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Blay R, Flores LE, Kupzyk K, Waltman N, Lappe J, Mack L, Bilek L. Twelve-month resistance and impact exercise program or risedronate provides a relative benefit to hip bone structure in postmenopausal women: results from a randomized controlled trial. Osteoporos Int 2024; 35:877-891. [PMID: 38368307 DOI: 10.1007/s00198-023-07008-x] [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: 01/16/2023] [Accepted: 12/19/2023] [Indexed: 02/19/2024]
Abstract
Bone strength estimates are important for fracture prevention. This study compared bone strength changes in postmenopausal women with low bone mass who were assigned to 12 months of exercise, a bone medication, or control. Exercise and bone medications benefited structure at the hip. Structure should be considered in fracture prevention research. PURPOSE Exercise and bisphosphonates reduce fracture risk, but their impact on estimates of bone strength remains uncertain. This study compared changes in tibial bone strength using peripheral quantitative computed tomography (pQCT) and hip structure analysis (HSA) outcomes from dual-energy X-ray absorptiometry (DXA) scans in postmenopausal women with low bone mass assigned to 12 months of exercise, risedronate, or control. METHODS In this RCT, 276 postmenopausal women within 6 years of menopause were randomly assigned to three groups: exercise (92), risedronate (91), or control (93). Exercise included weighted jogging and progressive resistance exercises; risedronate treatment was 150 mg monthly; all groups received calcium and vitamin D. pQCT and DXA images were obtained at baseline and 6 and 12 months and compared between groups over time. RESULTS Participants had a mean (± SD) age of 54.5 (± 3.2) years with an average of 36.7 (± 40.7) months postmenopause. No significant differences were found between groups for the change in pQCT outcomes (volumetric bone mineral density, area, and strength estimates). At 12 months, mean percent differences (95% CI) in HSA measures between exercise and controls were as follows: intertrochanteric, cross-sectional area 2.25% (0.28, 4.12) (p = .03), cross-sectional moment of inertia (CSMI) 5.67% (1.47, 9.87) (p < .01), and section modulus (SM) 4.38% (1.02, 7.74) (p = .01), and narrow neck, average cortical thickness 2.37% (-0.08, 4.83) (p = .031). Mean percent differences (95% CI) in HSA measures between risedronate and control were as follows: intertrochanteric, CSMI 4.28% (-0.24, 8.81) (p = .03) and SM 3.35% (-0.21, 6.91) (p = .03), and shaft, subperiosteal width 0.82% (0.05, 1.58) (p = .047), CSMI 2.53% (0.88, 4.18) (p = .004), and SM 1.57% (0.34, 2.8) (p = .008). Exercise maintained neck-shaft angle compared to both control 1.27% (0.13, 2.41) (p = .04) and risedronate 1.31% (0.23, 2.39) (p = .03). All other differences for changes in HSA outcomes over time were not significantly different between the exercise and risedronate groups. CONCLUSION Exercise and bisphosphonates may influence structural and strength estimates at the hip, but not at peripheral sites (tibia). Neither exercise nor bisphosphonates were found to be superior in improving estimates of hip bone strength.
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Affiliation(s)
- R Blay
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - L E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - K Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - N Waltman
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - J Lappe
- Creighton Osteoporosis Research Center, Omaha, NE, USA
| | - L Mack
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - L Bilek
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
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Ng CA, Gandham A, Mesinovic J, Owen PJ, Ebeling PR, Scott D. Effects of Moderate- to High-Impact Exercise Training on Bone Structure Across the Lifespan: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Bone Miner Res 2023; 38:1612-1634. [PMID: 37555459 DOI: 10.1002/jbmr.4899] [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: 03/14/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
Moderate- to high-impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta-analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomized controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to or greater than running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine, and femur. Percentage changes in bone variables were compared among groups using mean differences (MD) and 95% confidence intervals (CI) calculated via random effects meta-analyses. Subgroup analyses were performed in children/adolescents (<18 years), adults (18-50 years), postmenopausal women, and older men. Twenty-eight RCTs (n = 2985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95% CI 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid/proximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft, or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid/proximal tibia cortical vBMD (-0.20% [-0.24, -0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%]). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta-analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites, but additional high-quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Carrie-Anne Ng
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Australia
| | - Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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Chiba D, Sasaki E, Ota S, Oyama T, Ishibashi H, Kimura Y, Nakaji S, Ishibashi Y. Lower bone mineral density can be a risk for an enlarging bone marrow lesion: A longitudinal cohort study of Japanese women without radiographic knee osteoarthritis. Mod Rheumatol 2023; 33:1044-1051. [PMID: 35919930 DOI: 10.1093/mr/roac079] [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: 03/09/2022] [Revised: 05/15/2022] [Accepted: 07/24/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The aim is to elucidate the relationship between bone mineral density (BMD) at baseline and the change of bone marrow lesion (BML) during a 2-year follow-up (2YFU) period. METHODS Seventy-eight female participants (mean age: 54.9 ± 9.6 years) without radiographic knee osteoarthritis were eligible. Based on right-knee magnetic resonance imaging, maximum BML area (BMLa) was calculated by tracing the BML border. The change in BMLa was defined using the following formula: [2YFU] - [Baseline] = ΔBMLa. Positive ΔBMLa was defined as enlarged; negative ΔBMLa was defined as regressed. Dual-energy X-ray absorptiometry was performed to measure the BMD of distal radius. Young adult mean [YAM (%)] of the BMD was used for statistical analysis. Linear regression analysis was conducted with ΔBMLa as the dependent variable and YAM as the independent variable. Receiver operating characteristic curve and logistic regression analyses were conducted for YAM to predict the prevalence of BML enlargement or regression. RESULTS Twenty-six (33.3%) patients had enlarged BMLa, 12 (15.4%) participants showed regressing BMLa, and 40 (51.3%) patients remained stable. YAM was negatively associated with ΔBMLa (β: - 0.375, P = 0.046). The best predictor of BML enlargement risk was 85% (odds ratio: 8.383, P = 0.025). CONCLUSIONS Lower BMD could predict BML enlargement during a 2YFU period.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Tetsushi Oyama
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hikaru Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Mohebbi R, Shojaa M, Kohl M, von Stengel S, Jakob F, Kerschan-Schindl K, Lange U, Peters S, Thomasius F, Uder M, Kemmler W. Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporos Int 2023:10.1007/s00198-023-06682-1. [PMID: 36749350 DOI: 10.1007/s00198-023-06682-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16-0.42), 0.27 (95% CI: 0.16-0.39), and 0.41 (95% CI: 0.30-0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I2 = 20%, TH BMD) to substantial (I2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur.
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Affiliation(s)
- Ramin Mohebbi
- Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Mahdieh Shojaa
- Department Population-Based Medicine, Institute of Health Science, University Hospital Tübingen, Tübingen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Franz Jakob
- Bernhard-Heine-Centrum Für Bewegungsforschung, University of Würzburg, Würzburg, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Katharina Kerschan-Schindl
- Austrian Society for Bone and Mineral Research, Vienna, Austria
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Uwe Lange
- German Society for Physical and Rehabilitative Medicine, Dresden, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Stefan Peters
- German Association for Health-Related Fitness and Exercise Therapy (DVGS), Hürth-Efferen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Friederike Thomasius
- Osteology Umbrella Association Germany, Austria, Switzerland
- Frankfurt Center of Bone Health, Frankfurt, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany.
- Research Group On Guideline "Exercise and Fracture Prevention, Frankfurt, Germany.
