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Zouhal H, Berro AJ, Maliha E, Khalil N, El Khoury G, Jayavel A, Laziri F, Saeidi A, Laher I, El Hage R. Team sports practice and bone health: A systematic review and meta- analysis. J Clin Densitom 2024; 27:101508. [PMID: 39068702 DOI: 10.1016/j.jocd.2024.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
The primary aim of this study was to explore the effects of team sports practice on bone health indices in adults engaged in team sports. The secondary aim was to investigate the osteogenic effects of each type of team sport. This systematic literature search was conducted using common electronic databases from inception in June 2023, using key terms (and synonyms searched for by the MeSH database) that were combined using the operators "AND", "OR", "NOT": (``men'' OR ``man'' OR ``women'' OR ``woman'') AND (``bone mineral density'' OR ``BMD'' OR ``bone mineral content'' OR ``BMC'' OR ``peak bone mass'' OR ``mechanical loading'' OR ``osteoporosis'' OR ``bone geometry'' OR ``bone resistance'') AND (``team sport'' OR ``sport'' OR rugby OR basketball OR volleyball OR handball OR soccer OR football OR ``players''). After screening, 16 studies were included in the final analysis (5 continents, 2740 participants). The training duration lasted 1 to 13 years. Team sport training had a moderate impact on whole body bone mineral density (WB BMD) (1.07 SMD; 95 % [0.77, 1.37], p < 0.00) but a more significant impact on whole body bone mineral content (WB BMC) (1.3 SMD; 95 % [0.81, 1.79], p < 0.00). Subgroup analyses indicated that rugby training had a moderate but non-significant impact on WB BMD (1.19 SMD; 95 % [-0.13, 2.52], p = 0.08) but a greater impact on WB BMC (2.12 SMD; 95 % [0.84, 3.39], p < 0.00); basketball training had a moderate but significant impact on WB BMD (1 SMD; 95 % [0.35, 1.64], p < 0.00) and a trivial non-significant impact on WB BMC (0.18 SMD; 95 % [-1.09, 1.46], p = 0.78); volleyball training had a moderate but non-significant impact on WB BMD (0.63 SMD; 95 % [-0.22, 1.49], p = 0.15) and a significant impact on WB BMC (2.39 SMD; 95 % [1.45, 3.33], p < 0.00). Handball training produced a moderate significant impact on WB BMD (1.02 SMD; 95 % [0.33, 1.71], p < 0.00) and WB BMC (0.97 SMD; 95 % [0.47, 1.48], p < 0.00), and soccer training led to moderate but significant effects on WB BMD (1.16 SMD; 95 % [0.88, 1.44], p < 0.00) and a large effect on WB BMC (1.34 SMD; 95 % [0.92, 1.77], p < 0.00). Rugby training was associated with a higher WB BMC compared to basketball training (p = 0.03). Our systematic review and meta-analysis suggests that team sports, such as rugby, basketball, volleyball, handball and soccer have moderate to large effects on WB BMD and WB BMC. Specifically, our findings indicate that handball and soccer enhance WB BMD and WB BMC, whereas rugby only increases WB BMC. There is currently insufficient evidence indicating the superiority of any type of sport training that improves bone health in adults.
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Affiliation(s)
- Hassane Zouhal
- University of Rennes, M2S (Laboratoire Mouvement, Sport, Santé) - EA 1274, F-35000 Rennes, France; Institut International des Sciences du Sport (2I2S), 35850 Irodouer, France
| | - Abdel-Jalil Berro
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon
| | - Elie Maliha
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon
| | - Nour Khalil
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon
| | - Gisèle El Khoury
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon
| | - Ayyappan Jayavel
- SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur, Kanchipuram, India
| | - Fatiha Laziri
- Laboratoire Ecologie, Environnement et Santé Equipe Santé Humaine et Environnement Faculté des Sciences de Université Moulay Ismail, Meknès, Morocco
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, University of Kurdistan, Sanandaj, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, Canada
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon.
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Bagheri R, Karimi Z, Mousavi Z, Ziaee Bashirzad M, Camera DM, Sadeghi R, Dabbagh VR, Kargarfard M, Dutheil F. High-Protein Diets during either Resistance or Concurrent Training Have No Detrimental Effect on Bone Parameters in Resistance-Trained Males. Nutrients 2024; 16:325. [PMID: 38276563 PMCID: PMC10819948 DOI: 10.3390/nu16020325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The effects of combining resistance training (RT) and concurrent training (CT; resistance + endurance training) with varied protein doses on bone measures remain poorly understood. Hence, we conducted a comparison of the impacts of two high-protein diets (1.6 or 3.2 g kg-1 d-1) over 16 weeks in resistance-trained males, either with CT or RT alone. METHODS A total of forty-eight males, all of whom were resistance-trained, had the following demographics: 26.6 ± 6 years, body mass index: 25.6 ± 2.9 kg m-2 administered either 3.2 g kg-1 d-1 protein (CT2; n = 12; RT2; n = 12) or 1.6 g kg-1 d-1 protein (CT1; n = 12; RT1; n = 12) during 16 weeks (four sessions·w-1). Bone parameters were assessed pre- and post-intervention. RESULTS There was no significant interaction between the intervention group and time for the legs, arms, ribs, or pelvis area BMC and BMD (p > 0.05). For the BMD of the pelvis and the BMC of the right ribs, however, there were significant time effects noted (p < 0.05). Furthermore, there was a significant interaction between the intervention group and time in the lumbar and thoracic spines, with a particular time effect noted for the thoracic spine region (p < 0.05). The regional differences in skeletal responses to the intervention are highlighted by these data. CONCLUSION Our findings show that the intake of two high-protein diets combined with RT and CT during 16 weeks had no adverse effects on bone tissue parameters. While these findings indicate that protein intake between 2 and 3 times the current RDI does not promote bone demineralization when consumed in conjunction with exercise, future studies investigating the long-term effects of chronic high protein intake on bone tissue health are warranted.
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Affiliation(s)
- Reza Bagheri
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan 8174673441, Iran;
| | - Zohreh Karimi
- Department of Physical Education and Sport Sciences, Science and Research Branch, Islamic Azad University, Tehran 1477893855, Iran;
| | - Zeynabalsadat Mousavi
- Nutrition and Food Service, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran 1416634793, Iran;
| | - Mahdi Ziaee Bashirzad
- Department of Sport Science, Islamic Azad University, Bojnourd Branch, Bojnourd 9417697796, Iran;
| | - Donny M. Camera
- Department of Health and Biostatistics, Swinburne University, Melbourne, VIC 3122, Australia;
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad 9177949025, Iran; (R.S.); (V.R.D.)
| | - Vahid Reza Dabbagh
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad 9177949025, Iran; (R.S.); (V.R.D.)
| | - Mehdi Kargarfard
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan 8174673441, Iran;
| | - Frederic Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Witty Fit, F-63000 Clermont-Ferrand, France;
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Berro AJ, El Hawly W, El Khoury G, El Hage Z, Jayavel A, Saeidi A, Laher I, Pinti A, Bassim Y, Hackney AC, Granacher U, Zouhal H, El Hage R. Effects of the Type of Exercise Training on Bone Health Parameters in Adolescent Girls: A Systematic Review. J Clin Densitom 2024; 27:101454. [PMID: 38052114 DOI: 10.1016/j.jocd.2023.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
Interventional studies offer strong evidence for exercise's osteogenic impact on bone particularly during growth. With rising osteoporosis rates in older women, enhancing bone strength early in life is crucial. Thus, investigating the osteogenic effects of different types of physical activities in young females is crucial. Despite varied findings, only two systematic reviews tried to explore this topic without examining how different types of exercise may affect bone health in adolescent girls. The first aim of this systematic review was to assess the impact of exercise training on bone health parameters in adolescent girls, and the second aim was to investigate whether the type of exercise training can modulate this effect. A systematic literature search was conducted using common electronic databases from inception - January 2023. Seven studies (355 participants) were eligible for inclusion in this systematic review. Two studies dealt with resistance training, 3 studies applied plyometric training, 1 study used team sports, and 1 study used dancing. Results indicate that plyometric training increases lumbar spine bone mass in adolescent girls. Well-designed randomized controlled trials with a proper training period (> 12 weeks) are needed to advocate a specific type of training which has the highest osteogenic effect.
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Affiliation(s)
- Abdel Jalil Berro
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon
| | - Wassim El Hawly
- Laboratoire Mouvement, Equilibre, Performance, Santé (MEPS), Université de Pau et des Pays de l'Adour, Campus Montaury, Anglet 64600, France
| | - Gisèle El Khoury
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon
| | - Zaher El Hage
- Department of Psychology, Education and Physical Education, Faculty of Humanities, Notre Dame University, Louaize, Lebanon
| | - Ayyappan Jayavel
- SRM College of Physiotherapy, SRM Institute of Science and Technology, Kattankulathur Kanchipuram, India
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, University of Kurdistan, Sanandaj, Iran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Antonio Pinti
- Univ. Polytechnique Hauts-de-France, INSA Hauts-de-France, LARSH - Laboratoire de Recherche, Sociétés & Humanités, Valenciennes F-59313, France
| | | | - Anthony C Hackney
- Department of Exercise & Sport Science; Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States
| | - Urs Granacher
- Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, Germany
| | - Hassane Zouhal
- University Rennes, M2S (Laboratoire Mouvement, Sport, Santé) - EA 1274, Rennes F-35000, France; Institut International des Sciences du Sport (2IS), Irodouer 35850, France
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Sciences, University of Balamand, PO Box 100, Tripoli, Lebanon.
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Schifino AG, Cooley MA, Zhong RX, Heo J, Hoffman DB, Warren GL, Greising SM, Call JA. Tibial bone strength is negatively affected by volumetric muscle loss injury to the adjacent muscle in male mice. J Orthop Res 2024; 42:123-133. [PMID: 37337074 PMCID: PMC10728344 DOI: 10.1002/jor.25643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
This study's objective was to investigate how contractile strength loss associated with a volumetric muscle loss (VML) injury affects the adjacent tibial bone structural and functional properties in male C57BL/6J mice. Mice were randomized into one of two experimental groups: VML-injured mice that were injured at age 12 weeks and aged to 20 weeks (8 weeks postinjury, VML) and 20-week-old age-matched uninjured mice (Uninjured-20). Tibial bone strength, mid-diaphysis cortical geometry, intrinsic material properties, and metaphyseal trabecular bone structure were assessed by three-point bending and microcomputed tomography (µCT). The plantar flexor muscle group (gastrocnemius, soleus, plantaris) was analyzed for its functional capacities, that is, peak-isometric torque and peak-isokinetic power. VML-injured limbs had 25% less peak-isometric torque and 31% less peak-isokinetic power compared to those of Uninjured-20 mice (p < 0.001). Ultimate load, but not stiffness, was significantly less (10%) in tibias of VML-injured limbs compared to those from Uninjured-20 (p = 0.014). µCT analyses showed cortical bone thickness was 6% less in tibias of VML-injured limbs compared to Uninjured-20 (p = 0.001). Importantly, tibial bone cross-section moment of inertia, the primary determinant of bone ultimate load, was 16% smaller in bones of VML-injured limbs compared to bones from Uninjured-20 (p = 0.046). Metaphyseal trabecular bone structure was also altered up to 23% in tibias of VML-injured limbs (p < 0.010). These changes in tibial bone structure and function after a VML injury occur during a natural maturation phase between the age of 12 and 20 weeks, as evidenced by Uninjured-20 mice having greater tibial bone size and strength compared to uninjured-aged 12-week mice.
