnitude whole-body vibration therapy can provide a signicant
improvement in reducing bone loss in the lumbar spine in postmenopausal
women.
Merriman H, Jackson K. e eects of whole-body
vibration training in aging adults: a systematic review. J
Geriatr Phys er. ;():-. []
Some but not all of the studies in this review reported similar improvements in
muscle performance, balance, and functional mobility with WBV as compared to
traditional exercise programs. Bone studies consistently showed that WBV
improved bone density in the hip and tibia but not in the lumbar spine.
Oliveira LC, Oliveira RG, Pires-Oliveira DA. Eects of
whole body vibration on bone mineral density in
postmenopausal women: a systematic review and
meta-analysis. Osteoporos Int. ;():-. []
Despite WBV presenting potential to act as a coadjutant in the prevention or
treatment of osteoporosis, especially for BMD of the lumbar spine, the ideal
intervention is not yet clear. Our subgroup analyses helped to demonstrate the
various factors which appear to inuence the eects of WBV on BMD,
contributing to clinical practice and the denition of protocols for future
interventions.
Fratini A, Bonci T, Bull AM. Whole Body Vibration
Treatments in Postmenopausal Women Can Improve
Bone Mineral Density: Results of a Stimulus Focussed
Meta-Analysis. PLoS One. ;():e. []
Whole body vibration treatments in elderly women can reduce BMD decline.
However, many factors (e.g., amplitude, frequency and subject posture) aect the
capacity of the vibrations to propagate to the target site; the adequate level of
stimulation required to produce these eects has not yet been dened.
Lau RW, Liao LR, Yu F, Teo T, Chung RC, Pang MY. e
eects of whole body vibration therapy on bone
mineral density and leg muscle strength in older adults:
a systematic review and meta-analysis. Clin Rehab.
;():-.[]
Whole body vibration is benecial for enhancing leg muscle strength among
older adults. However, the review suggests that whole body vibration has no
overall treatment eect on bone mineral density in older women.
JepsenDB,omsenK,HansenS,JørgensenNR,
Masud T, Ryg J. Eect of whole-body vibration exercise
in preventing falls and fractures: a systematic review
and meta-analysis. BMJ Open. ; ;():e.
[]
Whole body vibration reduces fall rate but seems to have no overall eect on
BMD or microarchitecture.
considerations that must be taken into account [] are that
women require a greater intensity of exercise to obtain certain
results on bone mass. Hence, it is always important to per-
form a balanced agonists and antagonists training taking into
account that the speed of execution during the movements
is pertinent in obtaining greater osteogenic stimulation. e
eectiveness of progressive resistance training is conrmed
also in the review of Cheung and Giangregorio [] who
considered this exercise the best one in postmenopausal
women to improve both spine and hip BMD. is would not
be the case of older adults, in which physical activity and
exercise only have minimal eects on BMD, while strength
training should be suggested. However, in clinical practice, in
osteoporotic individuals with high risk of vertebral fracture,
the use of resistance machines should be well thought out,
since this technique oen requires forward bending and
twisting of the trunk to perform the exercise or to adjust
the equipment and to ensure the proper setting. ey can be
utilized only if is used and adjusted with the proper form [].
In summary:
(i) Strength training determines an increase in specic site
bone density, in particular at the neck of the femur and
at the lumbar spine, which is maintained in the short to
medium term. At least 3 sessions a week for a year are
recommended.
(ii) Progressive resistance training for the lower limbs is
themosteectivetypeofexerciseinterventiononbone
mineral density (BMD) for the neck of femur.
3.3. Multicomponent Training. e multicomponent training
consists of a combination of dierent exercises (aerobics,
strengthening, progressive resistance, balancing, and danc-
ing) and it is aimed at increasing or preserving bone mass.
is implies that the same interventions are provided to all
people, dierently from multifactorial training, customized
on the individual characteristics [].
e association of several types of exercise is advised
to the patients aected by osteoporosis with the goal to
counter the reduction of bone mass [–, , –].
e combination of multiple types of exercise would have
a signicant eect on BMD at three sites: femoral neck
and greater trochanter, but the maximum benet would be
achieved at the spine level [].
However, diverse methodological and reporting discrep-
ancies with respect to the proposed mix of exercises, the
characteristics of patients with or without fractures, and the
BioMed Research International
outcome measures seem relevant in determining the result of
the exercise program. e revision of Gomez-Cabello et al. []
reports substantially two studies [, ] that demonstrate a
signicant improvement in BMD at the level of the lumbar
spine, the neck of the femur, and the greater trochanter,
following programs including muscle strengthening and
impact exercises. e meta-analysis conducted by Nikander
et al. [] reports in postmenopausal women dierent results
about the eects of the exercise. While resistance training
seems to have a good eect on lumbar BMD, the association
of this type of exercise with so-called “low-moderate” impact
exercises such as jogging, walking, and stair climbing is much
more eective in preserving BMD at both lumbar and femoral
level [].
It is interesting to note from this review how the most
challenging high impact exercise programs, such as jumping,
are only eective when they are associated with other low-
impact exercises. Bolan at al. [] report in their systematic
review a positive osteogenic eect of resistance training alone
or associated with high impact weight-bearing activities and
recall that the intensity and increment of the type of load
are two fundamental elements of exercise to avoid adaptation
phenomena and produce an improvement on bone mass
rather than just decreasing the loss.
Giangregorio et al. [] stressed the importance for
individuals with osteoporosis and osteoporotic vertebral
fracture to engage in a multicomponent exercise program
with resistance training combined with balance training. In
particular, it is stated that such individuals should not engage
in aerobic training to the exclusion of resistance or balance
training.
Xu et al. [] quantied the frequency with which a
multicomponent training must be carried out in order to be
eective. ey suggest that each session should be between 
and  min,  or more times per week for at least  months.
Also, in the review of studies analyzed by Marquez et al.
[, ], the combination of non-high-impact weight-bearing
exercises for muscle strengthening, resistance, aerobic, and
balance exercises determined an increase in BMD at the
lumbar spine and femoral neck in elderly subjects. According
to this group, a multicomponent exercise program with
moderate-high impact (marching on the spot, stepping at
/ b/m, on a bench of  cm, and heel drops on a rigid
surface) was able to determine an increase in BMD in the
femoral neck in a population of elderly women who had never
performed exercise programs before.
In summary:
(i) Combined exercise and group exercise programs,
including weight-bearing activities, balance training,
jogging, low-impact loading, high magnitude exercise,
muscle strength, and simulated functional tasks, are
advised to determine BMD increasing or at least
to preserve it. However the combination of exercise
should be tailored on the patient’s clinical features.
No agreement exists on the best protocol in terms of
duration, frequency, and the type of exercises to be
combined. e most relevant eect was detected at the
spine.
3.4. Training with Vibrating Platforms. e vibration of the
entire body is a physiotherapy intervention based on the
use of a high frequency mechanical stimulus generated
by a vibrating platform (Whole Body Vibration or WBV)
that activates the mechanoreceptors of the bone favoring
osteogenesis. e results of the studies included in two
systematic reviews [, ] conclude that the treatment with
aWBVseemstobemoreeectivethansimplewalkingand
of similar ecacy to strength training to improve bone mass
at specic sites (femoral neck and spine) in postmenopausal
women.
