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Bae S, Lee S, Park H, Ju Y, Min SK, Cho J, Kim H, Ha YC, Rhee Y, Kim YP, Kim C. Position Statement: Exercise Guidelines for Osteoporosis Management and Fall Prevention in Osteoporosis Patients. J Bone Metab 2023; 30:149-165. [PMID: 37449348 PMCID: PMC10345999 DOI: 10.11005/jbm.2023.30.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The effectiveness of exercise for improving osteoporosis and fall prevention in patients diagnosed with osteoporosis or osteopenia has not been fully summarized. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology has developed exercise guidelines for patients with osteoporosis or osteopenia and provide evidence-based recommendations. METHODS A systematic review identified randomized controlled trials (RCT) assessing the effect of resistance, impact, balance, aerobic training, and physical activity in osteoporosis and osteopenia on bone quality, physical performance, quality of life, and fall prevention. PubMed, Embase, KoreaMed, and RISS were searched from January 2000 to August 2022. Ten key questions were established to review the evidence and formulate recommendations. RESULTS The 50 RCTs reported that even with osteoporosis and osteopenia, resistance and impact training consistently maximized bone strength, improved body strength and balance, and eventually reduced fall incidences. Resistance exercise combining 3 to 10 types of free weight and mechanical exercise of major muscle groups performed with an intensity of 50% to 85% 1-repetition maximum, 5 to 12 repetitions/set, 2 to 3 days/week, for 3 to 12 months is recommended. Impact exercises such as jumping chin-ups with drop landings and jump rope performed 50 jumps/session for at least 6 months with 3 or more days/week are recommended. CONCLUSIONS A multi-component exercise mainly comprised of resistance and impact exercise seems to be an effective strategy to attenuate the risk factors of osteoporosis and osteopenia. The integration of exercise guidelines and individualized exercise plans has significant potential to reduce the morbidity and mortality of osteoporosis.
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Affiliation(s)
- Seongryu Bae
- Department of Health Care and Science, Dong-A University, Busan,
Korea
| | - Seungyong Lee
- Department of Physical Education, Incheon National University, Incheon,
Korea
| | - Hyuntae Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan,
Korea
| | - Yongin Ju
- Department of Health and Sports Science, Kawasaki University of Medical Welfare, Kawasaki,
Japan
| | - Seok-Ki Min
- Department of Sport Science, Korea Institute of Sport Science, Seoul,
Korea
| | - Jinkyung Cho
- Department of Sport Science, Korea Institute of Sport Science, Seoul,
Korea
| | - Hyojin Kim
- Department of Physical Education, Dongduk Women’s University, Seoul,
Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul,
Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul,
Korea
| | - Young-Pyo Kim
- Department of Kinesiology, College of Natural Science, Jeju National University, Jeju,
Korea
| | - Changsun Kim
- Department of Physical Education, Dongduk Women’s University, Seoul,
Korea
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Schinzel E, Kast S, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, Kladny B, Lange U, Peters S, Thomasius F, Clausen J, Uder M, Kemmler W. The effect of aquatic exercise on bone mineral density in older adults. A systematic review and meta-analysis. Front Physiol 2023; 14:1135663. [PMID: 36994417 PMCID: PMC10042290 DOI: 10.3389/fphys.2023.1135663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
Introduction: Aquatic or water-based exercise is a very popular type of exercise in particular for people with physical limitations, joint problems and fear of falling. The present systematic review and meta-analysis aimed to provide evidence for the effect of aquatic exercise on Bone Mineral Density (BMD) in adults.Methods: A systematic literature search of five electronic databases (PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science and CINAHL) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted until 2022/01/30, with an update to 2022/10/07. We included controlled trials with a duration of more than 6 months and at least two study groups, aquatic exercise (EG) versus non-training controls (CG) with no language restrictions. Outcome measures were standardized mean differences (SMD) with 95%-confidence intervals (95%-CI) for BMD changes at the lumbar spine (LS) and femoral neck (FN). We applied a random-effects meta-analysis and used the inverse heterogeneity (IVhet) model to analyze the data.Results: Excluding an outlier study with an exceptionally high effect size for LS-BMD, we observed a statistically significant (p = .002) effect (EG vs. CG) of aquatic exercise for the LS-BMD (n = 10; SMD: 0.30; 95%-CI: 0.11–0.49). In parallel, the effect of aquatic exercise on FN-BMD was statistically significant (p = .034) compared to the CG (n = 10; SMD: 0.76, 95%-CI: 0.06–1.46). Of importance, heterogeneity between the trial results was negligible for LS (I2: 7%) but substantial for FN-BMD (I2: 87%). Evidence for risks of small study/publication bias was low for LS-BMD and considerable for FN-BMD.Discussion: In summary, the present systematic review and meta-analysis provides further evidence for the favorable effect of exercise on bone health in adults. Due to its safety and attractiveness, we particularly recommend water-based exercise for people unable, afraid or unmotivated to conduct intense land-based exercise programs.