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Affiliation(s)
| | - Marion A. Cooley
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, August University, Augusta, GA USA
| | - Roger X. Zhong
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA USA
| | - Junwon Heo
- Department of Physiology & Pharmacology, University of Georgia, Athens, GA USA
| | | | - Gordon L. Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA USA
| | | | - Jarrod A. Call
- Department of Physiology & Pharmacology, University of Georgia, Athens, GA USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA USA
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Pandit A, Tran TB, Letton M, Cowley E, Gibbs M, Wewege MA, Hagstrom AD. Data Informing Governing Body Resistance-Training Guidelines Exhibit Sex Bias: An Audit-Based Review. Sports Med 2023; 53:1681-1691. [PMID: 37382828 PMCID: PMC10432356 DOI: 10.1007/s40279-023-01878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
The objective of this review was to examine the ratio of female and male participants utilised in data informing consensus statements and position stands in the field of resistance training (RT). In order to achieve this objective, we conducted an 'audit' style review. We accessed three databases: SPORTDiscus, MEDLINE and Google Scholar utilising the following search terms: resistance or strength training AND consensus statements or position statements/stands. Eligibility criteria included consensus statements and position stands for RT in youth, adults and older adults. In this paper we have used the term 'female' to describe biological sex. Gender is a social construct and often describes roles and behaviours that society assigns to men or women. In this paper we have used the term 'women' to describe gender. Reference lists from each guideline were screened with the number of male and female participants extracted from each study. We also extracted data on the gender of the authors of the statements. We located 11 guidelines encompassing a total of 104,251,363 participants. Youth guidelines were comprised of 69% male participants. There were 287 studies that included both sexes, 205 male-only and 92 female-only studies. Adult guidelines were comprised of 70% male participants. There were 104 studies that included both sexes, 240 male-only and 44 female-only studies. Older adult guidelines were comprised of 54% female participants. There were 395 studies that included both sexes, 112 male-only and 83 female-only studies. Women authors comprised 13% of all authors of position stands and consensus statements. These results demonstrate an under-representation of females and women as both participants and as authors. It is imperative to ensure that data informing governing body guidelines and consensus statements are representative of the population they aim to inform. If this is not possible, guidelines should clearly state when their data and recommendations are based primarily upon one sex.
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Affiliation(s)
- Anurag Pandit
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Thai Binh Tran
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Meg Letton
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Emma Cowley
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mitchell Gibbs
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Michael A Wewege
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Amanda D Hagstrom
- Faculty of Medicine and Health, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia.
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Singh H, Moore BA, Rathore R, Reed WR, Thompson WR, Fisher G, Lein DH, Hunter GR. Skeletal effects of eccentric strengthening exercise: a scoping review. BMC Musculoskelet Disord 2023; 24:611. [PMID: 37491261 PMCID: PMC10367324 DOI: 10.1186/s12891-023-06739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Conventional progressive concentric strengthening exercise (CSE) to improve bone mineral density (BMD) and bone mineral content (BMC) may not be feasible for populations with chronic musculoskeletal and/or metabolic conditions, such as osteoporosis or obesity. Muscle lengthening exercise, also known as an eccentric strengthening exercise (ESE), may have a special utility for those populations due to greater force generation versus CSE. In fact, greater mechanical loading can be induced on bone at lower resistance levels with ESE. However, effects of ESE on BMD and BMC are unclear. Thus, the purpose of this review was to interrogate the effects of ESE on BMD and BMC. METHODS A literature review was conducted between January 1995 and April 2022 focusing on randomized controlled trials investigating the effects of ESE on BMD and/or BMC in humans. Terms covering the domains of exercise, bone, and populations were searched on PubMed, CINAHL, and Scopus. The methodological quality of each interventional study was rated using Physiotherapy Evidence Database (PEDro) scale. Cohen's d was calculated to determine the magnitude of the effects of ERE on site-specific outcome measures of BMD and/or BMC. RESULTS Out of 1,182 articles initially found, a total of seven full length articles met our inclusion criteria. Of the seven studies, most of the interventions were performed in young (n = 5, PEDro = 5-7) versus middle-aged (n = 1, PEDro = 4) or older (n = 1, PEDro = 6) adults. BMD and BMC generally improved due to ESE; however the effects of ESE on BMD and BMC were non-homogenous. Effect size (d) ranged from 0.10-0.87 in young adults while it was 1.16 in older adults. Effect size (d) could not be calculated for the middle-aged adult study due to critical methodological limitations of the intervention. CONCLUSIONS Large variability exists for the effectiveness of ESE on BMD/BMC across the human life spectrum. The benefits of ESE on BMD holds promise but rigorous studies are lacking. Further research is needed to examine if the dose, mode, age, and sex-specificity dictate effects of ESE on BMD/BMC.
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Affiliation(s)
- Harshvardhan Singh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, US.
| | - Bethany A Moore
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, US
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, US
| | - Roshita Rathore
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, US
| | - William R Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, US
| | - William R Thompson
- Department of Physical Therapy, Indiana University, Indianapolis, IN, US
| | - Gordon Fisher
- Department of Kinesiology, University of Alabama at Birmingham, Birmingham, AL, US
| | - Donald H Lein
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, US
| | - Gary R Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, US
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Cui W, Li D, Jiang Y, Gao Y. Effects of exercise based on ACSM recommendations on bone mineral density in individuals with osteoporosis: a systematic review and meta-analyses of randomized controlled trials. Front Physiol 2023; 14:1181327. [PMID: 37528896 PMCID: PMC10389279 DOI: 10.3389/fphys.2023.1181327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose: To analyze the effects of different exercise dose on lumbar spine and femoral neck bone mineral density (BMD) in individuals with osteoporosis (OP). Design: A systematic search was conducted in four electronic databases, namely, PubMed, Embase, Web of Science, and Cochrane, with the topic of the impact of exercise on BMD in individuals with OP. Randomized controlled trials comparing exercise intervention with no intervention were identified, and changes in lumbar spine and femoral neck BMD were reported and evaluated using standardized mean difference (SMD) and 95% confidence interval (95% CI). The intervention measures in the studies were evaluated and categorized as high adherence with the exercise testing and prescription recommendations for individuals with OP developed by the American College of Sports Medicine (ACSM) or low/uncertainty adherence with ACSM recommendations. A random effects model was used to conduct meta-analyses and compare the results between subgroups. Results: A total of 32 studies involving 2005 participants were included in the analyses, with 14 studies categorized as high adherence with ACSM recommendations and 18 studies categorized as low or uncertain adherence. In the analyses of lumbar spine BMD, 27 studies with 1,539 participants were included. The combined SMD for the high adherence group was 0.31, while the combined SMD for the low or uncertain adherence group was 0.04. In the analyses of femoral neck BMD, 23 studies with 1,606 participants were included. The combined SMD for the high adherence group was 0.45, while the combined SMD for the low or uncertain adherence group was 0.28. Within resistance exercise, the subgroup with high ACSM adherence had a greater impact on lumbar spine BMD compared to the subgroup with low or uncertain ACSM adherence (SMD: 0.08 > -0.04). Similarly, for femoral neck BMD, resistance exercise with high ACSM adherence had a higher SMD compared to exercise with low or uncertain ACSM adherence (SMD: 0.49 > 0.13). Conclusion: The results suggest that exercise interventions with high adherence to ACSM recommendations are more effective in improving lumbar spine and femoral neck BMD in individuals with OP compared to interventions with low or uncertain adherence to ACSM recommendations. Systematic Review Registration: PROSPERO, identifier CRD42023427009.
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Affiliation(s)
- Wenlai Cui
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
| | - Dong Li
- Department of International Cultural Exchange, Chodang University, Muan County, Republic of Korea
| | - Yueshuai Jiang
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
| | - Yang Gao
- School of Dance and Martial Arts, Capital University of Physical Education and Sports, Beijing, China
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The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. J Clin Med 2023; 12:jcm12020548. [PMID: 36675477 PMCID: PMC9864448 DOI: 10.3390/jcm12020548] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of this systematic review was to determine whether strength exercises improve the symptoms of menopause and to provide an update on the most recent scientific evidence on the type and regimen of exercise that help reduce the symptoms. METHODS An electronic search of scientific databases was performed from 2015 to 2022. Randomized clinical trials that analyzed the effects of strength exercises versus other types of interventions, considering all the outcome measures of interest, were included in this review. RESULTS We found 5964 potential articles. After applying the selection criteria, we selected 12 of the articles. The studies compared strength exercises versus other therapies or compared strength exercises versus no intervention in one of the groups. The results showed improvements in the strength of the legs and pelvic floor, physical activity, bone density, metabolic and hormonal changes, heart rate and blood pressure and a change in hot flashes. CONCLUSIONS There is evidence that strength exercises can be beneficial for improving strength, physical activity, bone density and hormonal and metabolic levels. In terms of the appropriate type of strength training, the evidence is still unclear given that the same benefits are achieved by various types of exercises.
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9
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Effect of resistance exercise on bone health of old aged individuals: Review. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Lee S, Kim JS, Park KS, Baek KW, Yoo JI. Daily Walking Accompanied with Intermittent Resistance Exercise Prevents Osteosarcopenia: A Large Cohort Study. J Bone Metab 2022; 29:255-263. [PMID: 36529868 PMCID: PMC9760770 DOI: 10.11005/jbm.2022.29.4.255] [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: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to analyze the effects of walking and resistance exercises on bone structure, bone mineral density (BMD), and skeletal muscle mass. We used data from the fourth Korean National Health and Nutrition Examination Survey (KNHANES). METHODS A total of 3,477 participants aged ≥19 years underwent hip structural analysis (HSA), BMD, and skeletal muscle index (SMI). All radiologic evaluations were performed using dual energy X-ray absorptiometry (DXA). The Korean short version of the International Physical Activity Questionnaire was used to measure physical activity status. The physical activity recommendations of the American College of Rheumatology Work Group Panel were used to evaluate the extent of activity. RESULTS The BMD and SMI in the group in which walking activity was performed 5 days or more per week for at least 30 min per day were significantly higher than those in the group in which walking activity was not performed. HSA and SMI in the group in which resistance exercise was performed 2 days or more per week for at least 30 min per day were found to be significantly higher than those in the group in which strengthening exercises were not performed. CONCLUSIONS If resistance exercise and walking are combined, bone loss and muscle loss are prevented maintaining cortical thickness in the elderly. Walking for more than 5 days a week and resistance exercise for more than 2 days a week will help to maintain the skeletal muscle as well as the cortex around the femur neck, thus helping to prevent fragility fractures in older individuals.