To obtain these results, Dionello et al. [] report an
average duration of the training from  to  months with
one or two weekly sessions lasting from  to  minutes,
with vertical or horizontal vibratory energy, at a variable
frequencyfromHztoHzwithamplitudefrom.
mm to  mm. e positive eect of WBV in improving
BMD in dierent sites is supported also by other reviews
[–] and conrmed by Oliveira et al. [] concluding that,
despite WBV presenting potential to act as a coadjutant in the
prevention or treatment of osteoporosis, especially for BMD
of the lumbar spine, the ideal intervention is not yet clear.
Fratini et al. [] also claim that whole body vibration
produces signicant BMD improvements on the hip and
spine when compared to no intervention, while treatment
associated with exercise training resulted in negligible out-
comes when compared to exercise training or to placebo. e
authors specify that the most osteogenic eect is obtained
with side-alternating platforms, due to the similarity of the
stimulus with gait, mechanical oscillations of magnitude
higher than  g, and/or frequency lower than  Hz, while
exercising on the platform does not provide further improve-
ment of BMD. us, it is better if the subject during the treat-
ment assumes static postures, such as full-standing or hack
squat. However, many factors (e.g., amplitude, frequency,
and subject posture) aect the capacity of the vibrations to
propagate to the target site; the adequate level of stimulation
required to produce these eects has not yet been dened.
Conversely, a previous systematic review [ ] showed that
while the use of vibration platforms can improve muscle
strength in the lower limbs of elderly patients, it does
not seem to induce signicant changes in bone mineral
density in women. Similarly, while the analysis performed
by Cheung and Giangregorio [] on  systematic reviews
shows only a modest clinical improvement of BMD at the hip
in postmenopausal women, the review of Jepsen et al. []
reports only a reduction in fall rate, but not in BMD.
In summary:
(i) Training with vibrating platforms is reported to have
eect on enhancing muscle strength, improving bal-
ance, and reducing the risk of fall in osteoporotic
patients, while controversial ndings on improvement
of BMD in dierent sites were reported.
4. Conclusions
Although several exercise recommendations for individuals
with osteoporosis have been proposed, reviews are oen
BioMed Research International
inconclusive, for the methodological variability emerging
from the studies.
However, results from the Cochrane review [] suggest a
relatively small, statistically signicant, but possibly impor-
tant eect of exercise on bone density in postmenopausal
women compared with control groups. e exercise types
most eective on BMD for the neck of femur, which should
be considered in clinical practice, appear to be the progres-
sive resistance strength training for the lower limbs. e
most eective intervention for BMD at the spine has been
suggested to be the multicomponent training exercise pro-
gramme. Weight-bearing aerobic exercise and training with
vibrating platforms may have also an impact in improving
BMD. ese evidences are relevant not only because they
support the possibility to increase BMD in postmenopausal
women, but also because they conrm the possibility to
prevent further bone loss in osteoporotic patients, thus
limiting the risk of fractures. Key considerations for future
research lines emerge from this review: () the need for
studies to evaluate the eects of the longer-term exercise; ()
the need for studies on male patients; () the need for studies
that use evaluation criteria of the outcome that are more
sensitive to changes in the bone structure; () inclusion of
parameters such as diet or drugs as a covariate in the analysis
of the eects of the exercise; () the need to stratify studies on
theeectsofexerciseonBMDbasedonage;and()theneed
to understand the eects of deconditioning.
Conflicts of Interest
e authors declare that they have no conicts of interest.
Acknowledgments
isstudywassupportedbytheErasmusProject“ACTLIFE-
Physical activity the tool to improve the quality of life in
osteoporosis people,” Grant Agreement n.  –  / 
–.
References
[] A. G´omez-Cabello,I.Ara,A.Gonz´alez-Ag¨uero,J.A.Casaj´us,
and G. Vicente-Rodr´ıguez, “Eects of training on bone mass in
older adults: a systematic review,Sports Medicine,vol.,no.
, pp. –, .
[] D. Bonaiuti, G. Arioli, G. Diana et al., “SIMFER rehabilitation
treatment guidelines in postmenopausal and senile osteoporo-
sis,European Journal of Physical and Rehabilitation Medicine,
vol. , no. , pp. –, .
[]D.Bonaiuti,B.Shea,R.Iovineetal.,“Exerciseforprevent-
ing and treating osteoporosis in postmenopausal women.,
Cochrane Database of Systematic Reviews (Online),no.,p.
CD, .
[] M.E.Nelson,W.J.Rejeski,S.N.Blairetal.,“Physicalactivity
and public health in older adults: recommendation from the
American College of Sports Medicine and the American Heart
Association,Circulation, vol. , no. , pp. –, .
[] W.M.Kohrt,S.A.Bloomeld,K.D.Little, M.E.Nelson,and
V. R. Yingling, “Physical activity and bone health,Medicine &
Science in Sports & Exercise,vol.,no.,pp.,.
[] R. Nikander, H. Siev¨anen, A. Heinonen, R. M. Daly, K. Uusi-
Rasi, and P. Kannus, “Targeted exercise against osteoporosis:
a systematic review and meta-analysis for optimising bone
strength throughout life,BMC Medicine,vol.,article,.
[] T. Mori, C. J. Crandall, and D. A. Ganz, “Cost-eectiveness
of combined oral bisphosphonate therapy and falls prevention
exercise for fracture prevention in the USA,Osteoporosis
International, vol. , no. , pp. –, .
[] A. Guadalupe-Grau, T. Fuentes, B. Guerra, and J. A. L. Calbet,
“Exercise and bone mass in adults,Sports Medicine,vol.,no.
, pp. –, .
[] M. R. Hingorjo, S. Zehra, S. Saleem, and M. A. Qureshi, “Serum
Interleukin- and its relationshipwith adiposity Indices before
and aer short-term endurance exercise,Pakistan Journal of
Medical Sciences,vol.,no.,.
[] B. Morseth, N. Emaus, and L. Jørgensen, “Physical activity and
bone: e importance of the various mechanical stimuli for
bone mineral density. A review,Norsk epidemiologi,vol.,no.
, pp. –, .
[] C. H. Zehnacker and A. Bemis-Dougherty, “Eect of weighted
exercises on bone mineral density in post menopausal women
a systematic review,Journal of Geriatric Physical erapy,vol.
, no. , pp. –, .
[] L. Langsetmo, C. L. Hitchcock, E. J. Kingwell et al., “Phys-
ical activity, body mass index and bone mineral density-
associations in a prospective population-based cohort of
women and men: e Canadian Multicentre Osteoporosis
Study (CaMos),Bone,vol.,no.,pp.,.
[]M.Rossini,S.Adami,F.Bertoldoetal.,“Guidelinesfor
the diagnosis, prevention and management of osteoporosis,
Reumatismo,vol.,no.,pp.,.
[] M. McMahon, “What impact does aquatic therapy have on
bone density in postmenopausal women? If it has a positive
or maintenance eect, what are the programme parameters
that facilitate these outcomes?” Aqualines: e Journal of the
Hydrotherapy Association of Chartered Physiotherapists,vol.,
no.,pp.,.