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Affiliation(s)
- Eileen Schinzel
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Stephanie Kast
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
| | - Matthias Kohl
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - Simon von Stengel
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
| | - Franz Jakob
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- Bernhard-Heine-Centrum für Bewegungsforschung, University of Würzburg, Würzburg, Germany
| | - Katharina Kerschan-Schindl
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- Austrian Society for Bone and Mineral Research, Vienna, Austria
| | - Bernd Kladny
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- German Society for Orthopaedics and Trauma (DGOU), Berlin, Germany
| | - Uwe Lange
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- German Society for Physical and Rehabilitative Medicine, Leipzig, Germany
| | - Stefan Peters
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- German Association for Health-Related Fitness and Exercise Therapy (DVGS), Hürth, Germany
| | - Friederike Thomasius
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- Osteology Umbrella Association Germany, Austria, Switzerland
- Frankfurt Center of Bone Health, Frankfurt, Germany
| | - Jürgen Clausen
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- Deutsche Rheuma-Liga Bundesverband eV, Bonn, Germany
| | - Michael Uder
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
| | - Wolfgang Kemmler
- Institute of Radiology, FAU-Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Research Group on Guideline “Exercise and Fracture Prevention”, Frankfurt, Germany
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Wolfgang Kemmler,
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Ito E, Sato Y, Kobayashi T, Soma T, Matsumoto T, Kimura A, Miyamoto K, Matsumoto H, Matsumoto M, Nakamura M, Sato K, Miyamoto T. Low energy availability reduces bone mass and gonadal function in male mice. J Bone Miner Metab 2023; 41:182-192. [PMID: 36914793 DOI: 10.1007/s00774-023-01413-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION In women, the female athlete triad, marked by low energy availability, functional hypothalamic amenorrhea and osteoporosis, is a recognized risk for stress fractures. Stress injuries also occur in men, but by contrast risks and mechanisms underlying them are less characterized. MATERIALS AND METHODS 5 week-old wild-type male mice were fed ad libitum (ad) or subjected to 60% food restriction (FR) for five weeks. In both groups, some mice were allowed access to an exercise wheel in cages to allow voluntary wheel running (ex) and/or treated with active vitamin D analogues. Mice were sacrificed and analyzed at 10 weeks of age. RESULT Male FR mice exhibited significantly reduced testicle weight, serum testosterone levels and bone mass. Such bone losses in FR male mice were enhanced by exercise. Histological analysis revealed that both bone-resorbing and -forming activities were significantly reduced in FR or FR plus exercise (FR + ex) mice, mimicking a state of low bone turnover. Significantly reduced bone mass in FR or FR + ex male mice was significantly rescued by treatment with active vitamin D analogues, with significant restoration of osteoblastic activities. Serum levels of insulin-like growth factor I (IGF-I), which is critical for bone remodeling, were significantly lower in FR versus control male mice. CONCLUSIONS Low energy availability puts men at risk for stress injuries as well, and low energy availability is upstream of gonadal dysfunction and osteoporosis in males. Active vitamin D analogues could serve as therapeutic or preventive options for stress injuries in men.