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5
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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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Suominen TH, Alén M, Törmäkangas T, Degens H, Rittweger J, Heinonen A, Suominen H, Korhonen MT. Regular Strength and Sprint Training Counteracts Bone Aging: A 10-Year Follow-Up in Male Masters Athletes. JBMR Plus 2021; 5:e10513. [PMID: 34258508 PMCID: PMC8260815 DOI: 10.1002/jbm4.10513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/06/2022] Open
Abstract
Cross-sectional and interventional studies suggest that high-intensity strength and impact-type training provide a powerful osteogenic stimulus even in old age. However, longitudinal evidence on the ability of high-intensity training to attenuate age-related bone deterioration is currently lacking. This follow-up study assessed the role of continued strength and sprint training on bone aging in 40- to 85-year-old male sprinters (n = 69) with a long-term training background. Peripheral quantitative computed tomography (pQCT)-derived bone structural, strength, and densitometric parameters of the distal tibia and tibia midshaft were assessed at baseline and 10 years later. The groups of well-trained (actively competing, sprint training including strength training ≥2 times/week; n = 36) and less-trained (<2 times/week, no strength training, switched to endurance training; n = 33) athletes were formed according to self-reports at follow-up. Longitudinal changes in bone traits in the two groups were examined using linear mixed models. Over the 10-year period, group-by-time interactions were found for distal tibia total bone mineral content (BMC), trabecular volumetric bone mineral density (vBMD), and compressive strength index, and for mid-tibia cortical cross-sectional area, medullary area, total BMC, and BMC at the anterior and posterior sites (polar mass distribution analysis) (p < 0.05). These interactions reflected maintained (distal tibia) or improved (mid-tibia) bone properties in the well-trained and decreased bone properties in the less-trained athletes over the 10-year period. Depending on the bone variable, the difference in change in favor of the well-trained group ranged from 2% to 5%. The greatest differences were found in distal tibia trabecular vBMD and mid-tibia posterior BMC, which remained significant (p < 0.05) after adjustment for multiple testing. In conclusion, our longitudinal findings indicate that continued strength and sprint training is associated with maintained or even improved tibial properties in middle-aged and older male sprint athletes, suggesting that regular, intensive exercise counteracts bone aging. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Tuuli H Suominen
- Gerontology Research Center, Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Markku Alén
- Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research University of Oulu Oulu Finland
| | - Timo Törmäkangas
- Gerontology Research Center, Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Hans Degens
- Department of Life Sciences, Musculoskeletal Science, and Sports Medicine Research Centre Manchester Metropolitan University Manchester UK.,Institute of Sport Science and Innovations Lithuanian Sports University Kaunas Lithuania
| | - Jörn Rittweger
- Institute of Aerospace Medicine German Aerospace Center (DLR) Cologne Germany.,Department of Pediatrics and Adolescent Medicine University of Cologne Cologne Germany
| | - Ari Heinonen
- Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Harri Suominen
- Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Marko T Korhonen
- Gerontology Research Center, Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
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Kistler-Fischbacher M, Weeks BK, Beck BR. The effect of exercise intensity on bone in postmenopausal women (part 1): A systematic review. Bone 2021; 143:115696. [PMID: 33357833 DOI: 10.1016/j.bone.2020.115696] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous systematic reviews and meta-analyses of exercise effects on bone have reported null or modest effect sizes. While animal research has determined that a strong positive relationship exists between load magnitude/intensity and bone adaptation, nevertheless many human exercise interventions have been applied at low intensity. Meta-analytic pooling of exercise interventions irrespective of intensity dilutes the ability to detect efficacy of any one training regimen. Parsing out efficacy of low, moderate and high intensity exercise interventions will assist the determination of optimal exercise prescription for bone. OBJECTIVES First, to summarise and critically evaluate existing evidence of exercise effect on bone mass, bone structure and bone turnover markers (BTMs) in healthy postmenopausal women. Second, to examine the influence of intensity on bone response to exercise. METHODS Electronic databases (Embase, Scopus, CINAHL Plus, SPORTDiscus), database platforms (PubMed, Cochrane CENTRAL, ProQuest Central, Web of Science) and reference lists of included studies were searched for controlled trials and randomised controlled trials that described the effect of any exercise intervention compared to control on bone mass, bone structure or BTMs in healthy postmenopausal women. Fracture incidence was included as an exploratory endpoint. Data was extracted and weighed against the results of a comprehensive risk of bias analysis. RESULTS One hundred trials were included, investigating a total of 120 exercise interventions. Of those, 57 interventions were low intensity, 57 were moderate, and six were high intensity. On balance, low intensity exercise was not an effective stimulus to increase bone mass. Higher quality evidence suggests moderate to high intensity interventions, particularly those that combined high intensity resistance and impact training, were most beneficial for bone mass. Only high intensity exercise appears to improve structural parameters of bone strength, however, data are limited. Only low and moderate intensity interventions have measured BTMs and no notable benefits have been observed. The quality of trials varied greatly, and risk of bias determinations were frequently limited by insufficiently reported detail. CONCLUSION Heterogeneity in both study quality and outcomes limits the ability to draw strong conclusions from this comprehensive systematic review of RCT and CT reports. Nevertheless, there is a tendency in the higher quality data to indicate exercise intensity is positively related to the adaptive bone response. Part 2 of this review series reports a meta-analysis of the RCT data in order to draw quantitative conclusions from the higher quality trials. STUDY REGISTRATION Registered on PROSPERO (CRD42018117254).
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Affiliation(s)
- Melanie Kistler-Fischbacher
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia
| | - Benjamin K Weeks
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; The Bone Clinic, Brisbane, QLD, Australia.
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8
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Addison BJ, Lieberman DE. Assessing patterns of variation in BV/TV in the calcaneus and C2 vertebra of Gorilla gorilla, Pan troglodytes, and populations of Homo sapiens from the Pleistocene and Holocene that differ in physical activity levels. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 173:337-349. [PMID: 33448347 DOI: 10.1002/ajpa.24064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/26/2020] [Accepted: 04/10/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Because trabecular bone volume fraction (BV/TV) is influenced by variations in physical activity recent declines in BV/TV in humans are often attributed to modern sedentary lifestyles. This study tests the hypothesis that presumed variations in mechanical loading between groups can predict the observed BV/TV patterns in humans, chimpanzees and gorillas in two bones: the calcaneus which experiences high and well characterized impact forces, and the C2 vertebrae which experiences reduced locomotor forces. MATERIALS AND METHODS BV/TV and other structural variables were quantified from high-resolution microCT scans in gorillas, chimpanzees, and four Homo sapiens populations: Pleistocene, semi-sedentary Natufians; Holocene hunter-gatherers from Point Hope, Alaska; Holocene nomadic pastoralists from medieval Europe; and modern, sedentary Americans. RESULTS In the calcaneal tuberosity, Natufian BV/TV was 36, 46, and 46% greater than Alaskans (p = .02), Europeans (p = .005) and modern Americans (p = .002), respectively, but not significantly different from apes. BV/TV was not significantly different between modern Americans and Alaskans or Europeans. In the C2, Natufian BV/TV was 53 and 25% greater than in the Alaskan (p = .0001) and European (p = .048) populations. DISCUSSION These results suggest that phenomena other than or in addition to variations in physical activity are needed to explain BV/TV patterns observed in H. sapiens, and point to a systemic decline in H. sapiens BV/TV after the Pleistocene.
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Affiliation(s)
- Brian J Addison
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States
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Kemmler W, Shojaa M, Kohl M, von Stengel S. Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis. Calcif Tissue Int 2020; 107:409-439. [PMID: 32785775 PMCID: PMC7546993 DOI: 10.1007/s00223-020-00744-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/31/2020] [Indexed: 01/22/2023]
Abstract
In this sub-analysis of a comprehensive meta-analysis, we aimed to determine the effect of different types of exercise on (areal) bone mineral density (BMD) in postmenopausal women. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) with at least one exercise and one control group, (c) intervention ≥ 6 months, (d) BMD assessments at lumbar spine (LS), femoral neck (FN) or total hip (TH), (e) in postmenopausal women. Eight electronic databases were scanned without language restrictions up to March 2019. The present subgroup analysis was conducted as a mixed-effect meta-analysis with "type of exercise" as the moderator. The 84 eligible exercise groups were classified into (a) weight bearing (WB, n = 30) exercise, (b) (dynamic) resistance exercise (DRT, n = 18), (c) mixed WB&DRT interventions (n = 36). Outcome measures were standardized mean differences (SMD) for BMD-changes at LS, FN and TH. All types of exercise significantly affect BMD at LS, FN and TH. SMD for LS average 0.40 (95% CI 0.15-0.65) for DRT, SMD 0.26 (0.03-0.49) for WB and SMD 0.42 (0.23-0.61) for WB&DRT. SMD for FN were 0.27 (0.09-0.45) for DRT, 0.37 (0.12-0.62) for WB and 0.35 (0.19-0.51) for WB&DRT. Lastly, SMD for TH changes were 0.51 (0.28-0.74) for DRT, 0.40 (0.21-0.58) for WB and 0.34 (0.14-0.53) for WB&DRT. In summary, we provided further evidence for the favorable effect of exercise on BMD largely independent of the type of exercise. However, in order to generate dedicated exercise recommendations or exercise guideline, meta-analyses might be a too rough tool.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany.
| | - Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
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Erickson KR, Grosicki GJ, Mercado M, Riemann BL. Bone Mineral Density and Muscle Mass in Masters Olympic Weightlifters and Runners. J Aging Phys Act 2020; 28:749-755. [PMID: 32422599 DOI: 10.1123/japa.2019-0426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/10/2020] [Accepted: 02/12/2020] [Indexed: 11/18/2022]
Abstract
The authors examined the musculoskeletal implications of delayed exercise adoption in two distinct cohorts of masters athletes with ∼10 years of training experience: Olympic weightlifters (OWLs) and distance runners (RUNs). Total body and regional bone mineral density (BMD), and dual-energy X-ray absorptiometry-derived lean mass were compared in 51 OWLs and 43 RUNs. Multiple linear regression analyses were conducted on BMD and lean mass with the exercise group (i.e., OWLs vs. RUNs), age, sex, and years of experience as independent variables. Age was associated (p < .05) with less femoral (β = -0.25) and lumbar (β = -0.27) BMD. Total body (β = 0.23), lumbar (β = 0.25), and radial (β = 0.36) BMD were greater (p < .05) in OWLs versus RUNs. Lean mass was greater in OWLs versus RUNs (β = 0.29, p < .01), but did not relate to total body BMD (r = .15; p = .08). Greater total and regional BMD and lean mass in OWLs compared with RUNs may reduce risk for developing osteoporosis and/or sarcopenia and associated downstream health outcomes.
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Harding AT, Weeks BK, Lambert C, Watson SL, Weis LJ, Beck BR. Effects of supervised high-intensity resistance and impact training or machine-based isometric training on regional bone geometry and strength in middle-aged and older men with low bone mass: The LIFTMOR-M semi-randomised controlled trial. Bone 2020; 136:115362. [PMID: 32289518 DOI: 10.1016/j.bone.2020.115362] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Few data exist on the effects of bone-targeted exercise on geometric and biomechanical indices of bone strength in men. The Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) trial was designed to compare the efficacy and safety of two novel, supervised, twice-weekly, high-intensity exercise programs in middle-aged and older men with osteopenia and osteoporosis on musculoskeletal health and risk factors related to falls and fractures. The current report includes secondary outcomes of the LIFTMOR-M exercise intervention trial. PURPOSE Our goal was to determine the effects of two supervised, twice-weekly, high-intensity exercise programs on bone geometry and strength of the proximal femur, and distal and proximal sites of the tibia and radius in middle-aged and older men with osteopenia and osteoporosis. METHODS Generally-healthy men (≥45 years), with low lumbar spine (LS) and/or proximal femur areal bone mineral density (aBMD), were recruited from the community. Eligible participants were randomised to either eight months of twice-weekly supervised high-intensity progressive resistance and impact training (HiRIT) or supervised machine-based isometric axial compression (IAC) exercise training. Intervention group outcomes were compared at baseline and eight months with a matched but non-randomised control group (CON) who self-selected to usual activities. DXA scans (Medix DR, Medilink, France) of the skeletally non-dominant proximal femur were analysed using 3D hip software (DMS Group, France) to derive femoral neck (FN) and total hip (TH) bone mineral content (BMC), volume, and volumetric bone mineral density (vBMD) for total, trabecular and cortical bone compartments. Total FN cortical thickness was determined as well as anterior, posterior, lateral and medial subregions. pQCT scans (XCT-3000, Stratec, Germany) of the 4 and 38% sites of the tibia, and 4 and 66% sites of the radius were conducted to determine a range of geometric and bone structural strength indices. Intervention effects were examined using univariate ANCOVA of percent change, and repeated measures ANCOVA of raw baseline and follow-up data, controlling for initial values, using intention-to-treat and per-protocol approaches. RESULTS Ninety-three men (67.1 ± 7.5 yrs, 175.2 ± 6.7 cm, 82.1 ± 11.6 kg, 26.7 ± 3.5 kg/m2) with lower than average aBMD (LS T-score -0.06 ± 1.04, FN T-score -1.58 ± 0.58, TH T-score -1.00 ± 0.58) were recruited, and designated CON (n = 26) or randomised to HiRIT (n = 34) or IAC (n = 33). Compliance to the supervised exercise programs did not differ (HiRIT 77.8 ± 16.6% versus IAC 78.5 ± 14.8%, p = 0.872). HiRIT improved medial FN cortical thickness compared with CON (5.6 ± 1.7% versus -0.1 ± 1.9%, p = 0.028) and IAC (5.6 ± 1.7% versus 0.7 ± 1.7%, p = 0.044). Distal tibia total BMC, vBMD, area and bone strength index, and trabecular BMC and bone strength index all declined for CON compared with maintenance for both HiRIT and IAC (all p < 0.05). HiRIT maintained distal tibia trabecular area compared with a loss in CON (0.2 ± 0.5% versus -1.6 ± 0.5%, p = 0.013). HiRIT and IAC maintained distal radius total BMC compared with loss in CON (-0.1 ± 0.7% versus -3.7 ± 0.8%, p = 0.001; 1.3 ± 0.7% versus -3.7 ± 0.8%, p < 0.001, respectively). HiRIT and IAC maintained distal radius total bone strength index compared with loss in CON (1.4 ± 1.4% versus -6.0 ± 1.6%, p = 0.001; 0.2 ± 1.3% versus -6.0 ± 1.6%, p = 0.004, respectively). HiRIT reduced proximal radius cortical area compared with CON (-3.1 ± 1.0% versus 1.1 ± 1.2%, p = 0.011) and IAC (-3.1 ± 1.0% versus -0.2 ± 1.0%, p = 0.042). No between-group differences were detected in any pQCT-derived bone outcome at the diaphyseal tibia 38% site. CONCLUSION Findings indicate that supervised HiRIT provides a positive stimulus to cortical bone at the medial FN compared with supervised IAC exercise, and both HiRIT and IAC preserve bone strength at the distal tibia and distal radius. These effects may translate into a reduced risk of lower and upper extremity fracture in middle-aged and older men with low bone mass.
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Affiliation(s)
- Amy T Harding
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Benjamin K Weeks
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Conor Lambert
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Steven L Watson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Lisa J Weis
- The Bone Clinic, Brisbane, Queensland, Australia
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; The Bone Clinic, Brisbane, Queensland, Australia.
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12
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Shojaa M, Von Stengel S, Schoene D, Kohl M, Barone G, Bragonzoni L, Dallolio L, Marini S, Murphy MH, Stephenson A, Mänty M, Julin M, Risto T, Kemmler W. Effect of Exercise Training on Bone Mineral Density in Post-menopausal Women: A Systematic Review and Meta-Analysis of Intervention Studies. Front Physiol 2020; 11:652. [PMID: 32655410 PMCID: PMC7325605 DOI: 10.3389/fphys.2020.00652] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a major health problem in post-menopausal women (PMW). Exercise training is considered a cost-effective strategy to prevent osteoporosis in middle aged-older people. The purpose of this study is to summarize the effect of exercise on BMD among PMW. A comprehensive search of electronic databases was conducted through PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest, and Primo. BMD changes (standardized mean differences: SMD) of the lumbar spine (LS) femoral neck (FN) and/or total hip were considered as outcome measures. After subgroup categorization, statistical methods were used to combine data and compare subgroups. Seventy-five studies were included. The pooled number of participants was 5,300 (intervention group: n = 2,901, control group: n = 2,399). The pooled estimate of random effect analysis was SMD = 0.37, 95%-CI: 0.25–0.50, SMD = 0.33, 95%-CI: 0.23–0.43, and SMD = 0.40, 95%-CI: 0.28–0.51 for LS, FN, and total Hip-BMD, respectively. In the present meta-analysis, there was a significant (p < 0.001), but rather low effect (SMD = 0.33–0.40) of exercise on BMD at LS and proximal femur. A large variation among the single study findings was observed, with highly effective studies but also studies that trigger significant negative results. These findings can be largely attributed to differences among the exercise protocols of the studies. Findings suggest that the true effect of exercise on BMD is diluted by a considerable amount of studies with inadequate exercise protocols.