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Affiliation(s)
- Sangyeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju,
Korea
| | - Ji-Seok Kim
- Department of Physical Education, Gyeongsang National University, Jinju,
Korea
| | - Ki-Soo Park
- Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University, Jinju,
Korea
| | - Kyung-Wan Baek
- Department of Physical Education, Gyeongsang National University, Jinju,
Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongang National University Hospital, Gyeongsang National University, Jinju,
Korea
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11
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Borgia B, Dufek JS, Radzak KN, Freedman Silvernail J. The effect of exercise modality on age-related changes observed during running. Eur Rev Aging Phys Act 2022; 19:21. [PMID: 36115944 PMCID: PMC9482262 DOI: 10.1186/s11556-022-00302-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION With the increase in participation by older adults in endurance events, research is needed to evaluate how exercising throughout the lifespan can affect the aging process regarding gait and mobility. The purpose of this study was to determine how the type of exercise modality one participates in will affect age-related declines observed during running. METHODS Fifty-six individuals between the ages of 18-65 who considered running, resistance training or cycling/swimming as their primary form of activity participated in this study. Kinematics were captured using a 10-camera motion capture system while participants ran at a controlled pace of 3.5 m/s (± 5%) over a 10-m runway with force platforms collecting kinetic data. Eight successful trials were chosen for analysis. A one-way ANOVA assessed differences in mean kinematic and kinetic variables of interest between physical activity groups (α = 0.05). RESULTS Older resistance trainers exhibited greater maximal knee power compared to older runners. No other group differences were observed. CONCLUSION Despite type of exercise modality, regularly participating in exercise has positive effects. This is evident through the preservation of the function of the lower extremity with age, specifically function of the ankle, and its contribution to healthy movement patterns.
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Affiliation(s)
- Brianne Borgia
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.
| | - Janet S. Dufek
- grid.272362.00000 0001 0806 6926Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV USA
| | - Kara N. Radzak
- grid.272362.00000 0001 0806 6926Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV USA
| | - Julia Freedman Silvernail
- grid.272362.00000 0001 0806 6926Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV USA
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12
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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: 15] [Impact Index Per Article: 7.5] [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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13
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Zouhal H, Berro AJ, Kazwini S, Saeidi A, Jayavel A, Clark CCT, Hackney AC, VanDusseldorp TA, Ben Abderrahman A, El Hage R. Effects of Exercise Training on Bone Health Parameters in Individuals With Obesity: A Systematic Review and Meta-Analysis. Front Physiol 2022; 12:807110. [PMID: 35237177 PMCID: PMC8883041 DOI: 10.3389/fphys.2021.807110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 01/07/2023] Open
Abstract
Background Osteoporosis causes bone fragility, increasing the risk of fractures. Evidence suggests a strong correlation between obesity and fracture risk. Physical training is known to enhance bone resistance and protect from fracture; however, its osteogenic effect in the presence of obesity remains unknown. Objective We sought to evaluate the influence of exercise training on bone health indices in individuals with obesity. Methods This systematic literature search was conducted using common electronic databases from inception - December 2019. The following key terms (and synonyms searched for by the MeSH database) were included and combined using the operators “AND,” “OR,” “NOT”: [(“body mass index” OR obesity OR obese OR overweight OR fat mass) AND (“bone mineral density” OR “bone mineral content” OR “peak bone mass” OR “mechanical loading” OR “Osteoporosis” OR “bone geometry” OR “bone resistance”) AND (“exercise training” OR “physical training” OR “strength training,” OR “resistance training” OR “aerobic training” OR “combined training”)]. Results After screening, 10 studies (889 initial records) were included in the final analysis (8 different countries, 263 participants). Two studies investigated males, six females, and two, both sexes. The training duration was at least eight weeks with 2–3 sessions/week. Physical training displayed a significant trivial impact on the whole body (WB) BMD (0.13 SMD; 95% CI [0.00, 0.26], p = 0.046). Subgroup analyses indicated a significant small increase in the WB BMD (0.27 SMD; 95% CI [0.00, 0.53], p = 0.048) in the endurance training group, a non-significant trivial increase in the WB BMD (0.11 SMD; 95% CI [−0.06, 0.29], p = 0.203) in the resistance group, and a non-significant trivial increase in the WB BMD (0.03 SMD; 95% CI [−0.26, 0.32], p = 0.86) in the combined training group. In addition, a significant small decrease was found in the weight of trained subjects (−0.24 SMD; 95% CI [−0.42, −0.05], p = 0.011). Conclusion Physical training has little to no effect on the WB BMD in subjects with overweight/obesity. Currently, insufficient evidence to advocate for any specific type of exercise for enhancing bone health exists for overweight/obese individuals. Investigations examining the impact of varying types of physical exercise on WB BMD of obese individuals are needed.
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Affiliation(s)
- Hassane Zouhal
- University Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
- *Correspondence: Hassane Zouhal
| | - Abdel Jalil Berro
- Division of Education, Faculty of Arts and Sciences, Department of Physical Education, University of Balamand, Tripoli, Lebanon
| | - Sarah Kazwini
- Division of Education, Faculty of Arts and Sciences, Department of Physical Education, University of Balamand, Tripoli, Lebanon
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
| | - Ayyappan Jayavel
- SRM College of Physiotherapy, SRM Institute of Science and Technology, Chennai, India
| | - Cain C. T. Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Anthony C. Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States
| | - Trisha A. VanDusseldorp
- Department of Exercise & Sport Management, Kennesaw State University, Kennesaw, GA, United States
- Trisha A. VanDusseldorp
| | | | - Rawad El Hage
- Division of Education, Faculty of Arts and Sciences, Department of Physical Education, University of Balamand, Tripoli, Lebanon
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14
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Montalcini T, Pujia A, Donini LM, Frittitta L, Galvano F, Natali A, Pironi L, Porrini M, Riso P, Rivellese AA, Russo D, Scapagnini G, Serafini M, Tagliabue A, De Lorenzo A. A Call to Action: Now Is the Time to Screen Elderly and Treat Osteosarcopenia, a Position Paper of the Italian College of Academic Nutritionists MED/49 (ICAN-49). Nutrients 2020; 12:E2662. [PMID: 32878316 PMCID: PMC7550989 DOI: 10.3390/nu12092662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is a risk factor for the development of multiple chronic diseases, including cardiovascular disease, cancer and dementia. Life expectancy has increased in certain countries but this phenomenon is associated with a reduction of years of healthy life. Aging is associated with a number of physical and functional changes, especially sarcopenia. Sarcopenia is a clinical condition associated with a decrease in skeletal muscle and muscle strength, however, sarcopenia is a reversible condition. On the basis of the current scientific literature, sarcopenia could more appropriately capture an individual's vulnerability to negative health-related outcomes since it represents an early form of the chronic diseases. Recognition of this clinical condition can improve the management of older individuals in many different clinical settings. Despite the limitations of the indirect methods used to study body composition, the Italian College of the Academic Nutritionists ME/49 recommends that health authorities and health professionals around the world should make a greater effort to diagnose sarcopenia earlier and to manage it more effectively. In line with the development of cancer screening, the use of two diagnostic tools for sarcopenia (BIA and DXA) should be implemented.
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Affiliation(s)
- Tiziana Montalcini
- Department of Clinical and Experiment Medicine, University of Catanzaro Magna Grecia, Viale Europa, 88100 Catanzaro, Italy;
| | - Arturo Pujia
- Department of Clinical and Experiment Medicine, University of Catanzaro Magna Grecia, Viale Europa, 88100 Catanzaro, Italy;
| | - Lorenzo M. Donini
- Department of Experimental Medicine, University of la Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Lucia Frittitta
- Department of Clinical and Experiment Medicine, University of Catania, Via Santa Sofia, 86-95123 Catania, Italy;
| | - Fabio Galvano
- Department of Biomedical and Biotechnology Science, University of Catania, Via Santa Sofia, 86-95123 Catania, Italy;
| | - Andrea Natali
- Department of Clinical and Experiment Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy;
| | - Loris Pironi
- Department of Medical and Surgical Science, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy;
| | - Marisa Porrini
- Department of Food, Nutrition and Environment Science, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy; (M.P.); (P.R.)
| | - Patrizia Riso
- Department of Food, Nutrition and Environment Science, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy; (M.P.); (P.R.)
| | - Angela Albarosa Rivellese
- Department of Clinical and Experiment Medicine, University of Naples Federico II, Corso Umberto I, 40, 80138 Napoli, Italy;
| | - Diego Russo
- Department of Health Science, University of Catanzaro Magna Grecia, Viale Europa, 88100 Catanzaro, Italy;
| | - Giovanni Scapagnini
- Department of Medicine and Health Science, University of Molise, Via F. De Sanctis, 86100 Campobasso, Italy;
| | - Mauro Serafini
- Department of Bioscience and food technology, University of Teramo, Via Renato Balzarini, 1, 64100 Teramo, Italy;
| | - Anna Tagliabue
- Department of Public Health, University of Pavia, Corso Str. Nuova, 65, 27100 Pavia, Italy;
| | - Antonino De Lorenzo
- Biomedicine and Prevention, University of Tor Vergata, Via Montpellier, 1, 00133 Roma, Italy;
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Abstract
Healthy aging is the ability to maintain independence, purpose, vitality, and quality of life into old age despite unexpected medical conditions, accidents, and unhelpful social determinants of health. Exercise, or physical activity, is an important component of healthy aging, preventing or mitigating falls, pain, sarcopenia, osteoporosis, and cognitive impairment. A well-balanced exercise program includes daily aerobic, strength, balance, and flexibility components. Most older adults do not meet the currently recommended minutes of regular physical activity weekly. Counseling by health care providers may help older adults improve exercise habits, but it is also important to take advantage of community-based exercise opportunities.
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Affiliation(s)
- Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L475, Portland, OR 97239, USA.
| | - Suvi Neukam
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L475, Portland, OR 97239, USA
| | - Leah Kalin
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L475, Portland, OR 97239, USA
| | - Jessica Wright
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L475, Portland, OR 97239, USA
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16
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Loewen B, Collum C, Ryan GA. Exercise Benefits and Recommendations for the 6-Week Postpartum Period. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Shojaa M, von Stengel S, Kohl M, Schoene D, Kemmler W. Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters. Osteoporos Int 2020; 31:1427-1444. [PMID: 32399891 PMCID: PMC7360540 DOI: 10.1007/s00198-020-05441-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/28/2020] [Indexed: 12/25/2022]
Abstract
This systematic review and meta-analysis set out to determine the effect of dynamic resistance exercise (DRT) on areal bone mineral density (aBMD) in postmenopausal women and derive evidence-based recommendations for optimized training protocols. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) of isolated DRT with at least one exercise and one control group, (c) with intervention durations ≥ 6 months, (d) aBMD assessments at lumbar spine or proximal femur, (e) in cohorts of postmenopausal women. We searched eight electronic databases up to March 2019 without language restrictions. The meta-analysis was performed using a random-effects model. Standardized mean differences (SMD) for BMD changes at lumbar spine (LS), femoral neck (FN), and total hip (TH) were defined as outcome measures. Moderators of the exercise effects, i.e., "intervention length," "type of DRT," "training frequency," "exercise intensity," and "exercise volume," were addressed by sub-group analyses. The study was registered in the international prospective register of systematic reviews (PROSPERO) under ID: CRD42018095097. Seventeen articles with 20 exercise and 18 control groups were eligible. SMD average is 0.54 (95% CI 0.22-0.87) for LS-BMD, 0.22 (0.07-0.38) for FN-BMD, and 0.48 (0.22-0.75) for TH-BMD changes (all p ≤ 0.015). While sub-group analysis for FN-BMD revealed no differences within categories of moderators, lower training frequency (< 2 sessions/week) resulted in significantly higher BMD changes at LS and TH compared to higher training frequency (≥ 2 sessions/week). Additionally, free weight training was significantly superior to DRT devices for improving TH-BMD. This work provided further evidence for significant, albeit only low-moderate, effects of DRT on LS-, FN-, and TH-BMD. Unfortunately, sub-analysis results did not allow meaningful exercise recommendations to be derived. This systematic review and meta-analysis observed a significant low-moderate effect of dynamic resistance exercise on bone mineral density changes in postmenopausal women. However, sub-group analyses focusing on exercise characteristics found no results that enable the derivation of meaningful exercise recommendations in the area of exercise and osteoporosis prevention or therapy.