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Affiliation(s)
- Eri Ito
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yuiko Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tami Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoya Soma
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tatsuaki Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atushi Kimura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Mohebbi R, Shojaa M, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, Lange U, Peters S, Thomasius F, Uder M, Kemmler W. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporos Int 2023:10.1007/s00198-023-06682-1. [PMID: 36749350 DOI: 10.1007/s00198-023-06682-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16-0.42), 0.27 (95% CI: 0.16-0.39), and 0.41 (95% CI: 0.30-0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I2 = 20%, TH BMD) to substantial (I2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur.
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Affiliation(s)
- Ramin Mohebbi
- Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Mahdieh Shojaa
- Department Population-Based Medicine, Institute of Health Science, University Hospital Tübingen, Tübingen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Franz Jakob
- Bernhard-Heine-Centrum Für Bewegungsforschung, University of Würzburg, Würzburg, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Katharina Kerschan-Schindl
- Austrian Society for Bone and Mineral Research, Vienna, Austria
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Uwe Lange
- German Society for Physical and Rehabilitative Medicine, Dresden, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Stefan Peters
- German Association for Health-Related Fitness and Exercise Therapy (DVGS), Hürth-Efferen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Friederike Thomasius
- Osteology Umbrella Association Germany, Austria, Switzerland
- Frankfurt Center of Bone Health, Frankfurt, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany.
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.
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Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos 2022; 17:102. [PMID: 35896850 DOI: 10.1007/s11657-022-01140-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023]
Abstract
Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal. PURPOSE This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women. METHODS A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI). RESULTS The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm2; 95% CI, 0.00 to 0.01], p = 0.0005; I2 = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm2, 95% CI, 0.01 to 0.02], I2 = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm2, 95% CI 0.00, 0.02]; p = 0.009; I2 = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD. CONCLUSION Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.
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Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels. Int J Mol Sci 2021; 23:ijms23010044. [PMID: 35008468 PMCID: PMC8744774 DOI: 10.3390/ijms23010044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/23/2022] Open
Abstract
Calciotropic hormones, parathyroid hormone (PTH) and calcitonin are involved in the regulation of bone mineral metabolism and maintenance of calcium and phosphate homeostasis in the body. Therefore, an understanding of environmental and genetic factors influencing PTH and calcitonin levels is crucial. Genetic factors are estimated to account for 60% of variations in PTH levels, while the genetic background of interindividual calcitonin variations has not yet been studied. In this review, we analyzed the literature discussing the influence of environmental factors (lifestyle factors and pollutants) on PTH and calcitonin levels. Among lifestyle factors, smoking, body mass index (BMI), diet, alcohol, and exercise were analyzed; among pollutants, heavy metals and chemicals were analyzed. Lifestyle factors that showed the clearest association with PTH levels were smoking, BMI, exercise, and micronutrients taken from the diet (vitamin D and calcium). Smoking, vitamin D, and calcium intake led to a decrease in PTH levels, while higher BMI and exercise led to an increase in PTH levels. In terms of pollutants, exposure to cadmium led to a decrease in PTH levels, while exposure to lead increased PTH levels. Several studies have investigated the effect of chemicals on PTH levels in humans. Compared to PTH studies, a smaller number of studies analyzed the influence of environmental factors on calcitonin levels, which gives great variability in results. Only a few studies have analyzed the influence of pollutants on calcitonin levels in humans. The lifestyle factor with the clearest relationship with calcitonin was smoking (smokers had increased calcitonin levels). Given the importance of PTH and calcitonin in maintaining calcium and phosphate homeostasis and bone mineral metabolism, additional studies on the influence of environmental factors that could affect PTH and calcitonin levels are crucial.
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Exercise and Nutrition Impact on Osteoporosis and Sarcopenia-The Incidence of Osteosarcopenia: A Narrative Review. Nutrients 2021; 13:nu13124499. [PMID: 34960050 PMCID: PMC8705961 DOI: 10.3390/nu13124499] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.