[] T. E. Howe, B. Shea, L. J. Dawson et al., “Exercise for pre-
venting and treating osteoporosis in postmenopausal women,
Cochrane Database of Systematic Reviews,vol.,no.,pp.
, .
[]I.Polidoulis,J.Beyene,andA.M.Cheung,“eeectof
exercise on pQCT parameters of bone structure and strength
in postmenopausal women - A systematic review and meta-
analysis of randomized controlled trials,” Osteoporosis Interna-
tional,vol.,no.,pp.,.
[] M. Martyn-St James and S. Carroll, “Meta-analysis of walking
for preservation of bone mineral density in postmenopausal
women,” Bone,vol.,no.,pp.,.
[] D. Ma, L. Wu, and Z. He, “Eects of walking on the preser-
vation of bone mineral density in perimenopausal and post-
menopausal women: a systematic review and meta-analysis,
Menopause,vol.,no.,pp.,.
[] K. A. Bolam, J. G. Z. van Uelen, and D. R. Taae, “e eect
of physical exercise on bone density in middle-aged and older
men: a systematic review,Osteoporosis International,vol.,no.
, pp. –, .
[] G. A. Kelley, K. S. Kelley, and W. M. Kohrt, “Eects of ground
and joint reaction force exercise on lumbar spine and femoral
BioMed Research International
neck bone mineral density in postmenopausal women: A meta-
analysis of randomized controlled trials,” BMC Musculoskeletal
Disorders,vol.,.
[] T.H.Chow,B.Y.Lee,A.B.F.Ang,V.Y.K.Cheung,M.M.C.
Ho, and S. Takemura, “e eect of Chinese martial arts Tai
Chi Chuan on prevention of osteoporosis: A systematic review,
Journal of Orthopaedic Translation,vol.,pp.,.
[] Z.Sun,H.Chen,M.R.Berger,L.Zhang,H.Guo,andY.Huang,
“Eects of tai chi exercise on bone health in perimenopausal
and postmenopausal women: a systematic review and meta-
analysis,” Osteoporosis International,vol.,no.,pp.
, .
[] D. de Kam, E. Smulders, V. Weerdesteyn, and B. C. M.
Smits-Engelsman, “Exercise interventions toreduce fall-related
fractures and their risk factors in individuals with low bone
density: a systematic review of randomized controlled trials,
Osteoporosis International, vol. , no. , pp. –, .
[] M. Martyn-St James and S. Carroll, “A meta-analysis of impact
exercise on postmenopausal bone loss: the case for mixed load-
ing exercise programmes, British Journal of Sports Medicine,
vol. , no. , pp. –, .
[] A. Varahra, I. B. Rodrigues, J. C. MacDermid, D. Bryant,
and T. Birmingham, “Exercise to improve functional outcomes
in persons with osteoporosis: a systematic review and meta-
analysis,” Osteoporosis International,vol.,no.,pp.,
.
[] A. J. Serra, “Dierent land-based exercise training programs
to improve bone health in postmenopausal women,” Medical
Science and Technology,vol.,pp.,.
[] M. M.-S. James and S. Carroll, “Eects of dierent impact
exercise modalities on bone mineral density in premenopausal
women: A meta-analysis,Journal of Bone and Mineral
Metabolism,vol.,no.,pp.,.
[] J.Xu,G.Lombardi,W.Jiao,andG.Ban,“EectsofExercise
on Bone Status in Female Subjects, from Young Girls to
Postmenopausal Women: An Overview of Systematic Reviews
and Meta-Analyses,Sports Medicine,vol.,no.,pp.
, .
[] L. Slatkovska,S. M.H. Alibhai,J.Beyene,andA.M.Cheung,
“Eect of whole-body vibration on BMD: a systematic review
and meta-an alysis,Osteoporosis International,vol.,no.,pp.
–, .
[] C.Ma,A.Liu,M.Sun,H.Zhu,andH.Wu,“Eectofwhole-
bodyvibrationonreductionofbonelossandfallprevention
in postmenopausal women: a meta-analysis and systematic
review,Journal of Orthopaedic Surgery and Research, vol. , no.
, .
[] H. Merriman and K. Jackson, e eects of whole-body
vibration training in aging adults: A systematic review,Journal
of Geriatric Physical erapy,vol.,no.,pp.,.
[] L.C.Oliveira,R.G.Oliveira,andD.A.Pires-Oliveira,“Eects
of whole body vibration on bone mineral density in post-
menopausal women: a systematic review and meta-analysis,
Osteoporosis International,vol.,no.,pp.,.
[] A. Fratini, T. Bonci, A. M. Bull, and A. Nazarian, “Whole body
vibration treatments in postmenopausal women can improve
bone mineral density: Results of a stimulus focussed meta-
analysis,” PLoS ONE, vol. , no. , .
[]R.W.K.Lau,L.-R.Liao,F.Yu,T.Teo,R.C.K.Chung,and
M. Y. C. Pang, “ e eects of whole body vibration therapy on
bone mineral density and leg muscle strength in older adults:
A systematic review and meta-analysis, Clinical Rehabilitation,
vol. , no. , pp. –, .
[] D. B. Jepsen, K. omsen, S. Hansen, N. R. Jørgensen, T.
Masud, and J. Ryg, “Eect of whole-body vibration exercise in
preventing falls and fractures: a systematic review and meta-
analysis,” BMJ Open,vol.,no.,.
[]G.Ban,A.Colombini,G.Lombardi,andA.Lubkowska,
“Metabolic markers in sports medicine,Advances in Clinical
Chemistry,vol.,pp.,.
[] A. Andreoli, M. Celi, S. L. Volpe, R. Sorge, and U. Tarantino,
“Long-term eect of exercise on bone mineral density and
body composition in post-menopausal ex-elite athletes: A
retrospective study,European Journal of Clinical Nutrition,vol.
, no. , pp. –, .
[] J. F. Bean, A. Vora, and W. R. Frontera, “Benets of exercise
for community-dwelling older adults,” Archives of Physical
Medicine and Rehabilitation,vol.,no.,pp.SS,.
[] P.R.Ebeling,R. M.Daly,D.A.Kerr,andM.G. Kimlin,“An
evidence-informed strategy to prevent osteoporosis in australia
an outline of the building healthy bones throughout life white
paper,Medical Journal of Australia, vol. , supplement , no.
, pp. -, .
[
]J.Multanen,M.T.Nieminen,A.H¨akkinen et al., “Eects of
high-impact training on bone and articular cartilage: -month
randomized controlled quantitative MRI study,Journal of Bone
and Mineral Research, vol. , no. , pp. –, .
[] A. M. Cheung and L. Giangregorio, “Mechanical stimuli and
bone health: What is the evidence?” Current Opinion in
Rheumatology,vol.,no.,pp.,.
[] N. B. Watts, R. A. Adler, and J. P. Bilezikian, “Osteoporosis
in men: an endocrine society clinical practice guideline,e
Journal of Clinical Endocrinology & Metabolism,vol.,no.,
pp. –, .