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Affiliation(s)
- M Shojaa
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - S von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - M Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - D Schoene
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - W Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany.
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18
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Souza D, Barbalho M, Ramirez-Campillo R, Martins W, Gentil P. High and low-load resistance training produce similar effects on bone mineral density of middle-aged and older people: A systematic review with meta-analysis of randomized clinical trials. Exp Gerontol 2020; 138:110973. [PMID: 32454079 DOI: 10.1016/j.exger.2020.110973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of high-load (≥ 70 of 1RM) and low-load (< 70 of 1RM) resistance training (RT) on femoral neck and lumbar spine bone mineral density (BMD) in middle-aged and older people. DESIGN Systematic review with meta-analysis. DATA SOURCE English language searches of the electronic databases PubMed/Medline, Scopus and Web of Science. INCLUSION CRITERIA (i) older or middle-aged (≥ 45 years old) participants of both sexes with or without comorbidities, (ii) studies that compared high-load (≥70% 1 RM) versus low-load (<70% 1RM) RT, (iii) studies that examined femoral neck or lumbar spine BMD. RESULTS From 1052 studies found, six were included in qualitative and quantitative analysis. The meta-analysis revealed no difference between groups for femoral neck (weighted mean difference [MD] and 95% confidence interval (CI) = 0.00 g/cm2 [95% CI, -0.01 to 0.01]; P = 0.63) and lumbar spine (MD = 0.01 g/cm2 [95% CI, -0.00 to 0.02]; P = 0.12) BDM. There was a substantial heterogeneity for femoral neck (I2 = 47%; P = 0.07) and lumbar spine (I2 = 59%; P = 0.02). Subgroup analysis revealed a significant effect of high-load RT on femoral neck BMD when participants presented normal BMD values (MD = 0.01 g/cm2 [95% CI, -0.00 to 0.02]; P = 0.04) and on interventions lasting up to 6 months (MD = 0.01 g/cm2 [95% CI, -0.00 to 0.02]; P = 0.03). CONCLUSION Both high- and low-load RT have similar effects on femoral neck and lumbar spine BMD in aging people.
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Affiliation(s)
- Daniel Souza
- Faculdade de Educação Física e Dança, Universidade Federal de Goiás, Goiânia, Brazil.
| | - Matheus Barbalho
- Faculdade de Educação Física e Dança, Universidade Federal de Goiás, Goiânia, Brazil
| | - Rodrigo Ramirez-Campillo
- Laboratory of Human Performance, Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
| | - Wagner Martins
- University of Brasilia, Division of Physical Therapy, Ceilandia, Brazil
| | - Paulo Gentil
- Faculdade de Educação Física e Dança, Universidade Federal de Goiás, Goiânia, Brazil
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Vaghar MI. Association between lifestyle and pathologic fractures in patients admitted to surgery departments of selected hospitals affiliated to Alborz University of Medical Sciences in 2014-2015. J Family Med Prim Care 2019; 8:2799-2802. [PMID: 31681645 PMCID: PMC6820397 DOI: 10.4103/jfmpc.jfmpc_531_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/22/2019] [Accepted: 09/09/2019] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose: Health professions that previously focused on treatment of patients are now focusing on prevention and health provision by improving lifestyle and eliminating factors that somehow have a negative impact on human health. Some people have strong skeleton genetically, but others do not. So far, medical science has not been able to change the genetic characteristics of individuals; however, lifestyles can be changed to reach the maximum bone mass. The aim of this study was to investigate the association between lifestyle and pathologic fractures in patients admitted to surgery departments of selected Hospitals in 2014–2015. Materials and Methods: In this descriptive (correlational) study, using the Cochran sampling formula, 350 patients with fractures were selected by stratified sampling in surgery departments of selected hospitals affiliated to Alborz University of Medical Sciences. Data were collected using the standard lifestyle questionnaire, which was validated through the test–retest method. The qualitative data of this project were analyzed using SPSS 20 software at a significance level of 0.05. Results: Most of the subjects were in the age group of 72–85 years which included 103 (26.8%) people. In all, 187 (48.6%) subjects were male and 198 (51.4%) subjects were female. A total of 83 (21.6%) participants were in the healthy group, 123 (32.0%) subjects were in the osteoporosis group, 113 (29.3%) subjects were in the bone infection group, and 66 (17.1%) individuals were in the general bone disease group. Conclusion: All studied components including smoking, physical activity, and nutrition directly affect pathologic fractures.
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Affiliation(s)
- Mohammad Islami Vaghar
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Sivaramakrishnan D, Fitzsimons C, Kelly P, Ludwig K, Mutrie N, Saunders DH, Baker G. The effects of yoga compared to active and inactive controls on physical function and health related quality of life in older adults- systematic review and meta-analysis of randomised controlled trials. Int J Behav Nutr Phys Act 2019; 16:33. [PMID: 30953508 PMCID: PMC6451238 DOI: 10.1186/s12966-019-0789-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/08/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Yoga has been recommended as a muscle strengthening and balance activity in national and global physical activity guidelines. However, the evidence base establishing the effectiveness of yoga in improving physical function and health related quality of life (HRQoL) in an older adult population not recruited on the basis of any specific disease or condition, has not been systematically reviewed. The objective of this study was to synthesise existing evidence on the effects of yoga on physical function and HRQoL in older adults not characterised by any specific clinical condition. METHODS The following databases were systematically searched in September 2017: MEDLINE, PsycInfo, CINAHL Plus, Scopus, Web of Science, Cochrane Library, EMBASE, SPORTDiscus, AMED and ProQuest Dissertations & Theses Global. Study inclusion criteria: Older adult participants with mean age of 60 years and above, not recruited on the basis of any specific disease or condition; yoga intervention compared with inactive controls (example: wait-list control, education booklets) or active controls (example: walking, chair aerobics); physical function and HRQoL outcomes; and randomised/cluster randomised controlled trials published in English. A vote counting analysis and meta-analysis with standardised effect sizes (Hedges' g) computed using random effects models were conducted. RESULTS A total of 27 records from 22 RCTs were included (17 RCTs assessed physical function and 20 assessed HRQoL). The meta-analysis revealed significant effects (5% level of significance) favouring the yoga group for the following physical function outcomes compared with inactive controls: balance (effect size (ES) = 0.7), lower body flexibility (ES = 0.5), lower limb strength (ES = 0.45); compared with active controls: lower limb strength (ES = 0.49), lower body flexibility (ES = 0.28). For HRQoL, significant effects favouring yoga were found compared to inactive controls for: depression (ES = 0.64), perceived mental health (ES = 0.6), perceived physical health (ES = 0.61), sleep quality (ES = 0.65), and vitality (ES = 0.31); compared to active controls: depression (ES = 0.54). CONCLUSION This review is the first to compare the effects of yoga with active and inactive controls in older adults not characterised by a specific clinical condition. Results indicate that yoga interventions improve multiple physical function and HRQoL outcomes in this population compared to both control conditions. This study provides robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing. TRIAL REGISTRATION PROSPERO registration number: CRD42016038052 .
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Affiliation(s)
- Divya Sivaramakrishnan
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, St Leonard’s Land, Edinburgh, EH8 8AQ UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, St Leonard’s Land, Edinburgh, EH8 8AQ UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, St Leonard’s Land, Edinburgh, EH8 8AQ UK
| | - Kim Ludwig
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Lanarkshire Campus, South Lanarkshire, G72 0LH UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, St Leonard’s Land, Edinburgh, EH8 8AQ UK
| | - David H. Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, St Leonard’s Land, Edinburgh, EH8 8AQ UK
| | - Graham Baker
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, St Leonard’s Land, Edinburgh, EH8 8AQ UK
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21
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Berro AJ, Rassy NA, Ahmaidi S, Sabbagh P, Khawaja A, Maalouf G, El Hage R. Physical Performance Variables and Bone Parameters in a Group of Young Overweight and Obese Women. J Clin Densitom 2019; 22:293-299. [PMID: 30352782 DOI: 10.1016/j.jocd.2018.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 01/03/2023]
Abstract
The aim of this study was to explore the relationships between physical performance variables and bone parameters such as bone mineral density (BMD), bone mineral content, hip geometry indices, and trabecular bone score in a group of young overweight and obese adult women. Sixty-eight overweight/obese (body mass index ≥25 kg/m2; 25.5-42.4 kg/m2) young women whose ages range from 18 to 35 yr participated in this study. Body composition and bone outcomes were measured by dual-energy X-ray absorptiometry. Maximum oxygen consumption (VO2 max, in liter per minute) was determined indirectly using a progressive shuttle run test. One-repetition-maximum half-squat was directly measured. Vertical jump was measured and maximum power (P max) of the lower limbs was calculated. Lean mass was positively correlated to whole body (WB) BMD, total hip BMD, femoral neck (FN) BMD, femoral neck cross-sectional area (FN CSA) and femoral neck cross sectional moment of inertia (FN CSMI) (p < 0.05). VO2 max (in liter per minute) and muscle power were positively correlated to WB BMD, total hip BMD, FN BMD, FN CSA, and FN CSMI (p < 0.05). One-repetition-maximum half-squat was positively correlated with lumbar spine trabecular bone score, WB BMD, FN BMD, FN CSA and FN CSMI (p < 0.05). This study suggests that lean mass, vertical jump, VO2 max (liter per minute), muscle power and one-repetition-maximum half squat are positive determinants of BMD and hip geometry indices in young overweight and obese women.
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Affiliation(s)
- Abdel-Jalil Berro
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; EA-3300, APERE, Sport Sciences Department, University of Picardie Jules Verne, Amiens, France
| | - Nathalie Al Rassy
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; Laboratory of Pathophysiology of Inflammatory Bone Diseases PMOI EA4490, University of Littoral Opal Coast ULCO, Boulogne sur Mer and University of Lille, Lille, France
| | - Said Ahmaidi
- EA-3300, APERE, Sport Sciences Department, University of Picardie Jules Verne, Amiens, France
| | - Patchina Sabbagh
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; University of Lille, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Ronchin, France
| | - Anthony Khawaja
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon; Movement Sport Science and Health Laboratory (M2S), UFR-STAPS, University of Rennes 2, France
| | - Ghassan Maalouf
- Bellevue University Medical Center, Faculty of Medicine, Saint Joseph University, Mansourieh, Lebanon
| | - Rawad El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon.
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22
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Lionikaite V, Henning P, Drevinge C, Shah FA, Palmquist A, Wikström P, Windahl SH, Lerner UH. Vitamin A decreases the anabolic bone response to mechanical loading by suppressing bone formation. FASEB J 2019; 33:5237-5247. [PMID: 30668919 PMCID: PMC6436664 DOI: 10.1096/fj.201802040r] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Increased vitamin A consumption is associated with decreased cortical bone mass and increased fracture risk in humans. Rodent studies have demonstrated that hypervitaminosis A increases cortical bone resorption, whereas the importance of the effects on bone formation is less well defined. We used an experimental model of increased bone formation by loading of the tibiae to investigate the effect of vitamin A on bone formation. Control [retinol activity equivalents (RAE) 4.5 µg/g chow] or vitamin A (RAE 60 µg/g chow) diets were given to female C57BL/6N mice for 4 wk, after which the tibiae were subjected to axial loading on alternate days for 2 wk, while the diets were continued. Vitamin A inhibited the loading-induced increase in trabecular and cortical bone volume. This was attributed to inhibition of loading-induced increase in osteoblast number and activity, and expression of osteoblastic genes Sp7, Alpl, and Col1a1 in cortical bone. Vitamin A, loading, and combination thereof also resulted in site-specific effects on bone composition measured by Raman spectroscopy. In summary, a clinically relevant dose of vitamin A suppresses the loading-induced gain of bone mass by decreasing bone formation. These observations may have implications for regulation of bone mass caused by physical activity and the risk of osteoporosis in humans.-Lionikaite, V., Henning, P., Drevinge, C., Shah, F. A., Palmquist, A., Wikström, P., Windahl, S. H., Lerner, U. H. Vitamin A decreases the anabolic bone response to mechanical loading by suppressing bone formation.