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Affiliation(s)
- Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Simon Von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, Institute of Precision Medicine, Furtwangen University, Furtwangen im Schwarzwald, Germany
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Sofia Marini
- Department for Life Quality Studies, University of Bologna, Bologna, Italy
| | - Marie H Murphy
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Aoife Stephenson
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Strategy and Research, Vantaa, Finland
| | - Mikko Julin
- Department of Physiotherapy, Laurea University of Applied Sciences, Espoo, Finland
| | - Tapani Risto
- Department of Physiotherapy, Laurea University of Applied Sciences, Espoo, Finland
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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Babatunde OO, Bourton AL, Hind K, Paskins Z, Forsyth JJ. Exercise Interventions for Preventing and Treating Low Bone Mass in the Forearm: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 101:487-511. [DOI: 10.1016/j.apmr.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
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14
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Lambert C, Beck BR, Harding AT, Watson SL, Weeks BK. Regional changes in indices of bone strength of upper and lower limbs in response to high-intensity impact loading or high-intensity resistance training. Bone 2020; 132:115192. [PMID: 31846824 DOI: 10.1016/j.bone.2019.115192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/22/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022]
Abstract
It is well known that the bone response to physical activity is highly dependent on the nature of the loads imposed. Despite this, few direct comparisons of the effect of impact-style loading and resistance training on bone have been made. We therefore aimed to compare the effects of 10-month, twice-weekly, high-impact loading and 10-month, twice-weekly, high-intensity resistance training on indices of bone strength of both the upper and lower limbs of young adult women. Physically inactive, otherwise healthy, young adult women (18-30 years) with below average bone mass (T-score ≤ 0) were recruited as part of the OPTIMA-Ex trial. Testing included DXA- and pQCT-derived measures of bone mass and indices of bone strength and QUS-derived measures of bone quality of the dominant (D) and non-dominant (ND) upper (radius) and lower limbs (femoral neck, tibia, calcaneus). The present study examined those participants who completed the impact training (IT; n = 10) and resistance training (RT; n = 12) arms of the trial. Age differed between groups at baseline (IT = 23.2 ± 3.8 years, RT = 20.5 ± 1.8 years; p = 0.042). Compliance with the training programs did not differ (IT = 61.4 ± 15.1%, RT = 66.4 ± 11.2%, p = 0.381). Age and baseline differences in bone outcomes served as covariates for repeated measures and univariate ANCOVA conducted for dependent variables and percent change respectively. IT improved distal pQCT-derived bone mineral density (BMD) of the upper limb (ND radius: total BMD = 8.55 ± 2.26% versus 1.50 ± 2.04%, p = 0.040 and trabecular BMD = 1.86 ± 0.90% versus -1.30 ± 0.81%, p = 0.029) and lower limb (ND tibia trabecular BMD = 1.22 ± 0.55% versus -0.82 ± 0.50%, p = 0.017), more than RT. IT also improved upper limb bone strength index (BSI) (ND radius total BSI = 15.35 ± 2.83% versus 2.67 ± 2.55, p = 0.005) and lower limb BSI (D tibia total BSI = 5.16 ± 1.13% versus 0.37 ± 1.02%, p = 0.008; D tibia trabecular BSI = 3.93 ± 1.76% versus -2.84 ± 1.59, p = 0.014, ND tibia trabecular BSI = 3.57 ± 1.63% versus -3.15 ± 1.48%, p = 0.009) more than RT. Conversely, RT improved DXA-derived cortical volumetric BMD at the femoral neck more than IT (3.68 ± 1.99% versus -4.14 ± 2.20%, p = 0.021). Results suggest that IT and RT provide differing site-specific effects in both the upper and lower limbs, with superior bone responses observed at the distal segment from IT, while RT appeared to have greater effect on the shaft of the bone, on indices of bone-strength in young adult women.
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Affiliation(s)
- Conor Lambert
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; The Bone Clinic, Brisbane, Queensland, Australia
| | - Amy T Harding
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Steven L Watson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Benjamin K Weeks
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.
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15
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Impact of calcium, vitamin D, vitamin K, oestrogen, isoflavone and exercise on bone mineral density for osteoporosis prevention in postmenopausal women: a network meta-analysis. Br J Nutr 2020. [DOI: 10.1017/s0007114519002290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AbstractThe aim of this network meta-analysis is to compare bone mineral density (BMD) changes among different osteoporosis prevention interventions in postmenopausal women. We searched MEDLINE, Embase and Cochrane Library from inception to 24 February 2019. Included studies were randomised controlled trials (RCT) comparing the effects of different treatments on BMD in postmenopausal women. Studies were independently screened by six authors in three pairs. Data were extracted independently by two authors and synthesised using Bayesian random-effects network meta-analysis. The results were summarised as mean difference in BMD and surface under the cumulative ranking (SUCRA) of different interventions. A total of ninety RCT (10 777 participants) were included. Ca, vitamin D, vitamin K, oestrogen, exercise, Ca + vitamin D, vitamin D + vitamin K and vitamin D + oestrogen were associated with significantly beneficial effects relative to no treatment or placebo for lumbar spine (LS). For femoral neck (FN), Ca, exercise and vitamin D + oestrogen were associated with significantly beneficial intervention effects relative to no treatment. Ranking probabilities indicated that oestrogen + vitamin D is the best strategy in LS, with a SUCRA of 97·29 % (mean difference: +0·072 g/cm2 compared with no treatment, 95 % credible interval (CrI) 0·045, 0·100 g/cm2), and Ca + exercise is the best strategy in FN, with a SUCRA of 79·71 % (mean difference: +0·029 g/cm2 compared with placebo, 95 % CrI –0·00093, 0·060 g/cm2). In conclusion, in postmenopausal women, many interventions are valuable for improving BMD in LS and FN. Different intervention combinations can affect BMD at different sites diversely.
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16
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McMillan LB, Aitken D, Ebeling P, Jones G, Scott D. The relationship between objectively assessed physical activity and bone health in older adults differs by sex and is mediated by lean mass. Osteoporos Int 2018. [PMID: 29532131 DOI: 10.1007/s00198-018-4446-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Relationships between objectively assessed free-living physical activity (PA) and changes in bone health over time are poorly understood in older adults. This study suggests these relationships are sex-specific and that body composition may influence the mechanical loading benefits of PA. INTRODUCTION To investigate associations of objectively assessed PA and bone health in community-dwelling older adults. METHODS This secondary analysis of a subset of the Tasmanian Older Adult Cohort study included participants with PA assessed utilising ActiGraph GT1M accelerometers over 7 days (N = 209 participants, 53% female; mean ± SD age 64.5 ± 7.2 years). Steps/day and PA intensity were estimated via established thresholds. Bone mineral content (BMC) was acquired at the total hip, lumbar spine, legs and whole body by DXA at baseline and approximately 2.2 years later. Relationships between PA and BMC were assessed by multivariable linear regression analyses adjusted for age, smoking status, height and total lean mass. RESULTS Men with above-median total hip BMC completed significantly less steps per day, but there was no significant difference in PA intensity compared with those with below-median BMC. There were no significant differences in PA in women stratified by median BMC. In women, steps/day were positively associated with leg BMC (B = 0.178; P = 0.017), and sedentary behaviour was negatively associated with leg BMC (- 0.165; 0.016) at baseline. After adjustment for confounders including lean mass and height, higher sedentary behaviour at baseline was associated with declines in femoral neck BMC (- 0.286; 0.011) but also with increases in pelvic BMC (0.246; 0.030) in men and increases in total hip BMC (0.215; 0.032) in women, over 2.2 years. No other significant longitudinal associations were observed after adjustment for body composition. CONCLUSIONS Associations of accelerometer-determined sedentary behaviour and PA with bone health in older adults differ by sex and anatomical site and are mediated by body composition.