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Polisel EEC, Beck WR, Scariot PPM, Pejon TMM, Gobatto CA, Manchado-Gobatto FB. Effects of high-intensity interval training in more or less active mice on biomechanical, biophysical and biochemical bone parameters. Sci Rep 2021; 11:6414. [PMID: 33742012 PMCID: PMC7979708 DOI: 10.1038/s41598-021-85585-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
High-intensity interval training (HIIT) is of scientific interest due its role in improving physical fitness, but the effects of HIIT on bone health need be carefully explored. Further, it is necessary to know whether HIIT effects on bone health are dependent on the physical activity levels. This may be experimentally tested since we have built a large cage (LC) that allows animals to move freely, promoting an increase of spontaneous physical activity (SPA) in comparison to a small cage (SC). Thus, we examined the effects of HIIT on biophysical, biomechanical and biochemical parameters of bone tissue of C57BL/6J mice living in cages of two different sizes: small (SC) or large (LC) cages with 1320 cm2 and 4800 cm2 floor space, respectively. Male mice were subdivided into two groups within each housing type: Control (C) and Trained (T). At the end of the interventions, all mice were euthanized to extract the femur bone for biophysical, biomechanical and biochemical analyses. Based a significant interaction from two-way ANOVA, trained mice kept in large cage (but not for trained mice housed in SC) exhibited a reduction of tenacity and displacement at failure in bone. This suggests that long-term HIIT program, in addition with a more active lifestyle correlates with exerts negative effects on the bone of healthy mice. A caution must also be raised about the excessive adoption of physical training, at least regarding bone tissue. On the other hand, increased calcium was found in femur of mice housed in LC. In line with this, LC-C mice were more active (i.e. SPA) than other groups. This implies that an active lifestyle without long-term high intensity physical training seems to play a role in promoting benefits to bone tissue. Our data provides new insights for treatment of osteo-health related disorders.
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Affiliation(s)
- Emanuel E. C. Polisel
- grid.411087.b0000 0001 0723 2494Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP 13484-350 Brazil
| | - Wladimir R. Beck
- grid.411247.50000 0001 2163 588XLaboratory of Endocrine Physiology and Physical Exercise, Department of Physiological Sciences, Federal University of São Carlos, São Carlos, SP Brazil
| | - Pedro P. M. Scariot
- grid.411087.b0000 0001 0723 2494Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP 13484-350 Brazil
| | - Taciane M. M. Pejon
- grid.411247.50000 0001 2163 588XLaboratory of Endocrine Physiology and Physical Exercise, Department of Physiological Sciences, Federal University of São Carlos, São Carlos, SP Brazil
| | - Claudio A. Gobatto
- grid.411087.b0000 0001 0723 2494Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP 13484-350 Brazil
| | - Fúlvia B. Manchado-Gobatto
- grid.411087.b0000 0001 0723 2494Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Pedro Zaccaria Street, 1.300, Jardim Santa Luíza, Limeira, SP 13484-350 Brazil
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Shojaa M, Von Stengel S, Schoene D, Kohl M, Barone G, Bragonzoni L, Dallolio L, Marini S, Murphy MH, Stephenson A, Mänty M, Julin M, Risto T, Kemmler W. Effect of Exercise Training on Bone Mineral Density in Post-menopausal Women: A Systematic Review and Meta-Analysis of Intervention Studies. Front Physiol 2020; 11:652. [PMID: 32655410 PMCID: PMC7325605 DOI: 10.3389/fphys.2020.00652] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a major health problem in post-menopausal women (PMW). Exercise training is considered a cost-effective strategy to prevent osteoporosis in middle aged-older people. The purpose of this study is to summarize the effect of exercise on BMD among PMW. A comprehensive search of electronic databases was conducted through PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest, and Primo. BMD changes (standardized mean differences: SMD) of the lumbar spine (LS) femoral neck (FN) and/or total hip were considered as outcome measures. After subgroup categorization, statistical methods were used to combine data and compare subgroups. Seventy-five studies were included. The pooled number of participants was 5,300 (intervention group: n = 2,901, control group: n = 2,399). The pooled estimate of random effect analysis was SMD = 0.37, 95%-CI: 0.25–0.50, SMD = 0.33, 95%-CI: 0.23–0.43, and SMD = 0.40, 95%-CI: 0.28–0.51 for LS, FN, and total Hip-BMD, respectively. In the present meta-analysis, there was a significant (p < 0.001), but rather low effect (SMD = 0.33–0.40) of exercise on BMD at LS and proximal femur. A large variation among the single study findings was observed, with highly effective studies but also studies that trigger significant negative results. These findings can be largely attributed to differences among the exercise protocols of the studies. Findings suggest that the true effect of exercise on BMD is diluted by a considerable amount of studies with inadequate exercise protocols.