[] R. M. Daly, “Exercise and nutritional approaches to prevent frail
bones, falls and fractures: an update,Climacteric,vol.,no.,
pp. –, .
[] L. Zou, C. Wang, K. Chen et al., “e Eect of Taichi Practice
on Attenuating Bone Mineral Density Loss: A Systematic
Review and Meta-Analysis of Randomized Controlled Trials,
International Journal of Environmental Research and Public
Health,vol.,no.,p.,.
[] M. S. Lee, M. H. Pittler, B.-C. Shin, and E. Ernst, “Tai Chi for
osteoporosis: a systematic review,Osteoporosis International,
vol.,no.,pp.,.
[] H. Blake and H. Hawley, “Eects of tai chi exercise on physical
and psychological health of older people,” Current Aging Sci-
ence,vol.,no.,pp.,.
[] D. Kerr, A. Morton, I. Dick, and R. Prince, “Exercise eects on
bone mass in postmenopausal women are site-specic and load-
dependent,” Journal of Bone and Mineral Research, vol. , no. ,
pp.,.
[] M. Sinaki, E. Itoi, H. W. Wahner et al., “Stronger back muscles
reduce the incidence of vertebral fractures: A prospective 
year follow-up of postmenopausal women,Bone,vol.,no.
,pp.,.
[] D. A. Bemben and M. G. Bemben, “Dose-response eect of 
weeks of resistance training on bone mineral density in older
adults,Osteoporosis International, vol. , no. , pp. –,
.
[] V.P.Nicholson,M.R.McKean,G.J.Slater,A.Kerr,andB.J.
Burkett, “Low-Load Very High-Repetition Resistance Training
 BioMed Research International
Attenuates Bone Loss at the Lumbar Spine in Active Post-
menopausal Women,Calcied Tissue International,vol.,no.
, article no. , pp. –, .
[] L. M. Giangregorio, A. Papaioannou, N. J. MacIntyre et al., “Too
Fit to Fracture: Exercise recommendations for individuals with
osteoporosis or osteoporotic vertebral fracture,Osteoporosis
International,vol.,no.,pp.,.
[] S. Hopewell, O. Adedire, B. J. Copsey et al., “Multifactorial
and multiple component interventions for preventing falls in
older people living in the community,Cochrane Database of
Systematic Reviews,vol.,no.,.
[] B.R.Beck,R.M.Daly,M.A.F.Singh,andD.R.Taae,“Exercise
and Sports Science Australia (ESSA) position statement on
exercise prescription for the prevention and management of
osteoporosis,” Journal of Science and Medicine in Sport,vol.,
no.,pp.,.
[] A. Harding and B. Beck, “Exercise, osteoporosis, and bone
geometry,Sports,vol.,no.,p.,.
[] N. M. Schmitt, J. Schmitt, and M. D¨oren, “e role of physical
activity in the prevention of osteoporosis in postmenopausal
women-An update,” Maturitas,vol.,no.,pp.,.
[] R. Zhao, M. Zhao, andZ. Xu, “e eects of diering resistance
training modes on the preservation of bone mineral density in
postmenopausal women:a meta-analysis,Osteoporosis Interna-
tional,vol.,no.,pp.,.
[] W. Kemmler, S. Von Stengel, K. Engelke, L. H¨aberle, and W.
A. Kalender, “Exercise eects on bone mineral density, falls,
coronary r isk factors, and h ealth care costs in older women: e
randomized controlled senior tness and prevention (SEFIP)
study,JAMA Internal Medicine ,vol.,no.,pp.–,.
[]S.Kukuljan,C.A.Nowson,S.L.Bassetal.,“Eectsofa
multi-component exercise program and calcium-vitamin-D
-fortied milk on bone mineral density in older men: A
randomised controlled trial,Osteoporosis International,vol.,
no.,pp.,.
[] E. A. Marques, J. Mota, L. Machado et al., “Multicomponent
training prog ram with weig ht-bearing exercis es elicits favorabl e
bone density, muscle strength, and balance adaptations in older
women,” Calcied Tissue International,vol.,no.,pp.,
.
[] E. A. Marques, J. Mota, and J. Carvalho, “Exercise eects
on bone mineral density in older adults: a meta-analysis of
randomized controlled trials,AGE,vol.,no.,pp.,
.
[]C.F.Dionello,D.S´a-Caputo, H. V. F. S. Pereira et al.,
“Eects of whole body vibration exercises on bone mineral
density of women with postmenopausal osteoporosis without
medications: Novel ndings and literature review,Journal of
Musculoskeletal and Neuronal Interactions,vol.,no.,pp.
, .
... Unfortunately, treatment with medications such as biophosphonates and hormonal therapy comes with side effects [41]. Increasing skeletal loading through PA can have a positive influence on BMD and bone metabolism markers, such as collagen cross-links (CTx), osteocalcin (OC), bone alkaline phosphatase (BAP), and Procollagen-1 N-terminal propeptide (P1NP) in osteoporotic patients [10,21,[42][43][44][45][46][47]. Therefore, exercise interventions are considered an important treatment component for OP [18]. ...
... Previous reviews have investigated the effect of various types of training programs on bone health. Overall, multicomponent exercise programs (combined aerobic/impact and resistance training) were perceived as most successful in improving bone health [42,[48][49][50][51][52][53]. ...
Article
Full-text available
Depression constitutes a risk factor for osteoporosis (OP). Increasing physical activity might mitigate this risk, although intensive exercising may lead to opposing effects in depressed patients. The purpose of this scoping review was to summarize the evidence regarding the influence of exercise on bone health in depressed patients, divided into two sections: (1) Which bone markers are affected by depression? (2) How does exercise affect bone health in patients with depressive symptoms? A search of the literature was conducted in PubMed and Web of Science between August 2020–2022. Studies were included based on predetermined criteria for each sub-question. Regarding sub-question 1, eight studies revealed the following bone markers to be influenced by depression: P1NP, BAP, CTX, OC, RANKL, OPG, DPD, and PYD. Regarding sub-question 2, one study found a correlation between depression and bone health in an exercising population, and other studies detected improvements in bone health (n = 4) and depressive symptoms (n = 4) after exercise interventions. The current review shows the potential of exercise as a treatment form to improve bone health in depressed patients. Future trials are needed to assess the influence of exercise intervention on bone health in depressed patients.
... Μετά από 12 μήνες άσκησης με βάρη, ανιχνεύθηκε μη σημαντική αύξηση της BMD στην οσφυϊκή μοίρα της σπονδυλικής στήλης (1,17%) και μη σημαντικές μειώσεις (0,71%) στο ισχίο στην εκπαιδευμένη ομάδα ενώ η ομάδα ελέγχου παρουσίασε σημαντική απώλεια στην BMD της σπονδυλικής στήλης (2,26%) (de Matos et al., 2009). Υψηλή είναι η αποτελεσματικότητα της άσκησης δύναμης στα σημεία του ισχίου και της σπονδυλικής στήλης (υψηλά φορτία, 70-90% μέγιστης επανάληψης, 8-10 επαναλήψεις, 2-3 σετ, τουλάχιστον για 1 χρόνο, 3 φορές την εβδομάδα για 45-70 λεπτά ανά συνεδρία) (Benedetti et al., 2018). Η αερόβια προπόνηση λειτουργεί ως μέσο αναστολής της οστικής αποδόμησης, κυρίως στο ισχίο (Καρακύριου και συν., 2013). ...