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Affiliation(s)
- L B McMillan
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - P Ebeling
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Melbourne Medical School (Western Campus), Sunshine Hospital, The University of Melbourne, St Albans, Melbourne, VIC, 3021, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - D Scott
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Melbourne Medical School (Western Campus), Sunshine Hospital, The University of Melbourne, St Albans, Melbourne, VIC, 3021, Australia
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17
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Owen PJ, Daly RM, Livingston PM, Mundell NL, Dalla Via J, Millar JL, Fraser SF. Efficacy of a multi-component exercise programme and nutritional supplementation on musculoskeletal health in men treated with androgen deprivation therapy for prostate cancer (IMPACT): study protocol of a randomised controlled trial. Trials 2017; 18:451. [PMID: 28974267 PMCID: PMC5627417 DOI: 10.1186/s13063-017-2185-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 09/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Prostate cancer is the most commonly diagnosed cancer in men in developed countries. Androgen deprivation therapy (ADT) is a systemic treatment shown to increase survival in selected patients with prostate cancer. The use of ADT continues to increase for all stages and grades of prostate cancer despite known treatment-induced adverse effects. The primary aim of this study is to examine the efficacy of a targeted, multi-component resistance and impact-loading exercise programme together with a daily protein-, calcium- and vitamin D-enriched supplement on bone health in men treated with ADT for prostate cancer. Secondary aims are to determine the effects of this intervention on measures of total body and regional body composition, cardiometabolic risk, inflammatory markers, health-related quality of life and cognitive function. Methods This study is a two-arm randomised controlled trial. Men currently treated with ADT for prostate cancer will be randomised to either a 52-week, community-based, exercise training and nutritional supplementation intervention (n = 51) or usual care control (n = 51). Participants will be assessed at baseline, 26 weeks and 52 weeks for all measures. The primary outcome measures are proximal femur and lumbar spine areal bone mineral density (BMD). Secondary outcomes comprise: changes in tibial and radial bone structure and strength, total body and regional body composition, muscle strength and function, as well as cardiometabolic health, catabolic/inflammatory and anabolic/anti-inflammatory cytokines, health-related quality of life and cognitive function. Discussion This study investigates whether a multi-component intervention incorporating a targeted bone and muscle-loading programme in combination with a protein-, calcium- and vitamin D-enriched supplement can ameliorate multiple adverse effects of ADT when compared to usual care. The results will contribute to the development of exercise training and nutrition guidelines for optimising overall health in men treated with ADT for prostate cancer. Trial registration Australia New Zealand Clinical Trial Registry (ANZCTR), ID: ACTRN12614000317695. Registered on 25 march 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2185-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia.
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | | | - Niamh L Mundell
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jack Dalla Via
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Australia
| | - Steve F Fraser
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
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Suominen TH, Korhonen MT, Alén M, Heinonen A, Mero A, Törmäkangas T, Suominen H. Effects of a 20-week high-intensity strength and sprint training program on tibial bone structure and strength in middle-aged and older male sprint athletes: a randomized controlled trial. Osteoporos Int 2017. [PMID: 28623425 DOI: 10.1007/s00198-017-4107-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED This randomized, controlled, high-intensity strength and sprint training trial in middle-aged and older male sprint athletes showed significant improvements in mid-tibial structure and strength. The study reveals the adaptability of aging bone, suggesting that through a novel, intensive training stimulus it is possible to strengthen bones during aging. INTRODUCTION High-load, high-speed and impact-type exercise may be an efficient way of improving bone strength even in old age. We evaluated the effects of combined strength and sprint training on indices of bone health in competitive masters athletes, who serve as a group of older people who are likely to be able to participate in vigorous exercise of this kind. METHODS Seventy-two men (age 40-85) were randomized into an experimental (EX, n = 40) and a control (CTRL, n = 32) group. EX participated in a 20-week program combining heavy and explosive strength exercises with sprint training. CTRL maintained their usual, run-based sprint training schedules. Bone structural, strength and densitometric parameters were assessed by peripheral QCT at the distal tibia and tibial midshaft. RESULTS The intervention had no effects on distal tibia bone traits. At the mid-tibia, the mean difference in the change in cortical thickness (ThCO) in EX compared to CTRL was 2.0% (p = 0.007). The changes in structure and strength were more pronounced in the most compliant athletes (training adherence >75%). Compared to CTRL, total and cortical cross-sectional area, ThCO, and the area and density-weighted moments of inertia for the direction of the smallest flexural rigidity (I minA , I minD ) increased in EX by 1.6-3.2% (p = 0.023-0.006). Polar mass distribution analysis revealed increased BMC at the anteromedial site, whereas vBMD decreased (p = 0.035-0.043). CONCLUSIONS Intensive strength and sprint training improves mid-tibia structure and strength in middle-aged and older male sprint athletes, suggesting that in the presence of high-intensity loading exercise, the adaptability of the bone structure is maintained during aging.
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Affiliation(s)
- T H Suominen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - M T Korhonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - M Alén
- Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - A Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - A Mero
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - T Törmäkangas
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - H Suominen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Lambert C, Beck BR, Harding AT, Watson SL, Weeks BK. A protocol for a randomised controlled trial of the bone response to impact loading or resistance training in young women with lower than average bone mass: the OPTIMA-Ex trial. BMJ Open 2017; 7:e016983. [PMID: 28864705 PMCID: PMC5588984 DOI: 10.1136/bmjopen-2017-016983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/29/2017] [Accepted: 06/28/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The aim of the Osteoporosis Prevention Through Impact and Muscle-loading Approaches to Exercise trial is to compare the bone response to two known osteogenic stimuli - impact loading exercise and resistance training. Specifically, we will examine the effect of a 10-month, twice-weekly, high-intensity impact loading exercise intervention and a 10-month, twice-weekly, high-intensity resistance training intervention on bone mass and strength at clinically important skeletal sites. The intervention groups will be compared against a home-based 'positive' control group. Safety and acceptability of each exercise modality will also be determined. METHODS AND ANALYSIS Sedentary otherwise healthy young women aged 18-30 years with bone mineral density (BMD) T-scores less than or equal to 0 at the hip and lumbar spine, screened for conditions and medications that influence bone and physical function, will be recruited. Eligible participants are randomised to 10-month, twice-weekly, either supervised high-intensity impact training, high-intensity resistance training or a home-based 'positive' control group. The primary outcome measure will be lumbar spine areal BMD, while secondary outcome measures will include: whole body, femoral neck and regional measures (upper and lower limb) of bone, muscle and fat; anthropometrics; muscle strength and power; quality of life and exercise safety, enjoyment and acceptability. All outcome measures will be conducted at baseline (T0) and 10 months (T10) and will be analysed according to the intention-to-treat principle and per protocol. ETHICS AND DISSEMINATION The study has been granted ethical approval from the Griffith University Human Research Ethics Committee (GU Ref: 2015/775). Standard scientific reporting practices will occur, including publication in peer-reviewed journals. Participant confidentiality will be maintained in all forms of reporting. TRIAL REGISTRATION NUMBER ACTRN12616001444471.
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Affiliation(s)
- Conor Lambert
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- The Bone Clinic, Brisbane, Queensland, Australia
| | - Amy T Harding
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Steven L Watson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Benjamin K Weeks
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
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Creagh D, Cameron A. Estimating the Post-Mortem Interval of skeletonized remains: The use of Infrared spectroscopy and Raman spectro-microscopy. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2016.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Harding AT, Beck BR. Exercise, Osteoporosis, and Bone Geometry. Sports (Basel) 2017; 5:E29. [PMID: 29910388 PMCID: PMC5968984 DOI: 10.3390/sports5020029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 12/17/2022] Open
Abstract
Exercise is commonly recommended in the prevention and management of osteoporosis. The most common method to monitor bone mass and its response to interventions is bone densitometry. While closely associated with risk of fracture, densitometry-derived areal bone mineral density (aBMD) does not provide a reliable indication of bone geometry or morphological adaptation to stimuli. In fact, the effects of exercise interventions on aBMD are frequently modest, and may not fully represent the benefit of exercise to bone. Animal models suggest that mechanical loading indeed influences bone geometry and thus strength. Such an effect in humans has the potential to reduce osteoporotic fracture. The aim of the current narrative review is to provide an overview of what is known about the effects of exercise on bone geometry, with a focus on relevance to osteoporosis.
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Affiliation(s)
- Amy T Harding
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast 4222, Australia.
- School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast 4222, Australia.
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast 4222, Australia.
- School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast 4222, Australia.
- The Bone Clinic, Coorparoo, Brisbane 4151, Australia.