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Affiliation(s)
- Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Simon Von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, Institute of Precision Medicine, Furtwangen University, Furtwangen im Schwarzwald, Germany
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Sofia Marini
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Marie H Murphy
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Aoife Stephenson
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Strategy and Research, Vantaa, Finland
| | - Mikko Julin
- Department of Physiotherapy, Laurea University of Applied Sciences, Espoo, Finland
| | - Tapani Risto
- Department of Physiotherapy, Laurea University of Applied Sciences, Espoo, Finland
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Balance as an Additional Effect of Strength and Flexibility Aquatic Training in Sedentary Lifestyle Elderly Women. Curr Gerontol Geriatr Res 2020; 2020:1895473. [PMID: 32411217 PMCID: PMC7204381 DOI: 10.1155/2020/1895473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/10/2019] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate the additional effects of on balance an aquatic muscle strengthening and flexibility training program in healthy sedentary lifestyle elderly women. Method This controlled clinical trial included 56 healthy sedentary women, aged from 65 to 70 years, divided into two groups. The aquatic group (AG) underwent aquatic training (45 minutes/session, 32 sessions), and the control group (CG) received no intervention. Data were collected pre- and post-intervention, during a one-week period. Lower limb muscle strength was measured by a force sensor (myometer). Flexibility was measured by biophotogrammetry. Functional balance was evaluated by the Performance Oriented Mobility Assessment (POMA) and the Berg Balance Scale (BBS). Results Muscle strength, flexibility, and balance improved in AG (p < 0.001), but not in CG. Conclusion The aquatic exercises program, which was originally developed to promote muscle strength and flexibility, also improved functional balance. Aquatic training is an option for physical health promotion for sedentary lifestyle elderly women.
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Marini S, Barone G, Masini A, Dallolio L, Bragonzoni L, Longobucco Y, Maffei F. The Effect of Physical Activity on Bone Biomarkers in People With Osteoporosis: A Systematic Review. Front Endocrinol (Lausanne) 2020; 11:585689. [PMID: 33193098 PMCID: PMC7644859 DOI: 10.3389/fendo.2020.585689] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Bone imbalance between anabolic and catabolic processes at the level of remodeling unit due to the prevalence of resorbing activity, represents a health problem of aging. The consequence is the negative balance of bone turnover that can lead to osteoporosis. Physical activity (PA) can play a central role in the comprehensive management of osteoporosis, since it induces the anabolism of bone tissue. Bone turnover biomarkers, reflecting the cellular activity linked to bone metabolism, can represent an evaluation tool to assess the efficacy of PA in the osteoporotic population. The aim of this systematic review, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, was to investigate the effects of PA interventions on bone biomarkers in people with osteoporosis. METHODS A comprehensive literature search of electronic databases was conducted through PubMed, Cochrane, Cinahl, Embase, Trip, to find randomized controlled trials (RCTs) investigating the topic of PA and bone turnover biomarkers in the osteoporosis population. In accordance with the Cochrane risk-of-bias tool, the quality of each study was assessed. RESULTS Out of 992 identified articles, 136 full texts were screened. Only three RTCs matched the eligibility criteria. In one study, sub-maximal aerobic exercise improved Bone-specific alkaline phosphatase (bone formation biomarker) and Amino-terminal Crosslinked Telopeptide of type 1 collagen (bone resorption biomarker) in osteoporotic women. The other two studies showed a positive effect on total alkaline phosphatase (a non-specific bone formation biomarker) in women with osteoporosis. CONCLUSION The systematic review revealed possible exercise benefits in terms of improving bone formation and decreasing bone resorption biomarkers in the osteoporotic population. However, these results should be interpreted with caution, especially due to the limited number and poor quality of the studies included. Further research is needed to estimate the influence of PA on bone biomarkers in the osteoporosis management.