... Ασκήσεις χαμηλής έντασης (ποδηλασία, κολύμβηση κ.λπ.) έχουν μικρή ή καθόλου επίδραση στην υγεία των οστών (Daly et al., 2019). Μια από τις πιο κοινές μορφές αερόβιας άσκησης, υψηλής αποτελεσματικότητας, είναι η βάδιση (Benedetti et al., 2018). Οι ασκήσεις με ελεύθερο βάρος που εκτελούνται με υψηλά φορτία (>70% 1 RM) υποδηλώνουν μεγαλύτερη ενίσχυση της BMD (Watson et al., 2018). ...
Conference Paper
Full-text available
COVID-19 and incarceration changed the daily life of athletes significantly. The aim of this thesis was the recording and assessment of the emotional response of the sampled athletes during their incarceration due to COVID-19. In the survey participated 280 amateur athletes, of which 159 men and 121 women, aged between 18 and 48 years (MEAN = 26.51, SD = 6.41). The sample subjects were asked to answer the Greek version of the (ERQ) through a seven-point Likert-type scale that detects their emotional reactions, ranging from 1=Strongly Disagree to 7=Strongly Agree. In particular, the factors and were investigated in relation to gender, athletic experience and physical training during the 2nd and 3rd wave of Coronavirus. The athletes' responses were collected using the online form/questionnaire (GoogleForm). Variance analyses showed: (a) a statistically significant difference of the factor < Re-evaluation> with respect to gender and more specifically women had a higher score (MEAN=4.89, SD=1.51) compared to men (MEAN=4.62, SD=1.16) and (b) a statistically significant effect of the factor with respect to sports experience and weekly training. Specifically, there were significant differences between the group with the least years of experience (MEAN=4.33,SD=1.48), compared to the group with the most years of experience (MEAN=3.60, SD=1.54) and the group that did not train ,which showed a higher score (MEAN=4.17, SD=1.48), compared to the group that trained (MEAN=3.73, SD=1.52).Considering the restricted interpersonal communication due to COVID-19 pandemic, the use of technological tools indicates that evaluation is more crucial than ever. In conclusion, research can help individuals, such as athletes by informing them of the stress levels and perhaps protecting them from any negative mental health symptoms.
... Leddy et al. [5] found that early treatment with subsymptom threshold aerobic exercise safely speeds recovery from sport-related concussion and reduces the risk of persistent postconcussive symptoms. Benedetti et al. [6] suggest that physical exercise is an effective 2 of 12 means to stimulate bone osteogenesis in osteoporotic patients. In the study by Yang et al. [7], physical exercise was one of the therapeutic tools for atherosclerosis . ...
Article
Full-text available
Maximum data in exercise (Max-Ex), including maximum heart rate (HRmax), peak oxygen uptake (VO2pk), maximum power (MaxP), etc., are frequently used, whether it is for the determination of exercise intensity, the measurement of an athlete’s performance, assessment of recovery from disease, and so on. However, very often this choice does not take into account the targeted individual. We recruited 32 males and 29 females to undergo an incremental graded exercise test (GXT). Therefore, our study seeks to determine variations in Max-Ex, according to the noninvasive static human data (Non-In data). Data showed a significant relationship (p < 0.001) between body composition and Max-Ex. Of the 41 types of Non-In data we collected in communities, the body composition generally showed high correlation (maximum r = 0.839). 57.5% of the data, of which r > 0.6 were about body composition. The muscle-related body composition data had a greater effect on power, and the fat-related ones had a greater effect on HRmax and VO2pk. For some types of Max-Ex, the older and younger ones showed specific differences. Therefore, these results can be employed to adequately prescribe personalized health promotion programs according to diversity and availability, and have some reference value for other studies using Max-Ex.
... More in-detail, physical exercise might prevent bone loss, increase BMD, and reduce fall risk due to the well-known improvement in physical function, balance control, and muscle strength [20]. In this context, hip and trunk muscles are considered as main targets for physical training aiming at stimulating exercise-induced osteogenic effects [21]. ...
Article
Full-text available
Rehabilitation might improve bone health in breast cancer (BC) patients, but the effects on bone biomarkers are still debated. Thus, this meta-analysis of randomized controlled trials (RCTs) aims at characterizing the impact of rehabilitation on bone health biomarkers in BC survivors. On 2 May 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for RCTs assessing bone biomarker modifications induced by physical exercise in BC survivors. The quality assessment was performed with the Jadad scale and the Cochrane risk-of-bias tool for randomized trials (RoBv.2). Trial registration number: CRD42022329766. Ten studies were included for a total of 873 patients. The meta-analysis showed overall significant mean difference percentage decrease in collagen type 1 cross-linked N-telopeptide (NTX) serum level [ES: −11.65 (−21.13, −2.17), p = 0.02)] and an increase in bone-specific alkaline phosphatase (BSAP) levels [ES: +6.09 (1.56, 10.62). According to the Jadad scale, eight RCTs were considered high-quality studies. Four studies showed a low overall risk of bias, according to RoBv.2. The significant effects of rehabilitation on bone biomarkers suggested a possible implication for a precision medicine approach targeting bone remodeling. Future research might clarify the role of bone biomarkers monitoring in rehabilitation management of cancer treatment induced bone-loss.
... Einige Arbeiten berichten auch von einer möglichen positiven Wirkung durch aerobes Ausdauertraining auf Knochenstoffwechselparameter [127,128]. Des Weiteren könnte aerobes Training den altersbedingten Verlust an Knochenmasse verlangsamen, eine eindeutige positive Wirkung auf die Knochendichte wurde jedoch nicht berichtet [129,130]. Aerobes Training kann das Sturzrisiko reduzieren, wenn auch geringer als kombiniertes Kraft-und Ausdauertraining [131]. Außerdem scheint regelmäßiges aerobes Training, welches in höherer aerober Fitness resultiert, die Erholung nach intensiven Aktivitäten zu beschleunigen [132] ...