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DUFF WHITNEYRD, CHILIBECK PHILIPD, CANDOW DARRENG, GORDON JULIANNEJ, MASON RILEYS, TAYLOR-GJEVRE REGINA, NAIR BINDU, SZAFRON MICHAEL, BAXTER-JONES ADAM, ZELLO GORDONA, KONTULAINEN SAIJAA. Effects of Ibuprofen and Resistance Training on Bone and Muscle. Med Sci Sports Exerc 2017; 49:633-640. [DOI: 10.1249/mss.0000000000001172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Fong SS, Chan JS, Bae YH, Yam TT, Chung LM, Ma AW, Kuisma R. Musculoskeletal profile of middle-aged Ving Tsun Chinese martial art practitioners: A cross-sectional study. Medicine (Baltimore) 2017; 96:e5961. [PMID: 28121945 PMCID: PMC5287969 DOI: 10.1097/md.0000000000005961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional exploratory study aimed to quantify and compare the axial and appendicular bone mineral density (BMD), muscle mass, and muscle strength of middle-aged practitioners of Ving Tsun (VT; a hard-style Chinese martial art) with those of nonpractitioners.Eighteen VT practitioners (mean age ± standard deviation = 51.8 ± 17.7 years; 12 men and six women) and 36 active controls (mean age ± standard deviation = 58.7 ± 11.0 years; 18 men and 18 women) participated in the study. All participants underwent a 1-day battery of musculoskeletal examinations. The BMD of the total radius, total hip, femoral neck, and lumbar spine was measured using dual-energy X-ray absorptiometry, as was the lean mass of the arm, leg, and trunk. Muscle strength of the upper and lower limbs was assessed using a Jamar dynamometer and an isokinetic dynamometer at 60°/second, respectively.VT-trained participants had a 11.5% higher total radius BMD (P = 0.023), a 17.8% higher leg lean mass (P = 0.014), a 56.4% higher isokinetic body weight-adjusted peak torque of the knee extensors (P < 0.001), a 60.8% higher isokinetic body weight-adjusted peak torque of knee flexors (P < 0.001), and a 31.4% shorter time to reach peak torque in the knee flexors (P = 0.001) than the active controls. No significant differences were found in any of the other musculoskeletal outcomes between the 2 groups (P > 0.05).Middle-aged VT practitioners displayed a higher total radius BMD and leg lean mass and better knee extensor and flexor muscular performances than their healthy active counterparts. Healthcare professionals may consider using this alternative method of training to improve the musculoskeletal health of middle-aged adults.
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Affiliation(s)
| | - Jessie S.M. Chan
- Centre on Behavioral Health, Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Hong Kong
| | - Young-Hyeon Bae
- Department of Operation and Support, CJ Futures Management Institute, Republic of Korea
| | | | - Louisa M.Y. Chung
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong
| | - Ada W.W. Ma
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong
| | - Raija Kuisma
- School of Health Sciences, University of Brighton, Brighton, UK
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Honisett SY, Tangalakis K, Wark J, Apostolopoulos V, Stojanovska L. The Effects of Hormonal Therapy and Exercise on Bone Turnover in Postmenopausal Women: A Randomised Double-Blind Pilot Study. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2016; 37:23-32. [PMID: 27883319 DOI: 10.1515/prilozi-2016-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Hormone replacement therapy (HRT) and walking were investigated independently and in combination, to determine which treatment provided most effect on bone turnover in postmenopausal women. METHODS Using a randomised double-blind pilot study, 10 subjects received HRT (transdermal estradiol, 50 μg/day and oral MPA 5 mg/day) and 12 received placebo for 20 weeks. Following a baseline period of treatment, both groups undertook a graduated walking regimen, which increased in intensity, duration and frequency parameters from weeks 8-20. Measurements of aerobic capacity, female sex hormones, bone formation markers [osteocalcin (OC) and bone alkaline phosphatase (BAP)] and bone resorption markers [deoxypyridinoline (DPD) and pyridinoline (PYR)] were measured at baseline (T1), week 8 (T2) and week 20 (T3). RESULTS Age, time of postmenopause, weight or body mass index were no different between each groups. The HRT group had significantly higher estradiol levels compared with the placebo group at T2 and T3. FSH and LH levels were significantly reduced following HRT. DPD and PYR were significantly reduced from baseline levels at T2 and T3 with HRT. No significant changes occurred in OC or BAP levels with either HRT or walking. Walking did not change bone turnover markers in either the HRT or placebo group. CONCLUSION HRT reduces bone resorption, however, walking alone at the intensity and duration prescribed, or the combination of HRT and walking, provided no additional benefit after menopause. Therefore, HRT, but not walking is an effective treatment in reducing bone turnover in postmenopause women.
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Silk LN, Greene DA, Baker MK, Jander CB. Tibial bone responses to 6-month calcium and vitamin D supplementation in young male jockeys: A randomised controlled trial. Bone 2015; 81:554-561. [PMID: 26362226 DOI: 10.1016/j.bone.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/02/2015] [Accepted: 09/06/2015] [Indexed: 01/11/2023]
Abstract
Young male jockeys compromise bone health by engaging in caloric restriction and high volumes of physical activity during periods of musculoskeletal growth and development. The aim of this randomised, double-blinded, placebo-controlled trial was to establish whether calcium and vitamin D supplementation would improve bone properties of young male jockeys. We conducted a 6-month trial with two groups of weight-, height- and age-matched apprentice male jockeys (age=20.2 ± 3.2 yrs). Participants were supplemented with 800 mg of calcium and 400 IU of vitamin D (S, n=8) or a placebo (cellulose) (P, n=9) daily for 6-months. Baseline calcium intake was (669.7 ± 274.3 (S) vs 790.4 ± 423.9 (P) and vitamin D 64.6 ± 19.5 (S) vs 81.2 ± 24.4 (P) with no statistical differences. Peripheral quantitative computed tomography (pQCT) measured ultra-distal (4%) and proximal (66%) tibial bone properties at baseline and 6 months. Blood-borne markers of bone turnover, P1NP and CTX and vitamin D concentration were assessed. After co-varying for height, weight and baseline bone measurements, the supplemented group displayed greater post-intervention bone properties at the 66% proximal site with cortical content (mgmm) 6.6% greater (p<0.001), cortical area (mm(2)) 5.9% larger (p<0.001), cortical density (mgcm(2)) 1.3% greater (p=0.001), and total area (mm(2)) 4% larger (p=0.003). No other between group differences in bone variables were observed. Blood analysis indicated higher vitamin D levels (18.1%, p=0.014) and lower CTx (ng/L) (-24.8%, p=0.011) in the supplemented group with no differences observed in P1NP. This is the first randomised controlled trial to examine the efficacy of calcium and vitamin D supplementation in improving bone properties in a highly vulnerable, young athletic, weight-restricted population. Results using pQCT indicate beneficial effects of supplementation on bone properties in as little as six months. Although the study size is small, this intervention appears promising as a strategy for improving bone health in young athletes in weight-restricted sports.
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Affiliation(s)
- Leslie N Silk
- School of Exercise Science, Australian Catholic University, Australia.
| | - David A Greene
- School of Exercise Science, Australian Catholic University, Australia
| | - Michael K Baker
- School of Exercise Science, Australian Catholic University, Australia; The Boden Institute Of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Australia
| | - Caron B Jander
- School of Exercise Science, Australian Catholic University, Australia
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Nadell JA, Shaw CN. Phenotypic plasticity and constraint along the upper and lower limb diaphyses ofHomo sapiens. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 159:410-22. [DOI: 10.1002/ajpa.22889] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Colin N. Shaw
- Department of Archaeology and Anthropology; University of Cambridge; Cambridge UK
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Allison SJ, Poole KES, Treece GM, Gee AH, Tonkin C, Rennie WJ, Folland JP, Summers GD, Brooke-Wavell K. The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention. J Bone Miner Res 2015; 30:1709-16. [PMID: 25753495 DOI: 10.1002/jbmr.2499] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/23/2015] [Accepted: 03/03/2015] [Indexed: 02/02/2023]
Abstract
Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p < 0.001), with larger changes (> 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p < 0.001), with localized changes of > 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur.