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Affiliation(s)
- Sofia Marini
- Department of Life Quality Studies, University of Bologna, Campus of Rimini, Rimini, Italy
| | - Giuseppe Barone
- Department of Life Quality Studies, University of Bologna, Campus of Rimini, Rimini, Italy
| | - Alice Masini
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
- *Correspondence: Alice Masini,
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Laura Bragonzoni
- Department of Life Quality Studies, University of Bologna, Campus of Rimini, Rimini, Italy
| | - Yari Longobucco
- Clinical and Experimental Medicine Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Maffei
- Department of Life Quality Studies, University of Bologna, Campus of Rimini, Rimini, Italy
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Gandolfi NRS, Corrente JE, De Vitta A, Gollino L, Mazeto GMFDS. The influence of the Pilates method on quality of life and bone remodelling in older women: a controlled study. Qual Life Res 2019; 29:381-389. [PMID: 31512157 DOI: 10.1007/s11136-019-02293-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to evaluate the effects of the Pilates method on quality of life and bone remodeling markers in a group of older women. METHODS A longitudinal prospective study with intervention was performed on 40 women aged over 60 years; they were divided into two groups: one submitted to a 50-min Pilates exercise session once a week for 20 weeks (Pilates), and the other was not (Control). Both groups were compared for quality of life using the Medical Outcomes Study 36, and for bone-specific alkaline phosphatase (BSAP) and Type 1 collagen C-telopeptide (CTx) bone remodeling markers. RESULTS The Pilates group presented improvement in the quality of life evaluation scores: physical functioning (67.50 ± 18.88 × 86.25 ± 9.58; p = 0.0232), and physical component summary (65.00 ± 14.39 × 79.70 ± 3.83; p = 0.0220). The Pilates group also presented higher scores than that of Controls after the exercise program: physical functioning (86.25 ± 9.58 × 55.50 ± 20.83, p = 0.0003), physical role (100.00 ± 0.00 × 41.25 ± 46.79, p = 0.0009), emotional role (100.00 ± 0.00 × 48.33 ± 50.12, p = 0.0046), vitality (82.50 ± 14.28 × 60.25 ± 21.43, p = 0.011), physical component summary (79.70 ± 3.83 × 54.90 ± 15.05, p < 0.0001), and emotional component summary (74.10 ± 8.37 × 54.18 ± 22.55, p = 0.0111). No changes were noted in bone remodeling markers [CTx (0.39 ± 0.26 × 0.38 ± 0.22 ng/mL) and BSAP (10.73 ± 2.40 × 11.01 ± 3.56 μg/L)] and did not differ from the Control group both before (CTx: 0.39 ± 0.26 × 0.37 ± 0.17 ng/mL; BSAP: 10.73 ± 2.40 × 10.58 ± 3.49 μg/L; p > 0.05) and after exercise (CTx: 0.38 ± 0.22 × 0.38 ± 0.22 ng/mL; BSAP: 11.01 ± 3.56 × 9.85 ± 3.12 μg/L; p > 0.05). CONCLUSION The group of women submitted to Pilates presented improved quality of life but without changes in bone remodeling.