Article
Definition and epidemiology: Chronic kidney disease (CKD): abnormalities of kidney structure or function, present for over 3 months. Staging of CKD is based on GFR and albuminuria (not graded). Osteoporosis: compromised bone strength (low bone mass, disturbance of microarchitecture) predisposing to fracture. By definition, osteoporosis is diagnosed if the bone mineral density T‑score is ≤ -2.5. Furthermore, osteoporosis is diagnosed if a low-trauma (inadequate trauma) fracture occurs, irrespective of the measured T‑score (not graded). The prevalence of osteoporosis, osteoporotic fractures and CKD is increasing worldwide (not graded). PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT OF CHRONIC KIDNEY DISEASE-MINERAL AND BONE DISORDER (CKD-MBD): Definition of CKD-MBD: a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; renal osteodystrophy; vascular calcification (not graded). Increased, normal or decreased bone turnover can be found in renal osteodystrophy (not graded). Depending on CKD stage, routine monitoring of calcium, phosphorus, alkaline phosphatase, PTH and 25-OH-vitamin D is recommended (2C). Recommendations for treatment of CKD-MBD: Avoid hypercalcemia (1C). In cases of hyperphosphatemia, lower phosphorus towards normal range (2C). Keep PTH within or slightly above normal range (2D). Vitamin D deficiency should be avoided and treated when diagnosed (1C). Diagnosis and risk stratification of osteoporosis in ckd: Densitometry (using dual X‑ray absorptiometry, DXA): low T‑score correlates with increased fracture risk across all stages of CKD (not graded). A decrease of the T‑score by 1 unit approximately doubles the risk for osteoporotic fracture (not graded). A T-score ≥ -2.5 does not exclude osteoporosis (not graded). Bone mineral density of the lumbar spine measured by DXA can be increased and therefore should not be used for the diagnosis or monitoring of osteoporosis in the presence of aortic calcification, osteophytes or vertebral fracture (not graded). FRAX can be used to aid fracture risk estimation in all stages of CKD (1C). Bone turnover markers can be measured in individual cases to monitor treatment (2D). Bone biopsy may be considered in individual cases, especially in patients with CKD G5 (eGFR < 15 ml/min/1.73 m2) or CKD 5D (dialysis). Specific treatment of osteoporosis in patients with ckd: Hypocalcemia should be treated and serum calcium normalized before initiating osteoporosis therapy (1C). CKD G1-G2 (eGFR ≥ 60 ml/min/1.73 m2): treat osteoporosis as recommended for the general population (1A). CKD G3-G5D (eGFR < 60 ml/min/1.73 m2 to dialysis): treat CKD-MBD first before initiating osteoporosis treatment (2C). CKD G3 (eGFR 30-59 ml/min/1.73 m2) with PTH within normal limits and osteoporotic fracture and/or high fracture risk according to FRAX: treat osteoporosis as recommended for the general population (2B). CKD G4-5 (eGFR < 30 ml/min/1.73 m2) with osteoporotic fracture (secondary prevention): Individualized treatment of osteoporosis is recommended (2C). CKD G4-5 (eGFR < 30 ml/min/1.73 m2) and high fracture risk (e.g. FRAX score > 20% for a major osteoporotic fracture or > 5% for hip fracture) but without prevalent osteoporotic fracture (primary prevention): treatment of osteoporosis may be considered and initiated individually (2D). CKD G4-5D (eGFR < 30 ml/min/1.73 m2 to dialysis): Calcium should be measured 1-2 weeks after initiation of antiresorptive therapy (1C). Physical medicine and rehabilitation: Resistance training prioritizing major muscle groups thrice weekly (1B). Aerobic exercise training for 40 min four times per week (1B). Coordination and balance exercises thrice weekly (1B). Flexibility exercise 3-7 times per week (1B).
... In the cardiovascular system, exercise has the effect of lowering blood pressure [7]. In the skeletal muscle system, exercise can prevent osteoporosis, lessen risks of fall and reduce the possibility of disability [8]. In addition, exercise can improve cognitive function, delay dementia, improve depressive mood and even lower risks of cancer [1,[9][10][11]. ...
Article
Full-text available
Aim: In order to investigate the effect of cycling wheelchair training as an exercise for aged 65+ disabled patients on cognitive function, quality of life, aerobic capacity and physiological parameters. Methods: Participants in nursing home performed cycling wheelchair training for 30 min a day, 5 days a week, for a total of 4 weeks. The main outcome measure was the short form 12 survey (SF-12). Other outcome measures included the Mini-Mental State Examination (MMSE), aero bike work rate test, resting blood pressure, and heart rate. Results: In this study, 41 volunteers were recruited and no participants dropped out of the study voluntarily during training, and no serious adverse effect was identified. Physical and mental component summary total scores of SF-12 were significantly higher after training with statistical significance (p = 0.001). 8 subscales also showed significant improvements after training (p = 0.025 ~ <0.001). Total MMSE score has no difference before and after training. Attention/calculation (p = 0.018), short term memory (p = 0.041), and aerobic capacity (p < 0.001) as measured by subscales of MMSE and aero bike test showed marked improvements, while resting systolic blood pressure (p = 0.931) and heart rate (p = 0.793) did not change. Conclusions: Cycling wheelchair is practical for the disabled elderly to exercise, and a 4-week exercise program enhanced their quality of life and aerobic capacity.
... • type of training (66); • exercise intensity (63,67); • frequency of exercises, breaks between exercises and series (63, 67) • the number of body parts involved (68) • systematic approach (69) Exercise to prevent osteoporosis must be of such intensity that bone tissue shows a threshold sensitivity to mechanical stimulus, because bones show an osteogenic effect only when this threshold is exceeded (70). Studies among menopausal women have confirmed the effect of high-intensity walking on increasing BDM, particularly in the lower body. ...
Article
Full-text available
Osteoporosis, a disease of low bone mass, is characterized by reduced bone mineral density (BMD) through abnormalities in the microarchitecture of bone tissue. It affects both the social and economic areas, therefore it has been considered a lifestyle disease for many years. Bone tissue is a dynamic structure exhibiting sensitivity to various stimuli, including mechanical ones, which are a regulator of tissue sclerostin levels. Sclerostin is a protein involved in bone remodeling, showing an anti-anabolic effect on bone density. Moderate to vigorous physical activity inhibits secretion of this protein and promotes increased bone mineral density. Appropriate exercise has been shown to have an osteogenic effect. The effectiveness of osteogenic training depends on the type, intensity, regularity and frequency of exercise and the number of body parts involved. The greatest osteogenic activity is demonstrated by exercises affecting bone with high ground reaction forces (GRF) and high forces exerted by contracting muscles (JFR). The purpose of this study was to review the literature for the effects of various forms of exercise on sclerostin secretion.
Article
Objectives: This work aimed to study the effects of Yi Jin Jing plus Elastic Band Resistance exercise on bone mineral density at all parts of the body and bone metabolism index levels in postmenopausal women. Design: Randomized controlled trial. Methods: Forty postmenopausal women were randomly assigned equally to the exercise or to the control group. The control group maintained their lifestyle behaviors unaltered, whereas the exercise group received Yi Jin Jing plus Elastic Band Resistance exercise. The primary outcome was overall bone mineral density at each part, and the secondary one was bone metabolism indicator levels and bone mineral density on both sides. Results: The results after six months showed increased bone mineral density at all parts of the body in the exercise group (spine, P = 0.002; thighs, lumbar, and whole body, P < 0.05) and decreased bone mineral density in the control group (trunk, pelvis, and spine, P < 0.01). In particular, the decrease and increase were greater on the non-preferred (left) side than on the right side. As for bone metabolism indexes, β-Crosslaps levels reduced (P = 0.016) and a significant increase in 1,25-(OH)2-D3 (P < 0.001) can be observed in the exercise group. Conclusions: The results suggested that Yi Jin Jing plus Elastic Band Resistance exercise could delay the overall decrease of bone mineral density in postmenopausal women, especially on the non-preferred side. It also increased bone formation metabolite levels and inhibited bone resorption metabolite levels.