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Affiliation(s)
- Sarah J Allison
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | | | | | - Andrew H Gee
- Department of Engineering, University of Cambridge
| | - Carol Tonkin
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Winston J Rennie
- Department of Radiology, University Hospitals of Leicester, Leicester, UK
| | - Jonathan P Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Gregory D Summers
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derby, UK
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Impact exercise and bone density in premenopausal women with below average bone density for age. Eur J Appl Physiol 2015; 115:2457-69. [PMID: 26231378 DOI: 10.1007/s00421-015-3225-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the effects of two home-based impact exercise programs on areal bone mineral density (aBMD) in adult premenopausal women with below average aBMD for age (negative Z-scores; 40.8 years; n = 107). METHODS Two unilateral impact exercise programs were employed, one targeting the total hip and lumbar spine (n = 42 pairs), the other the distal radius (n = 24 pairs) with some individuals performing both. Force plate data were used to establish exercise loading characteristics (peak loads, time to peak), dual-energy X-ray absorptiometry (DXA) provided bone data. Calcium intake, health and extraneous physical activity (PA) were determined by survey. Exercise for both hip and spine consisted of unilateral landings from adjustable steps (maximum height 63.5 cm) while impacts were delivered to the forearm by arresting falls against a wall. An exercise log was used to provide the exercise prescription, record each exercise bout and any injuries. Participants were randomly assigned to exercise or control groups and pair-matched (age, BMI, Z-score, aBMD). Compliance was calculated as the number of sessions completed divided by the total prescribed number (mean ~50 %). RESULTS The programs delivered significant gains pre to post at each site compared with significant losses in controls (forearm: 3.9 vs -3.9 %; total hip: 2.0 vs -2.6 %; lumbar spine: 2.8 vs -2.9 % exercise and controls, respectively, all p < 0.001). No exerciser lost bone at the target site regardless of compliance which was strongly correlated with bone gains (R (2) = 0.53-0.68, all p < 0.001). CONCLUSIONS Impact exercise provides an effective means of improving below average aBMD without supervision in this at risk population.
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Duckham RL, Masud T, Taylor R, Kendrick D, Carpenter H, Iliffe S, Morris R, Gage H, Skelton DA, Dinan-Young S, Brooke-Wavell K. Randomised controlled trial of the effectiveness of community group and home-based falls prevention exercise programmes on bone health in older people: the ProAct65+ bone study. Age Ageing 2015; 44:573-9. [PMID: 25906791 DOI: 10.1093/ageing/afv055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/16/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND exercise can reduce osteoporotic fracture risk by strengthening bone or reducing fall risk. Falls prevention exercise programmes can reduce fall incidence, and also include strengthening exercises suggested to load bone, but there is little information as to whether these programmes influence bone mineral density (BMD) and strength. OBJECTIVE to evaluate the skeletal effects of home (Otago Exercise Programme, OEP) and group (Falls Exercise Management, FaME) falls prevention exercise programmes relative to usual care in older people. METHODS men and women aged over 65 years were recruited through primary care. They were randomised by practice to OEP, FaME or usual care. BMD, bone mineral content (BMC) and structural properties were measured in Nottingham site participants before and after the 24-week intervention. RESULTS participants were 319 men and women, aged mean(SD) 72(5) years. Ninety-two percentage of participants completed the trial. The OEP group completed 58(43) min/week of home exercise, while the FaME group completed 39(16) and 30(24) min/week of group and home exercise, respectively. Femoral neck BMD changes did not differ between treatment arms: mean (95% CI) effect sizes in OEP and FaME relative to usual care arm were -0.003(-0.011,0.005) and -0.002(-0.010,0.005) g cm(-2), respectively; P = 0.44 and 0.53. There were no significant changes in BMD or BMC at other skeletal sites, or in structural parameters. CONCLUSIONS falls prevention exercise programmes did not influence BMD in older people. To increase bone strength, programmes may require exercise that exerts higher strains on bone or longer duration.
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Affiliation(s)
- Rachel L Duckham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK Present Address: Centre for Physical Activity and Nutrition Research, Deakin University, Australia
| | - Tahir Masud
- Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rachael Taylor
- Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Denise Kendrick
- Department of Medicine, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Department of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Iliffe
- Department of Primary Care & Population Health, University College London, London, UK
| | - Richard Morris
- Department of Primary Care & Population Health, University College London, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guilford, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Susie Dinan-Young
- Department of Primary Care & Population Health, University College London, London, UK
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Jackowski SA, Baxter-Jones ADG, Gruodyte-Raciene R, Kontulainen SA, Erlandson MC. A longitudinal study of bone area, content, density, and strength development at the radius and tibia in children 4-12 years of age exposed to recreational gymnastics. Osteoporos Int 2015; 26:1677-90. [PMID: 25740207 DOI: 10.1007/s00198-015-3041-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 01/14/2015] [Indexed: 12/01/2022]
Abstract
UNLABELLED This study investigated the long-term relationship between the exposure to childhood recreational gymnastics and bone measures and bone strength parameters at the radius and tibia. It was observed that individuals exposed to recreational gymnastics had significantly greater total bone content and area at the distal radius. No differences were observed at the tibia. INTRODUCTION This study investigated the relationship between exposure to early childhood recreational gymnastics with bone measures and bone strength development at the radius and tibia. METHODS One hundred twenty seven children (59 male, 68 female) involved in either recreational gymnastics (gymnasts) or other recreational sports (non-gymnasts) between 4 and 6 years of age were recruited. Peripheral quantitative computed tomography (pQCT) scans of their distal and shaft sites of the forearm and leg were obtained over 3 years, covering the ages of 4-12 years at study completion. Multilevel random effects models were constructed to assess differences in the development of bone measures and bone strength measures between those exposed and not exposed to gymnastics while controlling for age, limb length, weight, physical activity, muscle area, sex, and hours of training. RESULTS Once age, limb length, weight, muscle area, physical activity, sex, and hours of training effects were controlled, it was observed that individuals exposed to recreational gymnastics had significantly greater total bone area (18.0 ± 7.5 mm(2)) and total bone content (6.0 ± 3.0 mg/mm) at the distal radius (p < 0.05). This represents an 8-21 % benefit in ToA and 8-15 % benefit to ToC from 4 to 12 years of age. Exposure to recreational gymnastics had no significant effect on bone measures at the radius shaft or at the tibia (p > 0.05). CONCLUSIONS Exposure to early life recreational gymnastics provides skeletal benefits to distal radius bone content and area. Thus, childhood recreational gymnastics exposure may be advantageous to bone development at the wrist.
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Affiliation(s)
- S A Jackowski
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N5B2, Canada
| | - A D G Baxter-Jones
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N5B2, Canada.
| | | | - S A Kontulainen
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N5B2, Canada
| | - M C Erlandson
- College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, S7N5B2, Canada
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Liphardt AM, Schipilow J, Hanley DA, Boyd SK. Bone quality in osteopenic postmenopausal women is not improved after 12 months of whole-body vibration training. Osteoporos Int 2015; 26:911-20. [PMID: 25567775 DOI: 10.1007/s00198-014-2995-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Whole-body vibration training may improve bone quality through structural adaptation. We tested if 12 months of training affects bone structure in osteopenic postmenopausal women by using advanced 3-dimensional high-resolution imaging techniques. We found that whole-body vibration training did not improve bone structure compared to inactive controls. INTRODUCTION Whole-body vibration training (WBVT) has been suggested as a preventive measure against bone loss. Contradicting results of previous studies may be confounded by insufficiently sensitive bone density measures to detect relevant bone changes. WBVT may improve bone quality through structural adaptations, without increasing bone mineral density (BMD). We hypothesized that 12 months of WBVT will improve or maintain bone microarchitecture and bone strength in osteopenic postmenopausal women. METHODS Twenty-two women received WBVT for 2-3 sessions/week and were compared with 20 controls. Bone outcomes were measured by high-resolution peripheral quantitative CT (HR-pQCT, XtremeCT, Scanco Medical) and finite element estimated bone strength. Balance and jump performance and maximum voluntary contraction (MVC) of knee flexor and extensor muscles were recorded. All measurements were taken at baseline, 4, 8, and 12 months and a reduced data set at 4 and 8 months follow-up and compared using a mixed model repeated measures ANOVA. RESULTS Thirty-one women completed the study with 90 % compliance (WBVT: n = 17, control n = 14). Total BMD (p < 0.001), cortical area*(p = 0.004), cortical thickness (p = 0.011), and cortical porosity (p = 0.024) all significantly decreased over time in both groups; WBVT did not affect the response. All other bone outcomes were not affected by WBVT or time. No difference in measures of balance, jump height, and MVC due to WBVT were detected. CONCLUSION In our cohort, WBVT did not lead to improved bone quality in postmenopausal osteopenic women after 12 months of training compared to controls, and there were no detected benefits related to balance and muscle strength outcomes.