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Affiliation(s)
| | - Jose Eduardo Corrente
- Biostatistics Department, Institute of Biosciences, Sao Paulo State University - Unesp, Botucatu, Sao Paulo, 18618-687, Brazil
| | - Alberto De Vitta
- Universidade Anhanguera - UNIDERP, Campo Grande, Mato Grosso do Sul, 79037-280, Brazil
| | - Loraine Gollino
- Internal Medicine Department, Botucatu Medical School, Sao Paulo State University - Unesp, Botucatu, Sao Paulo, 18618-687, Brazil
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Zhang L, Chen X, Wu J, Yuan Y, Guo J, Biswas S, Li B, Zou J. The effects of different intensities of exercise and active vitamin D on mouse bone mass and bone strength. J Bone Miner Metab 2017; 35:265-277. [PMID: 27357401 DOI: 10.1007/s00774-016-0764-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
Physical exercise is beneficial to bone health. However, little is known how different intensities of exercise affect bone mass and strength. In the present study, we used young mice to study the effects of different intensities of exercise on bone mass and bone strength in comparison to pharmacological doses of active vitamin D (calcitriol). We found that only the medium level of exercise tested showed a positive effect on bone mineral density, trabecular bone volume, and bone strength, which are attributable to a decrease in bone resorption and an increase in bone formation, with the latter being accompanied by an increase in the number of osteogenic mesenchymal stem cells in the bone marrow. Calcitriol increases bone volume and bone strength, yet the combination of calcitriol and medium-intensity exercise did not further improve bone mass or strength. Moreover, calcitriol also showed some protective effect on the bone in mice with high levels of exercise. These results indicate that exercise at medium intensity increases bone mass and strength via affecting both bone formation and resorption and that its beneficial effects on bone mass cannot be further improved by calcitriol.
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Affiliation(s)
- Lingli Zhang
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
| | - Xi Chen
- School of Sports Science, Wenzhou Medical University, Wenzhou, 325035, China
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
| | - Juanni Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
| | - Yu Yuan
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
| | - Jianmin Guo
- School of Kinesiology, Shanghai University of Sport, Shanghai, 200438, China
| | - Soma Biswas
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Baojie Li
- Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Bio-X Institutes, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jun Zou
- Scientific Research Department, Shanghai University of Sport, 399 Changhai Road, Yangpu District, Shanghai, 200438, China.
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14
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Simas V, Hing W, Pope R, Climstein M. Effects of water-based exercise on bone health of middle-aged and older adults: a systematic review and meta-analysis. Open Access J Sports Med 2017; 8:39-60. [PMID: 28392717 PMCID: PMC5376183 DOI: 10.2147/oajsm.s129182] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Age-related bone loss is a major health concern. Only exercises associated with high-impact and mechanical loading have been linked to a positive effect on bone turnover; however, these types of exercises may not always be appropriate for middle-aged and older adults due to physical decline or chronic disorders such as osteoarthritis. Water-based exercise (WBE) has been shown to affect different components of physical fitness, has lower risks of traumatic fracture, and applies less stress to joints. However, the effects of WBE on bone health are unclear. OBJECTIVE This study aimed to explore whether WBE is effective in preventing age-related bone deterioration in middle-aged and older adults. METHODS A search of relevant databases and the references of identified studies was performed. Critical narrative synthesis and meta-analyses were conducted. RESULTS Eleven studies, involving 629 participants, met all inclusion criteria. All participants were postmenopausal women. Eight studies compared WBE to a sedentary control group, and four studies had land-based exercise (LBE) participants as a comparison group. Meta-analyses revealed significant differences between WBE and control group in favor of WBE for changes in bone mineral density (BMD) at the lumbar spine (mean difference [MD] 0.03 g/cm2; 95% confidence interval [CI]: 0.01 to 0.05) and femoral neck (MD 0.04 g/cm2; 95% CI: 0.02 to 0.07). Significant differences were also revealed between WBE and LBE in favor of LBE for changes in lumbar spine BMD (MD -0.04 g/cm2; 95% CI: -0.06 to -0.02). However, there was no significant difference between WBE and LBE for changes in femoral neck BMD (MD -0.03 g/cm2; 95% CI: -0.08 to 0.01). CONCLUSION WBE may have benefits with respect to maintaining or improving bone health in postmenopausal women but less benefit when compared to LBE. Further research is required on this topic.