Article
Purpose Exercise training plays an important role in maintaining the bone health and prevention of osteoporosis or age-related bone loss. Aerobic exercise, resistance exercise or a combination of both are used to maintain bone health. Mechanical loading induced by resistance exercise stimulates a number of mechanisms that help to maintain or improve bone mineral density. The present review article aims at summarizing the mechanisms and the use of resistance exercises for improving or maintaining the bone and muscle mass. Methodology Literature search was done using PubMed Central, CINAHL, sciencedirect.com with keywords resisted exercises, osteoporosis, postmenopausal and effect of resisted exercises in osteoporosis. Results Resistance exercises have a significant effect in maintaining the musculoskeletal health. Mechanical loading of the bone especially with high intensity exercises, leads to an improvement in the bone mineral density. Conclusion Resistance exercises may help to regulate the bone health and prevent the development of osteoporosis. These can be included in the exercise programmes designed for osteoporotic or postmenopausal patients.
Article
Full-text available
Objective The myokine interleukin-15 (IL-15) is capable of modifying the metabolism of both skeletal and adipose tissue. This study compares the change in serum levels of IL-15 in obese and non-obese after a single session of submaximal exercise. Methods A cross-sectional study was carried out at Jinnah Medical and Dental College, Karachi, during Aug-Dec 2015, comprising of 133 medical students (aged 17-24 years). Cardiorespiratory fitness was evaluated by Queen’s College Step Test. Blood was obtained both before and just after exercise and serum levels of IL-15 determined by enzyme-linked immunosorbent assay. Results Mean serum level of IL-15 was 3.64±1.59 pg/mL. Higher levels of IL-15 were seen in lean subjects compared to overweight/obese, both before and after three minutes of exercise (all Ptrend<.001). The percent increase in IL-15 upon exercise was 12.7% higher in lean. Significant negative association was seen between interleukin-15 and adiposity, especially visceral fat (r = –.288, p=.001). Conclusion Interleukin-15 correlates negatively with adiposity indices, especially visceral fat. With the proven benefit of IL-15 in terms of adipose tissue stores and skeletal muscle mitochondrial biogenesis, endurance exercises, even of short duration, may possess therapeutic potential towards producing a healthier body.
Article
Full-text available
Background: Falls and fall-related injuries are common, particularly in those aged over 65, with around one-third of older people living in the community falling at least once a year. Falls prevention interventions may comprise single component interventions (e.g. exercise), or involve combinations of two or more different types of intervention (e.g. exercise and medication review). Their delivery can broadly be divided into two main groups: 1) multifactorial interventions where component interventions differ based on individual assessment of risk; or 2) multiple component interventions where the same component interventions are provided to all people. Objectives: To assess the effects (benefits and harms) of multifactorial interventions and multiple component interventions for preventing falls in older people living in the community. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, trial registers and reference lists. Date of search: 12 June 2017. Selection criteria: Randomised controlled trials, individual or cluster, that evaluated the effects of multifactorial and multiple component interventions on falls in older people living in the community, compared with control (i.e. usual care (no change in usual activities) or attention control (social visits)) or exercise as a single intervention. Data collection and analysis: Two review authors independently selected studies, assessed risks of bias and extracted data. We calculated the rate ratio (RaR) with 95% confidence intervals (CIs) for rate of falls. For dichotomous outcomes we used risk ratios (RRs) and 95% CIs. For continuous outcomes, we used the standardised mean difference (SMD) with 95% CIs. We pooled data using the random-effects model. We used the GRADE approach to assess the quality of the evidence. Main results: We included 62 trials involving 19,935 older people living in the community. The median trial size was 248 participants. Most trials included more women than men. The mean ages in trials ranged from 62 to 85 years (median 77 years). Most trials (43 trials) reported follow-up of 12 months or over. We assessed most trials at unclear or high risk of bias in one or more domains.Forty-four trials assessed multifactorial interventions and 18 assessed multiple component interventions. (I2 not reported if = 0%).Multifactorial interventions versus usual care or attention controlThis comparison was made in 43 trials. Commonly-applied or recommended interventions after assessment of each participant's risk profile were exercise, environment or assistive technologies, medication review and psychological interventions. Multifactorial interventions may reduce the rate of falls compared with control: rate ratio (RaR) 0.77, 95% CI 0.67 to 0.87; 19 trials; 5853 participants; I2 = 88%; low-quality evidence. Thus if 1000 people were followed over one year, the number of falls may be 1784 (95% CI 1553 to 2016) after multifactorial intervention versus 2317 after usual care or attention control. There was low-quality evidence of little or no difference in the risks of: falling (i.e. people sustaining one or more fall) (RR 0.96, 95% CI 0.90 to 1.03; 29 trials; 9637 participants; I2 = 60%); recurrent falls (RR 0.87, 95% CI 0.74 to 1.03; 12 trials; 3368 participants; I2 = 53%); fall-related hospital admission (RR 1.00, 95% CI 0.92 to 1.07; 15 trials; 5227 participants); requiring medical attention (RR 0.91, 95% CI 0.75 to 1.10; 8 trials; 3078 participants). There is low-quality evidence that multifactorial interventions may reduce the risk of fall-related fractures (RR 0.73, 95% CI 0.53 to 1.01; 9 trials; 2850 participants) and may slightly improve health-related quality of life but not noticeably (SMD 0.19, 95% CI 0.03 to 0.35; 9 trials; 2373 participants; I2 = 70%). Of three trials reporting on adverse events, one found none, and two reported 12 participants with self-limiting musculoskeletal symptoms in total.Multifactorial interventions versus exerciseVery low-quality evidence from one small trial of 51 recently-discharged orthopaedic patients means that we are uncertain of the effects on rate of falls or risk of falling of multifactorial interventions versus exercise alone. Other fall-related outcomes were not assessed.Multiple component interventions versus usual care or attention controlThe 17 trials that make this comparison usually included exercise and another component, commonly education or home-hazard assessment. There is moderate-quality evidence that multiple interventions probably reduce the rate of falls (RaR 0.74, 95% CI 0.60 to 0.91; 6 trials; 1085 participants; I2 = 45%) and risk of falls (RR 0.82, 95% CI 0.74 to 0.90; 11 trials; 1980 participants). There is low-quality evidence that multiple interventions may reduce the risk of recurrent falls, although a small increase cannot be ruled out (RR 0.81, 95% CI 0.63 to 1.05; 4 trials; 662 participants). Very low-quality evidence means that we are uncertain of the effects of multiple component interventions on the risk of fall-related fractures (2 trials) or fall-related hospital admission (1 trial). There is low-quality evidence that multiple interventions may have little or no effect on the risk of requiring medical attention (RR 0.95, 95% CI 0.67 to 1.35; 1 trial; 291 participants); conversely they may slightly improve health-related quality of life (SMD 0.77, 95% CI 0.16 to 1.39; 4 trials; 391 participants; I2 = 88%). Of seven trials reporting on adverse events, five found none, and six minor adverse events were reported in two.Multiple component interventions versus exerciseThis comparison was tested in five trials. There is low-quality evidence of little or no difference between the two interventions in rate of falls (1 trial) and risk of falling (RR 0.93, 95% CI 0.78 to 1.10; 3 trials; 863 participants) and very low-quality evidence, meaning we are uncertain of the effects on hospital admission (1 trial). One trial reported two cases of minor joint pain. Other falls outcomes were not reported. Authors' conclusions: Multifactorial interventions may reduce the rate of falls compared with usual care or attention control. However, there may be little or no effect on other fall-related outcomes. Multiple component interventions, usually including exercise, may reduce the rate of falls and risk of falling compared with usual care or attention control.