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Affiliation(s)
- Vikte Lionikaite
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, Institute for Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Petra Henning
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, Institute for Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christina Drevinge
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, Institute for Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; and
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; and
| | - Pernilla Wikström
- Department of Medical Bioscience, Pathology, Umeå University, Umeå, Sweden
| | - Sara H Windahl
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, Institute for Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ulf H Lerner
- Department of Internal Medicine and Clinical Nutrition, Centre for Bone and Arthritis Research, Institute for Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Etehadnezhad S, Moradi Z, Kashfi M, Khani-jeihooni A, khiyali Z. Predictors of Osteoporosis Preventive Behaviors among Women: An Application of the Transtheoretical Model. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2018. [DOI: 10.21859/jech.5.3.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hong AR, Kim SW. Effects of Resistance Exercise on Bone Health. Endocrinol Metab (Seoul) 2018; 33:435-444. [PMID: 30513557 PMCID: PMC6279907 DOI: 10.3803/enm.2018.33.4.435] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 12/31/2022] Open
Abstract
The prevalence of chronic diseases including osteoporosis and sarcopenia increases as the population ages. Osteoporosis and sarcopenia are commonly associated with genetics, mechanical factors, and hormonal factors and primarily associated with aging. Many older populations, particularly those with frailty, are likely to have concurrent osteoporosis and sarcopenia, further increasing their risk of disease-related complications. Because bones and muscles are closely interconnected by anatomy, metabolic profile, and chemical components, a diagnosis should be considered for both sarcopenia and osteoporosis, which may be treated with optimal therapeutic interventions eliciting pleiotropic effects on both bones and muscles. Exercise training has been recommended as a promising therapeutic strategy to encounter the loss of bone and muscle mass due to osteosarcopenia. To stimulate the osteogenic effects for bone mass accretion, bone tissues must be exposed to mechanical load exceeding those experienced during daily living activities. Of the several exercise training programs, resistance exercise (RE) is known to be highly beneficial for the preservation of bone and muscle mass. This review summarizes the mechanisms of RE for the preservation of bone and muscle mass and supports the clinical evidences for the use of RE as a therapeutic option in osteosarcopenia.
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Affiliation(s)
- A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
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Hsu WB, Hsu WH, Hung JS, Shen WJ, Hsu RWW. Transcriptome analysis of osteoblasts in an ovariectomized mouse model in response to physical exercise. Bone Joint Res 2018; 7:601-608. [PMID: 30581558 PMCID: PMC6269594 DOI: 10.1302/2046-3758.711.bjr-2018-0075.r2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives Osteoporosis is a metabolic disease resulting in progressive loss of bone mass as measured by bone mineral density (BMD). Physical exercise has a positive effect on increasing or maintaining BMD in postmenopausal women. The contribution of exercise to the regulation of osteogenesis in osteoblasts remains unclear. We therefore investigated the effect of exercise on osteoblasts in ovariectomized mice. Methods We compared the activity of differentially expressed genes of osteoblasts in ovariectomized mice that undertook exercise (OVX+T) with those that did not (OVX), using microarray and bioinformatics. Results Many inflammatory pathways were significantly downregulated in the osteoblasts after exercise. Meanwhile, IBSP and SLc13A5 gene expressions were upregulated in the OVX+T group. Furthermore, in in vitro assay, IBSP and SLc13A5 mRNAs were also upregulated during the osteogenic differentiation of MC3T3-E1 and 7F2 cells. Conclusion These findings suggest that exercise may not only reduce the inflammatory environment in ovariectomized mice, indirectly suppressing the overactivated osteoclasts, but may also directly activate osteogenesis-related genes in osteoblasts. Exercise may thus prevent the bone loss caused by oestrogen deficiency through mediating the imbalance between the bone resorptive activity of osteoclasts and the bone formation activity of osteoblasts. Cite this article: W-B. Hsu, W-H. Hsu, J-S. Hung, W-J. Shen, R. W-W. Hsu. Transcriptome analysis of osteoblasts in an ovariectomized mouse model in response to physical exercise. Bone Joint Res 2018;7:601–608. DOI: 10.1302/2046-3758.711.BJR-2018-0075.R2.
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Affiliation(s)
- W-B Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital, Pu-Tzi City, Taiwan
| | - W-H Hsu
- Sports Medicine Center and Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Pu-Tzi City, Taiwan; Chang Gung University, Pu-Tzi City, Taiwan
| | - J-S Hung
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Pu-Tzi City, Taiwan
| | - W-J Shen
- Po Cheng Orthopedic Institute, Kaohsiung, Taiwan
| | - R W-W Hsu
- Sports Medicine Center and Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Pu-Tzi City, Taiwan; Chang Gung University, Pu-Tzi City, Taiwan
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Pellikaan P, Giarmatzis G, Vander Sloten J, Verschueren S, Jonkers I. Ranking of osteogenic potential of physical exercises in postmenopausal women based on femoral neck strains. PLoS One 2018; 13:e0195463. [PMID: 29617448 PMCID: PMC5884624 DOI: 10.1371/journal.pone.0195463] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/22/2018] [Indexed: 01/03/2023] Open
Abstract
The current study aimed to assess the potential of different exercises triggering an osteogenic response at the femoral neck in a group of postmenopausal women. The osteogenic potential was determined by ranking the peak hip contact forces (HCFs) and consequent peak tensile and compressive strains at the superior and inferior part of the femoral neck during activities such as (fast) walking, running and resistance training exercises. Results indicate that fast walking (5-6 km/h) running and hopping induced significantly higher strains at the femoral neck than walking at 4 km/h which is considered a baseline exercise for bone preservation. Exercises with a high fracture risk such as hopping, need to be considered carefully especially in a frail elderly population and may therefore not be suitable as a training exercise. Since superior femoral neck frailness is related to elevated hip fracture risk, exercises such as fast walking (above 5 km/h) and running can be highly recommended to stimulate this particular area. Our results suggest that a training program including fast walking (above 5 km/h) and running exercises may increase or preserve the bone mineral density (BMD) at the femoral neck.
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Affiliation(s)
- Pim Pellikaan
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Georgios Giarmatzis
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Sabine Verschueren
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Cunha PM, Ribeiro AS, Tomeleri CM, Schoenfeld BJ, Silva AM, Souza MF, Nascimento MA, Sardinha LB, Cyrino ES. The effects of resistance training volume on osteosarcopenic obesity in older women. J Sports Sci 2017; 36:1564-1571. [PMID: 29125017 DOI: 10.1080/02640414.2017.1403413] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of this study was to analyze the effects of resistance training (RT) performed with 1 or 3 sets per exercise on osteosarcopenic obesity (OSO) syndrome parameters in older women. Sixty-two older women (68.0 ± 4.3 years, 26.8 ± 4.4 kg/m2) participated in a 12-week RT program. Participants were randomly assigned into one of the three groups: two training groups that performed either 1 set (G1S, n = 21) or 3 sets (G3S, n = 20) 3 times weekly, or a control group (CG, n = 21). Body composition was assessed by dual X-ray absorptiometry, strength was evaluated by 1 repetition maximum testing. The G3S presented significantly higher strength changes than G1S. The changes for percentage of body fat were higher for G3S compared to G1S. There was no difference in skeletal muscle mass between G3S and G1S, however both training groups displayed greater increases in this outcome compared to CG. There was no effect for bone mineral density. The overall analysis indicated higher (P < 0.05) positive changes for G3S than G1S (composed Z-score: G3S = 0.62 ± 0.40; G1S = 0.11 ± 0.48). The results suggest that a 12-week RT period is effective to improve the risk factors of OSO, and that 3 sets induce higher improvements than a single set.
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Affiliation(s)
- Paolo M Cunha
- a Metabolism, Nutrition, and Exercise Laboratory , Londrina State University , Londrina , Brazil
| | - Alex S Ribeiro
- b Center for Research in Health Sciences . University of Northern Paraná , Londrina , Brazil
| | - Crisieli M Tomeleri
- a Metabolism, Nutrition, and Exercise Laboratory , Londrina State University , Londrina , Brazil
| | - Brad J Schoenfeld
- c Exercise Science Department , CUNY Lehman College , Bronx , NY , USA
| | - Analiza M Silva
- d Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics , Universidade de Lisboa , Lisbon , Portugal
| | - Mariana F Souza
- e Universidade Federal do Vale do São Francisco , Recife , Brasil
| | | | - Luís B Sardinha
- d Exercise and Health Laboratory, CIPER, Faculty of Human Kinetics , Universidade de Lisboa , Lisbon , Portugal
| | - Edilson S Cyrino
- a Metabolism, Nutrition, and Exercise Laboratory , Londrina State University , Londrina , Brazil
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JafariNasabian P, Inglis JE, Kelly OJ, Ilich JZ. Osteosarcopenic obesity in women: impact, prevalence, and management challenges. Int J Womens Health 2017; 9:33-42. [PMID: 28144165 PMCID: PMC5245917 DOI: 10.2147/ijwh.s106107] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Osteosarcopenic obesity syndrome (OSO) has recently been identified as a condition encompassing osteopenia/osteoporosis, sarcopenia and obesity. OSO is especially deleterious in older adults (even if they are not obese by conventional measures), due to age-related redistribution of fat and its infiltration into bone and muscle. Osteoporosis and bone fractures in elderly increase the risk of sarcopenia, which, through decreased mobility, increases the risk of more falls and fractures, creating a vicious cycle. Obesity plays a dual role: to a certain extent, it promotes bone and muscle gains through mechanical loading; in contrast, increased adiposity is also a source of pro-inflammatory cytokines and other endocrine factors that impair bone and muscle. As the elderly population increases, changes in lifestyle to delay the onset of OSO, or prevent OSO, are warranted. Among these changes, dietary patterns and physical activity modifications are the first ones to be implemented. The typical Western diet (and lifestyle) promotes several chronic diseases including OSO, by facilitating a pro-inflammatory state, largely via the imbalance in omega-6/omega-3 fatty acid ratio and low-fiber and high-processed food consumption. Nutritional modifications to prevent and/or alleviate the OSO syndrome include adequate intake of protein, calcium, magnesium and vitamin D and increasing consumptions of foods containing omega-3 polyunsaturated fatty acids and fiber. Certain types of physical activity, often decreased in overweight/obese women and in elderly, might preserve bone and muscle, as well as help in reducing body fat accrual and fat infiltration. Habitual daily activities and some alternative modes of exercise may be more appropriate for older adults and play a crucial role in preventing bone and muscle loss and maintaining optimal weight. In conclusion, older adults who suffer from OSO syndrome may benefit from combined efforts to improve diet and physical activity, and such recommendations should be fostered as part of public health programs.