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Affiliation(s)
- Vini Simas
- Water-Based Research Unit, Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD
| | - Wayne Hing
- Water-Based Research Unit, Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD
| | - Rodney Pope
- Water-Based Research Unit, Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD
| | - Mike Climstein
- Water-Based Research Unit, Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD; Exercise, Health and Performance Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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15
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[New strategies for exercise training in osteoporosis]. Unfallchirurg 2015; 118:933-7. [PMID: 26467265 DOI: 10.1007/s00113-015-0080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the prevention and treatment of osteoporosis, movement with muscle strengthening and proprioceptive training plays a major role. This was taken into consideration in the guidelines by the governing body on osteoporosis (Dachverband Osteoporose, DVO) from 2014 on prophylaxis, diagnosis and treatment of osteoporosis and in the DVO guidelines from 2008 on physiotherapy and exercise therapy for osteoporosis. Increases in lumbar bone density of between 0.5 % and 2.5 % can be achieved in women by strengthening exercises with high resistance. With this combination and strengthening of the quadriceps muscle a reduction of falls and hence the fracture risk could also be achieved. In traumatology, training for muscle strengthening is not always possible, especially for elderly patients. Practically relevant alternatives are regular walking and aquatraining, which may also lead to a significant increase in bone mineral density. Furthermore, large effects can be achieved with alternating side whole-body vibration (WBV) training with whole body vibration plates with only 3 days of training per week and with short training periods (15-20 min). Rates of increase in leg strength between 20 % and almost 40 % and in bone density between 0.5 % and 4 % in 6 months have been described. Whether and with what intensity whole body vibration therapy could be used for e.g. more rapid healing of fractures, is currently unclear. Initial positive results have been described in animal models.
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Zhao R, Zhao M, Xu Z. The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int 2015; 26:1605-18. [PMID: 25603795 DOI: 10.1007/s00198-015-3034-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED This meta-analysis synthesized current evidence from 24 clinical trials to evaluate the impact of different resistance training modes on postmenopausal bone loss. Exercise interventions were categorized into two training modes, namely resistance-alone versus combined resistance training protocols. The combined resistance training protocols were defined as the combination of resistance training and high-impact or weight-bearing exercise. The results suggested that the combined resistance training protocols were effective in improving bone mineral density (BMD) at the femoral neck and lumbar spine. INTRODUCTION The current meta-analysis aimed to examine the effects of combined resistance and resistance-alone training protocols on the preservation of femoral neck and lumbar spine BMD in postmenopausal women. METHODS An electronic database search was conducted in PubMed, EMBASE, SPORTDiscus, Web of Science, and ProQuest up to March 1, 2014 for the influence of resistance exercise on BMD in postmenopausal women. The study quality was evaluated. The effect sizes were estimated in terms of the standardized mean difference (SMD). A subgroup analysis was conducted by exercise categories. RESULTS Twenty-four studies were included in the overall analysis of skeletal response to resistance exercise. The between-study heterogeneity was evident for the hip (I (2) = 46.5%) and spine (I (2) = 62.3%). The overall analysis suggested that resistance training significantly increased femoral neck BMD (SMD = 0.303, 95% confidence interval (95% CI) = 0.127-0.479, p = 0.001) and lumbar spine BMD (SMD = 0.311, 95% CI = 0.115-0.507, p = 0.002) in postmenopausal women. However, subgroup analysis indicated that combined resistance training programs significantly affected both the hip BMD (SMD = 0.411, 95% CI = 0.176-0.645, p = 0.001) and spine BMD (SMD = 0.431, 95% CI = 0.159-0.702, p = 0.002), whereas resistance-alone protocols only produced nonsignificant positive effects both on the femoral neck and lumbar spine BMD. CONCLUSIONS Combined resistance exercise protocols appear effective in preserving femoral neck and lumbar spine BMD in postmenopausal women, whereas resistance-alone protocols only produced a nonsignificant positive effect.
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Affiliation(s)
- R Zhao
- College of Physical Education and Health Sciences, Zhejiang Normal University, 688 Yingbin Road, Jinhua, 321004, Zhejiang Province, China,
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