Article
Full-text available
Objective To investigate the effect of whole-body vibration exercise (WBV) on fracture risk in adults ≥50 years of age. Design A systematic review and meta-analysis calculating relative risk ratios, fall rate ratio and absolute weighted mean difference using random effects models. Heterogeneity was estimated using I² statistics, and the Cochrane Collaboration’s risk of bias tool and the GRADE approach were used to evaluate quality of evidence and summarise conclusions. Data sources The databases PubMed, Embase and the Cochrane Central Register from inception to April 2016 and reference lists of retrieved publications. Eligibility criteria for selecting studies Randomised controlled trials examining the effect of WBV on fracture risk in adults ≥50 years of age. The primary outcomes were fractures, fall rates and the proportion of participants who fell. Secondary outcomes were bone mineral density (BMD), bone microarchitecture, bone turnover markers and calcaneal broadband attenuation (BUA). Results 15 papers (14 trials) met the inclusion criteria. Only one study had fracture data reporting a non-significant fracture reduction (risk ratio (RR)=0.47, 95% CI 0.14 to 1.57, P=0.22) (moderate quality of evidence). Four studies (n=746) showed that WBV reduced the rate of falls with a rate ratio of 0.67 (95% CI 0.50 to 0.89, P=0.0006; I²=19%) (moderate quality of evidence). Furthermore, data from three studies (n=805) found a trend towards falls reduction (RR=0.76, 95% CI 0.48 to 1.20, P=0.24; I²=24%) (low quality of evidence). Finally, moderate to low quality of evidence showed no overall effect on BMD and only sparse data were available regarding microarchitecture parameters, bone turnover markers and BUA. Conclusions WBV reduces fall rate but seems to have no overall effect on BMD or microarchitecture. The impact of WBV on fractures requires further larger adequately powered studies. This meta-analysis suggests that WBV may prevent fractures by reducing falls. PROSPERO registration number CRD42016036320; Pre-results.
Article
Full-text available
Background/Objective: Tai Chi Chuan (TCC) is suggested to have beneficial effects on the musculoskeletal system. The aim of this systematic review is to evaluate the evidence of the effect of TCC on bone mineral density (BMD) and its potential for prevention of osteoporosis. Methods: A literature search was conducted using PubMed, Embase, and Cochrane databases from inception to January 2017. Randomized controlled studies, case–control trials, prospective cohort studies, and cross-sectional studies which evaluated the effect of TCC on BMD were selected without any subject or language restriction. Results: Nine articles met the inclusion criteria, including seven randomized controlled trials (RCTs), one case–control trial (CCT), and one cross-sectional study, encompassing a total of 1222 participants. Five studies showed statistically significant improvements in BMD after TCC, three studies showed nonsignificant intergroup differences, and one study provided no statistical evaluation of results. The studies with nonsignificant results tended to have a shorter total duration of TCC practice. Apart from dual-energy X-ray absorptiometry (DXA), two studies additionally used peripheral quantitative computed tomography (pQCT) which showed statistically significant positive effects of TCC on preventing osteoporosis. Conclusion: TCC is beneficial to BMD and may be a cost-effective and preventive measure of osteoporosis. This beneficial effect is better observed in long-term TCC practice. The translational potential of this article: The beneficial effect of TCC on BMD is suggested to be clinically translated to its potential for early rehabilitation and prevention of secondary osteoporosis in patients after surgical treatment of common osteoporotic fractures. The length of practicing TCC, the form and style of TCC, and the types of patient suitable for TCC are to be investigated in future studies.
Article
Full-text available
Exercise is commonly recommended in the prevention and management of osteoporosis. The most common method to monitor bone mass and its response to interventions is bone densitometry. While closely associated with risk of fracture, densitometry-derived areal bone mineral density (aBMD) does not provide a reliable indication of bone geometry or morphological adaptation to stimuli. In fact, the effects of exercise interventions on aBMD are frequently modest, and may not fully represent the benefit of exercise to bone. Animal models suggest that mechanical loading indeed influences bone geometry and thus strength. Such an effect in humans has the potential to reduce osteoporotic fracture. The aim of the current narrative review is to provide an overview of what is known about the effects of exercise on bone geometry, with a focus on relevance to osteoporosis.
Article
Methods: Four databases were searched and yielded 1587 citations. Two reviewers independently determined study eligibility, rated risk of bias, appraised methodological quality of studies, and resolved discordance by consensus. Results: A total of 28 studies examining 2113 participants met inclusion criteria; 25 studies were suitable for meta-analyses. Four categories of exercise were identified using the ProFaNE taxonomy. After removing studies with high risk of bias and sorting them into intervention sub-types, we were able to sufficiently reduce the heterogeneity. The standardized mean difference (SMD) favored multicomponent exercise for mobility (- 0.56, 95% CI [- 0.81, - 0.32], p = 0.06, I2 = 51%); balance (0.50, 95% CI [0.27, 0.74], p = 0.28, I2 = 21%); and self-reported measures of functioning (- 0.69, 95% CI [- 1.04, - 0.34], p = 0.02, I2 = 61%). Trials were judged at low or unclear risk of selection bias, indicating inadequate reporting and at high risk of performance bias due to lack of participant blinding. The mean methodological quality rating of the studies was 63.5% indicating moderate quality. Conclusions: A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes. Due to substantial clinical heterogeneity of the target groups and specific demands of exercise modes, it is unclear which exercise program is optimal.
Article
OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management. Language: en
Article
Osteoporosis (low bone strength) and sarcopenia (low muscle mass, strength and/or impaired function) often co-exist (hence the term ‘sarco-osteoporosis’) and have similar health consequences with regard to disability, falls, frailty and fractures. Exercise and adequate nutrition, particularly with regard to vitamin D, calcium and protein, are key lifestyle approaches that can simultaneously optimize bone, muscle and functional outcomes in older people, if they are individually tailored and appropriately prescribed in terms of the type and dose. Not all forms of exercise are equally effective for optimizing musculoskeletal health. Regular walking alone has little or no effect on bone or muscle. Traditional progressive resistance training (PRT) is effective for improving muscle mass, size and strength, but it has mixed effects on muscle function and falls which may be due to the common prescription of slow and controlled movement patterns. At present, targeted multi-modal programs incorporating traditional and high-velocity PRT, weight-bearing impact exercises and challenging balance/mobility activities appear to be most effective for optimizing musculoskeletal health and function. Reducing and breaking up sitting time may also help attenuate muscle loss. There is also evidence to support an interaction between exercise and various nutritional factors, particularly protein and some multi-nutrient supplements, on muscle and bone health in the elderly. This review summary provides an overview of the latest evidence with regard to the optimal type and dose of exercise and the role of various nutritional factors for preventing bone and muscle loss and improving functional capacity in older people.