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Affiliation(s)
- Pegah JafariNasabian
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL
| | - Julia E Inglis
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL
| | | | - Jasminka Z Ilich
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL
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The Femoral Neck Mechanoresponse to Hip Extensors Exercise: A Case Study. J Osteoporos 2017; 2017:5219541. [PMID: 28168080 PMCID: PMC5267078 DOI: 10.1155/2017/5219541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/21/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022] Open
Abstract
Physical activity is recommended to prevent age-related bone loss. However, the proximal femur mechanoresponse is variable, possibly because of a muscle-dependant mechanoresponse. We compared the proximal femur response with the femoral strain pattern generated by the hip extensor muscles. A healthy participant underwent a six-month unilateral training of the hip extensor muscles using a resistance weight regularly adjusted to the 80% of the one-repetition maximum weight. DXA-based measurements of the areal Bone Mineral Density (aBMD) in the exercise leg were adjusted for changes in the control leg. The biomechanical stimulus for bone adaptation (BS) was calculated using published models of the musculoskeletal system and the average hip extension moment in elderly participants. Volumetric (ΔvBMD) and areal (ΔaBMD) BMD changes were calculated. The measured and calculated BMD changes consistently showed a positive and negative effect of exercise in the femoral neck (ΔaBMD = +0.7%; ΔvBMD = +0.8%) and the trochanter region (ΔaBMD = -4.1%; ΔvBMD = -0.5%), respectively. The 17% of the femoral neck exceeded the 75th percentile of the spatially heterogeneous BS distribution. Hip extensor exercises may be beneficial in the proximal femoral neck but not in the trochanteric region. DXA-based measurements may not capture significant aBMD local changes.
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Kim JE, Moon H, Jin HM. The effects of exercise training and type of exercise training on changes in bone mineral denstiy in Korean postmenopausal women: a systematic review. J Exerc Nutrition Biochem 2016; 20:7-15. [PMID: 27757382 PMCID: PMC5067416 DOI: 10.20463/jenb.2016.09.20.3.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/22/2022] Open
Abstract
[Purpose] To systematically review the effects of exercise training and the type of exercise training on changes in bone mineral density (BMD) in Korean postmenopausal women. [Methods] Korean studies Information Service System (KISS) and PubMed were searched and 17 randomized control trials were selected. Changes in BMD of lumbar spine (LS), femur neck (FN), Ward’s triangle (WT), and trochanter (Tro) were chosen as major outcomes. [Results] Exercise training increased BMD of LS, FN, WT, and Tro. According to the type of exercise training, combined exercise training (aerobic + resistance) showed improvements in BMD of LS, FN, WT, and Tro. However, aerobic exercise training alone and resistance exercise training alone showed inconsistent results. [Conclusion] Exercise training can improve the BMD of LS, FN, WT, and Tro in Korean postmenopausal women. The type of exercise training may be a crucial factor for maintaining or improving bone health of this population.
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Affiliation(s)
- Jung Eun Kim
- Department of Nutrition Science, Purdue University, West Lafayette, IN USA
| | - Hwasil Moon
- Division of Kinesiology & Sport Studies, Ewha Womans University, Seoul Republic of Korea
| | - Haeng Mi Jin
- Department of Sport Rehabilitation, The Graduate School of Alternative Medicine, Kyonggi University, Seoul Republic of Korea
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31
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Nam SS, Sunoo S, Park HY, Moon HW. The effects of long-term whole-body vibration and aerobic exercise on body composition and bone mineral density in obese middle-aged women. J Exerc Nutrition Biochem 2016; 20:19-27. [PMID: 27508150 PMCID: PMC4977903 DOI: 10.20463/jenb.2016.06.20.2.3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the effectiveness of whole-body passive vibration exercise and its differences from aerobic exercise on body composition, bone mineral density (BMD) and bone mineral content (BMC). METHODS Obese middle-aged women (n=33 out of 45) with 34±3% body fat completed the training protocol. They were randomly assigned into diet (n=9; control group), diet plus whole-body vibration exercise (n=13; vibration group), and diet plus aerobic exercise (n=11; aerobic group) groups and we compared their body composition, BMD, and BMC before and after 9 months of training. There were no significant differences in nutrient intake among groups during the training period. RESULTS Relative body fat (%) decreased significantly (p < .05) in all three groups and the exercise groups showed a greater reduction in fat mass than the diet only group. BMD in the whole body, lumbar spine, hip and forearm were not significantly different among the three groups. Total body BMC increased significantly in the vibration group throughout the first 6 months of training. CONCLUSION Results suggest that long- term vibration training when used in conjunction with a diet program is as effective as aerobic exercise with a diet program in improving body composition of obese middle-aged women without compromising BMC or BMD. Thus, it can be considered a novel and effective method for reducing body fat.
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Affiliation(s)
- Sang-Seok Nam
- Department of Sports Medicine, Kyung Hee University, Yongin-si Republic of Korea
| | - Sub Sunoo
- Department of Sports Medicine, Kyung Hee University, Yongin-si Republic of Korea
| | - Hun-Young Park
- Department of Sports Medicine, Kyung Hee University, Yongin-siRepublic of Korea; Performance Activity and Performance Institute, Konkuk University, SeoulRepublic of Korea
| | - Hwang-Woon Moon
- Department of Sports and Outdoors, Eulji University, Yangji-dong, Seongnam-si Republic of Korea
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Knobf MT, Jeon S, Smith B, Harris L, Kerstetter J, Thompson AS, Insogna K. Effect of a randomized controlled exercise trial on bone outcomes: influence of adjuvant endocrine therapy. Breast Cancer Res Treat 2016; 155:491-500. [DOI: 10.1007/s10549-016-3693-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
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OLÇUM M, BASKAN Ö, KARADAŞ Ö, ÖZÇİVİCİ E. Application of low intensity mechanical vibrations for bone tissue maintenance and regeneration. Turk J Biol 2016. [DOI: 10.3906/biy-1506-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kang JI, Jeong DK, Choi H. The effects of trunk stabilization exercise on bone density after menopause. J Phys Ther Sci 2015; 27:3869-72. [PMID: 26834370 PMCID: PMC4713809 DOI: 10.1589/jpts.27.3869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study examined the effect of low intensity exercise on bone density by conducting trunk stabilization exercise on females after menopause for 24 weeks. [Subjects and Methods] Thirty three female subjects over 47 years old and under the age of 53 were selected and 16 for experimental group and 17 for control group were randomly selected. Experimental group had performed spinal and pelvic stabilization exercise 30 minutes a day, 5times a week, for 24 weeks. Except for the daily life, control group did not participate in any characteristic movement. Bone density of every member in experimental group was measured using average value of bone density of 1st-4th lumbar through quantitative computer tomography. [Results] There was a meaningful difference in only control group about measured value of bone density within each group, experimental and control group, but there was no meaningful difference in measured value of bone density between two groups, experimental group and control group. [Conclusion] Through this research, we could see the fact that although trunk stability exercise could not change bone density meaningfully, it could maintain bone density. In the future, it is randomly necessary to study things related this because results of researches can show different results according to exercise intensity, exercise period, age, weight, hormone status and mediation period. It is considered that it will help to prevent and treat patients with osteoporosis a lot.
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Affiliation(s)
- Jeong-il Kang
- Department of Physical Therapy, Sehan University, Republic
of Korea
| | - Dae-Keun Jeong
- Department of Physical Therapy, Sehan University, Republic
of Korea
| | - Hyun Choi
- Department of Physical Therapy, Mokpo Mirae Hospital, Republic of Korea
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Hakestad KA, Torstveit MK, Nordsletten L, Risberg MA. Effect of exercises with weight vests and a patient education programme for women with osteopenia and a healed wrist fracture: a randomized, controlled trial of the OsteoACTIVE programme. BMC Musculoskelet Disord 2015; 16:352. [PMID: 26578370 PMCID: PMC4650105 DOI: 10.1186/s12891-015-0811-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/10/2015] [Indexed: 12/22/2022] Open
Abstract
Background Exercise programmes have shown to be important for the prevention of fractures in patients with established osteoporosis. However, few studies have evaluated the effect of such programmes for women with low bone mineral density (BMD) (osteoporosis or osteopenia) who have already suffered a fracture. Studies have indicated that exercise programmes concentrating on muscular strength and dynamic balance have a positive effect on significant risk factors for falls such as quadriceps strength and balance. The aim of the present study was to assess the effect of a 6-month exercise programme and a patient education component (OsteoACTIVE) on quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life in postmenopausal women with osteopenia and a previous wrist fracture. Methods Eighty postmenopausal women with low BMD and a healed wrist fracture were randomized to OsteoACTIVE (n = 42) (age 65.5, range 51.2–79.2 years) or patient education only (control group) (n = 38) (age 63.9, range 52.7–86.8 years). Follow-up was conducted after 6 months (end of intervention) and 1 year. Outcome measures included quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life. Results Thirty-five participants (83 %) completed the OsteoACTIVE programme. Mean adherence to OsteoACTIVE was 87 % (range 48–100 %). Twenty-five participants (72 %) met the a priori goal of 80 % adherence to the program. No adverse events were reported. There were no significant differences between the two groups over the 1-year follow-up for any of the outcome measures. Conclusion The OsteoACTIVE rehabilitation programme revealed no significant effect on quadriceps strength, BMD, dynamic balance, walking capacity or self-reported functional outcomes over the 1-year follow-up. Trial registration NCT01357278 at ClinicalTrials.gov (date of registration2010-04-21).
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Affiliation(s)
- K A Hakestad
- Department of Orthopaedic Surgery, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
| | - M K Torstveit
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand and Grimstand, Norway.
| | - L Nordsletten
- Department of Orthopaedic Surgery, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. .,University of Oslo, Oslo, Norway.
| | - M A Risberg
- Department of Orthopaedic Surgery, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. .,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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Hinton PS, Nigh P, Thyfault J. Effectiveness of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized, clinical trial. Bone 2015; 79:203-12. [PMID: 26092649 PMCID: PMC4503233 DOI: 10.1016/j.bone.2015.06.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/30/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the effects of 12 mo of resistance training (RT, 2×/wk, N=19) or jump training (JUMP, 3×/wk, N=19) on bone mineral density (BMD) and bone turnover markers (BTM) in physically active (≥ 4h/wk) men (mean age: 44 ± 2 y; median: 44 y) with osteopenia of the hip or spine. METHODS Participants rated pain and fatigue following each RT or JUMP session. All participants received supplemental calcium (1200 mg/d) and vitamin D (10 μg/d). BMD was measured at 0, 6, and 12 mo using DXA scans of the whole body (WB), total hip (TH) and lumbar spine (LS). BTM and 25 OHD were measured by ELISA. The effects of RT or JUMP on BMD and BTM were evaluated using 3x2 repeated measures ANOVA (time, group). This study was conducted in accordance with the Declaration of Helsinki and was approved by the University of Missouri IRB. RESULTS At baseline, 36 of 38 participants were vitamin D sufficient (25OHD >50 nmol/L); at 12 mo, all participants were 25OHD sufficient. 25OHD did not differ between groups. WB and LS BMD significantly increased after 6 months of RT or JUMP and this increase was maintained at 12 mo; TH BMD increased only in RT. Osteocalcin increased significantly after 12 mo of RT or JUMP; CTx decreased significantly after 6 mo and returned to baseline concentrations at 12 mo in both RT and JUMP. Pain and fatigue ratings after RT or JUMP sessions were very low at 0, 6, and 12 mo. CONCLUSION RT or JUMP, which appeared safe and feasible, increased BMD of the whole body and lumbar spine, while RT also increased hip BMD, in moderately active, osteopenic men.
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Affiliation(s)
- Pamela S Hinton
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia MO 65211, USA.
| | - Peggy Nigh
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia MO 65211, USA
| | - John Thyfault
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia MO 65211, USA; Internal Medicine - Division of GI and Hepatology, University of Missouri, Columbia MO 65211, USA
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Brenneman EC, Kuntz AB, Wiebenga EG, Maly MR. A Yoga Strengthening Program Designed to Minimize the Knee Adduction Moment for Women with Knee Osteoarthritis: A Proof-Of-Principle Cohort Study. PLoS One 2015; 10:e0136854. [PMID: 26367862 PMCID: PMC4569287 DOI: 10.1371/journal.pone.0136854] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED People with knee osteoarthritis may benefit from exercise prescriptions that minimize knee loads in the frontal plane. The primary objective of this study was to determine whether a novel 12-week strengthening program designed to minimize exposure to the knee adduction moment (KAM) could improve symptoms and knee strength in women with symptomatic knee osteoarthritis. A secondary objective was to determine whether the program could improve mobility and fitness, and decrease peak KAM during gait. The tertiary objective was to evaluate the biomechanical characteristics of this yoga program. In particular, we compared the peak KAM during gait with that during yoga postures at baseline. We also compared lower limb normalized mean electromyography (EMG) amplitudes during yoga postures between baseline and follow-up. Primary measures included self-reported pain and physical function (Knee injury and Osteoarthritis Outcome Score) and knee strength (extensor and flexor torques). Secondary measures included mobility (six-minute walk, 30-second chair stand, stair climbing), fitness (submaximal cycle ergometer test), and clinical gait analysis using motion capture synchronized with electromyography and force measurement. Also, KAM and normalized mean EMG amplitudes were collected during yoga postures. Forty-five women over age 50 with symptomatic knee osteoarthritis, consistent with the American College of Rheumatology criteria, enrolled in our 12-week (3 sessions per week) program. Data from 38 were analyzed (six drop-outs; one lost to co-intervention). Participants experienced reduced pain (mean improvement 10.1–20.1 normalized to 100; p<0.001), increased knee extensor strength (mean improvement 0.01 Nm/kg; p = 0.004), and increased flexor strength (mean improvement 0.01 Nm/kg; p = 0.001) at follow-up compared to baseline. Participants improved mobility on the six-minute walk (mean improvement 37.7 m; p<0.001) and 30-second chair stand (mean improvement 1.3; p = 0.006) at follow-up compared to baseline. Fitness and peak KAM during gait were unchanged between baseline and follow-up. Average KAM during the yoga postures were lower than that of normal gait. Normalized mean EMG amplitudes during yoga postures were up to 31.0% of maximum but did not change between baseline and follow-up. In this cohort study, the yoga-based strengthening postures that elicit low KAMs improved knee symptoms and strength in women with knee OA following a 12 week program (3 sessions per week). The program also improved mobility, but did not improve fitness or reduce peak KAM during gait. The KAM during the yoga postures were lower than that of normal gait. Overall, the proposed program may be useful in improving pain, strength, and mobility in women with knee osteoarthritis. Clinical efficacy needs to be assessed using a randomized controlled trial design. TRIAL REGISTRATION ClinicalTrials.gov NCT02146105.
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Affiliation(s)
- Elora C. Brenneman
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexander B. Kuntz
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Emily G. Wiebenga
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Monica R. Maly
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Mueller SM, Braendli S, Toigo M. Alterations in bone mineral density and lower extremity lean mass after hip arthroscopy in a professional female Ironman triathlete: a case study. SPRINGERPLUS 2015; 4:70. [PMID: 25713762 PMCID: PMC4329125 DOI: 10.1186/s40064-015-0859-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Femoroacetabular impingement is a pathomechanical condition of the hip, which is often treated through arthroscopic techniques. The ensuing immobilization period is associated with decreases in muscle mass and bone mass. To date, minimal knowledge is present about the development of tissue mass during the considerably short rehabilitation period before returning to competition in elite endurance athletes. CASE DESCRIPTION Before and after surgery, a professional female Ironman triathlete underwent dual-energy X-ray absorptiometry and peripheral quantitative computed tomography measurements. DISCUSSION AND EVALUATION Areal bone mineral density (aBMD) of the proximal femur and lower extremity lean mass decreased in the surgically treated lower extremity during the two-month period of immobilization after the hip arthroscopy. These losses were compensated for after only six weeks of rehabilitation. A similar progression of aBMD values was observed in the lumbar spine. The adaptational pattern in volumetric BMD (vBMD) and volumetric bone mineral content (vBMC) of the tibiae were more complex, but attained pre-immobilization values for most variables also after six weeks of rehabilitation. All other variables attained pre-immobilization values no later than nine months after the surgical intervention. CONCLUSIONS The athlete showed a high plasticity of bone and lean tissue with an optimal short- and midterm outcome. Following a two months immobilization period after a hip arthroscopy, aBMD, vBMD and vBMC achieved pre-surgical levels after four months of rehabilitation in a female Ironman triathlete. A nine-month follow-up measurement confirmed the safety of the fast return to sport.
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Affiliation(s)
- Sandro Manuel Mueller
- />Exercise Physiology Lab, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Simone Braendli
- />Exercise Physiology Lab, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Marco Toigo
- />Exercise Physiology Lab, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
- />Department of Orthopaedics, Laboratory for Muscle Plasticity, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence-informed strategy to prevent osteoporosis in Australia. Med J Aust 2015; 199:S1-S46. [PMID: 25370432 DOI: 10.5694/j.1326-5377.2013.tb04225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 12/02/2012] [Indexed: 12/14/2022]
Abstract
Osteoporosis imposes a tremendous burden on Australia: 1.2 million Australians have osteoporosis and 6.3 million have osteopenia. In the 2007–08 financial year, 82 000 Australians suffered fragility fractures, of which > 17 000 were hip fractures. In the 2000–01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions — to ensure people have adequate calcium intake, vitamin D levels and appropriate physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, muscle strengthening exercises and challenging balance/mobility activities should be conducted in a safe environment.
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Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC, Australia.
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC, Australia
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA, Australia
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Strength Gains as a Result of Brief, Infrequent Resistance Exercise in Older Adults. JOURNAL OF SPORTS MEDICINE 2014; 2014:731890. [PMID: 26464894 PMCID: PMC4590889 DOI: 10.1155/2014/731890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 12/25/2022]
Abstract
Chronological aging is associated with a decrease in skeletal muscle mass and bone mineral density, an increase in fat mass, frequency of falls and fractures, and the likelihood of obesity, diabetes, and coronary heart disease. Resistance exercise has been shown to counter all of these effects of aging and, in turn, reduce the risk of all-cause mortality. However, variables such as volume and frequency have become contentious issues, with recent publications suggesting that similar physiological adaptations are possible with both high- and low-volume approaches. The aim of this research was to consider strength increases as a result of brief, infrequent resistance exercise. The present study offers data from 33 (14 male and 19 female) older adults (M = 55 years) who underwent brief (<15 minutes per exercise session), infrequent (2×/week), resistance exercise to a high intensity of effort (6-repetition maximum) at a controlled repetition duration (10 seconds concentric : 10 seconds eccentric) on 5 resistance machines (chest press, leg press, pull-down, seated row, and overhead press). Data is presented for training interventions of 12 weeks (male) and 19 weeks (female). Significant strength increases were identified for all exercises. With the detailed health benefits obtainable, the present study suggests that resistance exercise can be efficacious in much smaller volumes than previously considered.
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Shirazi-Fard Y, Metzger CE, Kwaczala AT, Judex S, Bloomfield SA, Hogan HA. Moderate intensity resistive exercise improves metaphyseal cancellous bone recovery following an initial disuse period, but does not mitigate decrements during a subsequent disuse period in adult rats. Bone 2014; 66:296-305. [PMID: 24929241 DOI: 10.1016/j.bone.2014.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 05/21/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
Spaceflight provides a unique environment for skeletal tissue causing decrements in structural and densitometric properties of bone. Previously, we used the adult hindlimb unloaded (HU) rat model to show that previous exposure to HU had minimal effects on bone structure after a second HU exposure followed by recovery. Furthermore, we found that the decrements during second HU exposure were milder than the initial HU cycle. In this study, we used a moderate intensity resistance exercise protocol as an anabolic stimulus during recovery to test the hypothesis that resistance exercise following an exposure to HU will significantly enhance recovery of densitometric, structural, and, more importantly, mechanical properties of trabecular and cortical bone. We also hypothesized that resistance exercise during recovery, and prior to the second unloading period, will mitigate the losses during the second exposure. The hypothesis that exercise during recovery following hindlimb unloading will improve bone quality was supported by our data, as total BMC, total vBMD, and cancellous bone formation at the proximal tibia metaphysis increased significantly during exercise period, and total BMC/vBMD exceeded age-matched control and non-exercised values significantly by the end of recovery. However, our results did not support the hypothesis that resistance exercise prior to a subsequent unloading period will mitigate the detrimental effects of the second exposure, as the losses during the second exposure in total BMC, total vBMD, and cortical area at the proximal tibia metaphysis for the exercised animals were similar to those of the non-exercised group. Therefore, exercise did not mitigate effects of the second HU exposure in terms of pre-to-post HU changes in these variables, but it did produce beneficial effects in a broader sense.
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Affiliation(s)
- Yasaman Shirazi-Fard
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - Corinne E Metzger
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA.
| | - Andrea T Kwaczala
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA.
| | - Stefan Judex
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA.
| | - Susan A Bloomfield
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA.
| | - Harry A Hogan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843, USA.
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Winters-Stone KM, Laudermilk M, Woo K, Brown JC, Schmitz KH. Influence of weight training on skeletal health of breast cancer survivors with or at risk for breast cancer-related lymphedema. J Cancer Surviv 2014; 8:260-8. [PMID: 24390808 DOI: 10.1007/s11764-013-0337-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/16/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine whether the Physical Activity and Lymphedema (PAL) trial weight training program for breast cancer survivors at risk of or with breast cancer-related lymphedema provided skeletal benefits. METHODS Of the 295 participants in the randomized controlled PAL trial, 258 (weight training; N = 128; control, N = 130) had complete measures of bone mineral density (BMD (in grams per square centimeter)) of the proximal femur and lumbar spine and were also categorized by T scores. Women in the weight training group performed slowly progressive weight training 2 days/week for 12 months compared to women in the control group who maintained their usual physical activities. RESULTS There were no significant differences in the rate of BMD change at any skeletal site between weight training and control groups, regardless of menopausal status. Distribution of bone health categories was not significantly different between groups at baseline, but became different at 12 months (p < 0.03) among postmenopausal women due to an increase in the percentage of controls who became osteopenic (35 to 44%) compared to stable bone health in weight lifters. CONCLUSIONS The PAL weight training program that increased muscle strength without exacerbating or causing lymphedema among breast cancer survivors was not as efficacious at improving skeletal health. The skeletal loads produced from the PAL program may be insufficient to notably shift BMD, but may have a subtle osteogenic effect. IMPLICATIONS FOR CANCER SURVIVORS The safety and efficacy of rigorous weight training programs for improving skeletal health in women at risk for or with breast cancer-related lymphedema remain to be determined.
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Affiliation(s)
- Kerri M Winters-Stone
- School of Nursing, Oregon Health & Sciences University, Mailcode: SN-ORD, Portland, OR, 97239, USA,
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Primum non nocere: A commentary on avoidable injuries and safe resistance training techniques. ACTA ACUST UNITED AC 2014. [DOI: 10.17338/trainology.3.1_31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ebeling PR, Daly RM, Kerr DA, Kimlin MG. Building healthy bones throughout life: an evidence‐informed strategy to prevent osteoporosis in Australia. Med J Aust 2013. [DOI: 10.5694/mjao12.11363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter R Ebeling
- NorthWest Academic Centre, University of Melbourne, and Western Health, Melbourne, VIC
| | - Robin M Daly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, VIC
| | - Deborah A Kerr
- Curtin Health Innovation Research Institute and School of Public Health, Curtin University, Perth, WA
| | - Michael G Kimlin
- Faculty of Health, Queensland University of Technology, Brisbane, QLD
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Rossi AM, Moullec G, Lavoie KL, Gour-Provençal G, Bacon SL. The evolution of a Canadian Hypertension Education Program recommendation: the impact of resistance training on resting blood pressure in adults as an example. Can J Cardiol 2013; 29:622-7. [PMID: 23541664 DOI: 10.1016/j.cjca.2013.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/15/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022] Open
Abstract
Ever since the first set of hypertension recommendations which were generated from the Canadian Hypertension Education Program, lifestyle and health behaviour have been a key focus. An initial recommendation focused on the benefits of aerobic exercise to reduce resting blood pressure (BP). However, until the 2013 edition, resistance exercise (RT) was not included. The current article describes a meta-analysis that was conducted which helped inform the creation of the newly introduced recommendation. Literature searches were conducted in 4 electronic databases. Inclusion criteria included: (1) randomized controlled trials with 4-week minimum, RT-alone intervention arms; (2) BP-lowering as the primary outcome; (3) human, adult participants; and (4) reporting control data, baseline, and postintervention resting systolic BP and diastolic BP. Nine studies (11 intervention groups, 452 participants) were identified. The analyses indicated that diastolic BP was significantly reduced (-2.2 mm Hg; 95% confidence interval, -3.9 to -0.5) in those randomized to RT compared with control participants. In contrast, no statistically significant change in systolic BP (-1.0 mm Hg; 95% confidence interval, -3.4 to 1.4) was observed. None of the studies found RT to increase BP and no adverse effects of RT were explicitly reported. Results suggest that participation in RT is not harmful and does not increase BP. However, more evidence is needed before recommending RT as a specific BP-lowering therapy.
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Affiliation(s)
- Amanda M Rossi
- Department of Exercise Science, Concordia University, Montréal, Québec, Canada
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Balsamo S, Henrique da Mota LM, de Santana FS, Cunha Nascimento DD, Aguiar Bezerra LM, Coscrato Balsamo DO, Cunha Borges JL, de Paula AP, Bottaro M. Treinamento de força versus hidroginástica: uma análise transversal comparativa da densidade mineral óssea em mulheres na pós-menopausa. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000200006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kelley GA, Kelley KS, Kohrt WM. Exercise and bone mineral density in premenopausal women: a meta-analysis of randomized controlled trials. Int J Endocrinol 2013; 2013:741639. [PMID: 23401684 PMCID: PMC3563173 DOI: 10.1155/2013/741639] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 10/27/2012] [Accepted: 11/06/2012] [Indexed: 01/22/2023] Open
Abstract
Objective. Examine the effects of exercise on femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) in premenopausal women. Methods. Meta-analysis of randomized controlled exercise trials ≥24 weeks in premenopausal women. Standardized effect sizes (g) were calculated for each result and pooled using random-effects models, Z score alpha values, 95% confidence intervals (CIs), and number needed to treat (NNT). Heterogeneity was examined using Q and I(2). Moderator and predictor analyses using mixed-effects ANOVA and simple metaregression were conducted. Statistical significance was set at P ≤ 0.05. Results. Statistically significant improvements were found for both FN (7g's, 466 participants, g = 0.342, 95% CI = 0.132, 0.553, P = 0.001, Q = 10.8, P = 0.22, I(2) = 25.7%, NNT = 5) and LS (6g's, 402 participants, g = 0.201, 95% CI = 0.009, 0.394, P = 0.04, Q = 3.3, P = 0.65, I(2) = 0%, NNT = 9) BMD. A trend for greater benefits in FN BMD was observed for studies published in countries other than the United States and for those who participated in home versus facility-based exercise. Statistically significant, or a trend for statistically significant, associations were observed for 7 different moderators and predictors, 6 for FN BMD and 1 for LS BMD. Conclusions. Exercise benefits FN and LS BMD in premenopausal women. The observed moderators and predictors deserve further investigation in well-designed randomized controlled trials.
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Affiliation(s)
- George A. Kelley
- Department of Community Medicine, West Virginia University, Morgantown, WV 26506, USA
- Meta-Analytic Research Group, Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, P.O. Box 9190, Morgantown, WV 26506-9190, USA
| | - Kristi S. Kelley
- Department of Community Medicine, West Virginia University, Morgantown, WV 26506, USA
- Meta-Analytic Research Group, Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, P.O. Box 9190, Morgantown, WV 26506-9190, USA
| | - Wendy M. Kohrt
- Division of Geriatric Medicine, University of Colorado Denver, Anschutz Medical Campus, P.O. Box 6511, Mail Stop B179, 12631 East 17th Avenue-L15, Aurora, CO 80045, USA
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Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. AGE (DORDRECHT, NETHERLANDS) 2012; 34:1493-515. [PMID: 21922251 PMCID: PMC3528362 DOI: 10.1007/s11357-011-9311-8] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 08/24/2011] [Indexed: 05/08/2023]
Abstract
The purpose of the study was to assess the effects of exercise interventions with different impact loading characteristics on lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) in older adults. We searched electronic databases and hand searched selected journals up to February 2011 for randomized controlled trials (RCTs) investigating the effects of impact exercise interventions on LS and FN BMD in older adults. Exercise protocols were categorized according to impact loading characteristics. Weighted mean difference (WMD) meta-analyses were undertaken. Heterogeneity amongst trials and publication bias was tested. Random-effects models were applied. Trial quality assessment was also undertaken. Nineteen RCTs, including 1577 subjects, met the inclusion criteria. Twenty-two study group comparisons reported BMD data at the LS. Meta-analysis showed a significant change in BMD at this site (WMD 0.011 g/cm(2), 95% CI 0.003 to 0.020; p = 0.007), although results were moderately inconsistent (I(2) = 52.2%). BMD data at the FN were available from 19 study group comparisons among older adults. Results were inconsistent (I(2) = 63.6%) in showing a significant positive effect of exercise on BMD at this site (WMD 0.016 g/cm(2), 95% CI 0.005 to 0.027; p = 0.004). Combined loading studies of impact activity mixed with high-magnitude joint reaction force loading through resistance training were effective at LS (WMD 0.016 g/cm(2), 95% CI 0.002 to 0.036; p = 0.028), and no inconsistency existed among these trials. Odd-impact protocols were also effective in increasing BMD at LS (WMD 0.039 g/cm(2), 95% CI 0.002 to 0.075; p = 0.038) and FN (WMD 0.036 g/cm(2), 95% CI 0.012 to 0.061; p = 0.004), although heterogeneity was evident (I(2) = 87.5% and I(2) = 83.5%, respectively). We found consistency among results for low-impact and resistance exercise studies on LS and FN, although non-significant BMD changes were evident amongst these types of protocols at any site and amongst the RCTs that provided a combined loading impact exercise at FN. Funnel plots showed no evidence of publication bias. Trial quality was moderate to high. The findings from our meta-analysis of RCTs support the efficacy of exercise for increasing LS and FN BMD in older adults.
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Affiliation(s)
- Elisa A Marques
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal.
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Abstract
Mechanical loading is a crucial factor for maintaining skeletal health. Physical activities, exercise, and sports provide a wealth and variety of mechanical loads to bones, through muscle forces, ground reaction forces, and other contact or impact forces. Weightbearing activities can be effective exercises to enhance bone health-particularly, those that involve jumping and impact loads (with greater strain magnitudes, rates, and frequencies). Physical activity appears to be acutely beneficial for enhancing bone health in the early pubertal period and in older age, such as in postmenopausal women. In preparing this article, PubMed, Web of Science, and relevant edited books (English language) were reviewed from 1961 to present.
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Affiliation(s)
- Sarah L Manske
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Kelley GA, Kelley KS, Kohrt WM. Effects 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 2012; 13:177. [PMID: 22992273 PMCID: PMC3489866 DOI: 10.1186/1471-2474-13-177] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 09/14/2012] [Indexed: 11/24/2022] Open
Abstract
Background Low bone mineral density (BMD) and subsequent fractures are a major public health problem in postmenopausal women. The purpose of this study was to use the aggregate data meta-analytic approach to examine the effects of ground (for example, walking) and/or joint reaction (for example, strength training) exercise on femoral neck (FN) and lumbar spine (LS) BMD in postmenopausal women. Methods The a priori inclusion criteria were: (1) randomized controlled trials, (2) exercise intervention ≥ 24 weeks, (3) comparative control group, (4) postmenopausal women, (5) participants not regularly active, i.e., less than 150 minutes of moderate intensity (3.0 to 5.9 metabolic equivalents) weight bearing endurance activity per week, less than 75 minutes of vigorous intensity (> 6.0 metabolic equivalents) weight bearing endurance activity per week, resistance training < 2 times per week, (6) published and unpublished studies in any language since January 1, 1989, (7) BMD data available at the FN and/or LS. Studies were located by searching six electronic databases, cross-referencing, hand searching and expert review. Dual selection of studies and data abstraction were performed. Hedge’s standardized effect size (g) was calculated for each FN and LS BMD result and pooled using random-effects models. Z-score alpha values, 95%confidence intervals (CI) and number-needed-to-treat (NNT) were calculated for pooled results. Heterogeneity was examined using Q and I2. Mixed-effects ANOVA and simple meta-regression were used to examine changes in FN and LS BMD according to selected categorical and continuous variables. Statistical significance was set at an alpha value ≤0.05 and a trend at >0.05 to ≤ 0.10. Results Small, statistically significant exercise minus control group improvements were found for both FN (28 g’s, 1632 participants, g = 0.288, 95% CI = 0.102, 0.474, p = 0.002, Q = 90.5, p < 0.0001, I2 = 70.1%, NNT = 6) and LS (28 g’s, 1504 participants, g = 0.179, 95% CI = −0.003, 0.361, p = 0.05, Q = 77.7, p < 0.0001, I2 = 65.3%, NNT = 6) BMD. Clinically, it was estimated that the overall changes in FN and LS would reduce the 20-year relative risk of osteoporotic fracture at any site by approximately 11% and 10%, respectively. None of the mixed-effects ANOVA analyses were statistically significant. Statistically significant, or a trend for statistically significant, associations were observed for changes in FN and LS BMD and 20 different predictors. Conclusions The overall findings suggest that exercise may result in clinically relevant benefits to FN and LS BMD in postmenopausal women. Several of the observed associations appear worthy of further investigation in well-designed randomized controlled trials.
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Affiliation(s)
- George A Kelley
- Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, Robert C, Byrd Health Sciences Center, West Virginia University, Morgantown, WV 26506-9190, USA.
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