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Affiliation(s)
- A M Liphardt
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
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Shanb AA, Youssef EF. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. J Family Community Med 2014; 21:176-81. [PMID: 25374469 PMCID: PMC4214007 DOI: 10.4103/2230-8229.142972] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Osteoporosis is a major public health problem affecting the elderly population, particularly women. The objective of the study was to evaluate the effects of adding weight-bearing exercise as opposed to nonweight-bearing programs to the medical treatment of bone mineral density (BMD) and health-related quality of life (HRQoL) of elderly patients with osteoporosis. MATERIALS AND METHODS Participating in the study were 40 elderly osteoporotic patients (27 females and 13 males), with ages ranging from 60 to 67 years, who were receiving medical treatment for osteoporosis. They were assigned randomly into two groups: Group-I: Twenty patients practiced weight-bearing exercises. Group-II: Twenty patients did nonweight-bearing exercises. All patients trained for 45-60 min/session, two sessions/week for 6 months. BMD of the lumbar spine, right neck of femur, and right distal radial head of all patients were measured by dual-energy X-ray absorptiometry before and after both treatment programs. In addition, the QoL was measured by means of the HRQoL "ECOS-16" questionnaire. RESULTS T-tests proved that mean values of BMD of the lumbar spine, right neck of femur and right distal radial head were significantly increased in both groups with greater improvement in the weight-bearing group. The QoL was significantly improved in both groups, but the difference between them was not significant. CONCLUSION Addition of weight-bearing exercise program to medical treatment increases BMD more than nonweight-bearing exercise in elderly subjects with osteoporosis. Furthermore, both weight-bearing and nonweight-bearing exercise programs significantly improved the QoL of patients with osteoporosis.
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Affiliation(s)
- Alsayed A Shanb
- Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Enas F Youssef
- Department of Physical Therapy, College of Applied Medical Sciences, University of Dammam, Dammam, Kingdom of Saudi Arabia
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Abstract
Bone fragility is a major health concern, as the increased risk of bone fractures has devastating outcomes in terms of mortality, decreased autonomy, and healthcare costs. Efforts made to address this problem have considerably increased our knowledge about the mechanisms that regulate bone formation and resorption. In particular, we now have a much better understanding of the cellular events that are triggered when bones are mechanically stimulated and how these events can lead to improvements in bone mass. Despite these findings at the molecular level, most exercise intervention studies reveal either no effects or only minor benefits of exercise programs in improving bone mineral density (BMD) in osteoporotic patients. Nevertheless, and despite that BMD is the gold standard for diagnosing osteoporosis, this measure is only able to provide insights regarding the quantity of bone tissue. In this article, we review the complex structure of bone tissue and highlight the concept that its mechanical strength stems from the interaction of several different features. We revisited the available data showing that bone mineralization degree, hydroxyapatite crystal size and heterogeneity, collagen properties, osteocyte density, trabecular and cortical microarchitecture, as well as whole bone geometry, are determinants of bone strength and that each one of these properties may independently contribute to the increased or decreased risk of fracture, even without meaningful changes in aBMD. Based on these findings, we emphasize that while osteoporosis (almost) always causes bone fragility, bone fragility is not always caused just by osteoporosis, as other important variables also play a major role in this etiology. Furthermore, the results of several studies showing compelling data that physical exercise has the potential to improve bone quality and to decrease fracture risk by influencing each one of these determinants are also reviewed. These findings have meaningful clinical repercussions as they emphasize the fact that, even without leading to improvements in BMD, exercise interventions in patients with osteoporosis may be beneficial by improving other determinants of bone strength.
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Dionyssiotis Y, Skarantavos G, Papagelopoulos P. Modern rehabilitation in osteoporosis, falls, and fractures. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2014; 7:33-40. [PMID: 24963273 PMCID: PMC4064946 DOI: 10.4137/cmamd.s14077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 04/06/2014] [Accepted: 04/09/2014] [Indexed: 11/05/2022]
Abstract
In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance – the most important element in falls prevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life.
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Affiliation(s)
- Yannis Dionyssiotis
- 1st Department of Orthopaedics, General University Hospital Attikon, Chaidari, Greece
| | - Grigorios Skarantavos
- 1st Department of Orthopaedics, General University Hospital Attikon, Chaidari, Greece
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Ireland A, Maden-Wilkinson T, Ganse B, Degens H, Rittweger J. Effects of age and starting age upon side asymmetry in the arms of veteran tennis players: a cross-sectional study. Osteoporos Int 2014; 25:1389-400. [PMID: 24531424 DOI: 10.1007/s00198-014-2617-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/07/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED While tennis playing results in large bone strength benefits in the racquet arm of young players, the effects of tennis playing in old players have not been investigated. Large side asymmetries in bone strength were found in veteran players, which were more pronounced in men, younger players and childhood starters. INTRODUCTION Regular tennis results in large racquet arm bone and muscle strength advantages; however, these effects have not been studied in old players. The non-racquet arm can act as an internal control for the exercising racquet arm without confounding factors, e.g. genotype. Therefore, veteran tennis player side asymmetries were examined to investigate age, sex and starting age effects on bone exercise benefits. METHODS Peripheral quantitative computed tomography (pQCT) scans were taken at the radius, ulna and humerus mid-shaft and distal radius in both arms of 88 tennis players (51 males, 37 females; mean age 63.8 ± 11.8 years). Thirty-two players began playing in adulthood, thereby termed 'old starters'; players were otherwise termed 'young starters'. RESULTS Muscle size and bone strength were greater in the racquet arm; notably, distal radius bone mineral content (BMC) was 13 ± 10% higher and humeral bone area 23 ± 12% larger (both P < 0.001). Epiphyseal BMC asymmetry was not affected by age (P = 0.863) or sex (P = 0.954), but diaphyseal asymmetries were less pronounced in older players and women, particularly in the humerus where BMC, area and moment of resistance asymmetries were 28-34 % less in women (P < 0.01). Bone area and periosteal circumference asymmetries were smaller in old starters (all P < 0.01); most notably, no distal radius asymmetry was found in this group (0.4 ± 3.4%). CONCLUSIONS Tennis participation is associated with large side asymmetries in muscle and bone strength in old age. Larger relative side asymmetries in men, younger players and young starters suggest a greater potential for exercise benefits to bone in these groups.
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Affiliation(s)
- A Ireland
- Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK,
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36
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Maïmoun L, Coste O, Philibert P, Briot K, Mura T, Galtier F, Mariano-Goulart D, Paris F, Sultan C. Peripubertal female athletes in high-impact sports show improved bone mass acquisition and bone geometry. Metabolism 2013; 62:1088-98. [PMID: 23490587 DOI: 10.1016/j.metabol.2012.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/20/2012] [Accepted: 11/29/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Intensive physical training may have a sport-dependent effect on bone mass acquisition. This cross-sectional study evaluated bone mass acquisition in girls practicing sports that put different mechanical loads on bone. MATERIALS/METHODS Eighty girls from 10.7 to 18.0 years old (mean 13.83 ± 1.97) were recruited: 20 artistic gymnasts (AG; high-impact activity), 20 rhythmic gymnasts (RG; medium-impact activity), 20 swimmers (SW, no-impact activity), and 20 age-matched controls (CON; leisure physical activity <3h/wk). Areal bone mineral density (aBMD) was determined using DEXA. Hip structural analysis applied at the femur evaluated cross-sectional area (CSA, cm(2)), section modulus (Z, cm(3)), and buckling ratio. Bone turnover markers and OPG/RANKL levels were analyzed. RESULTS AG had higher aBMD than SW and CON at all bone sites and higher values than RG in the lumbar spine and radius. RG had higher aBMD than SW and CON only in the femoral region. CSA and mean cortical thickness were significantly higher and the buckling ratio was significantly lower in both gymnast groups compared with SW and CON. In RG only, endocortical diameter and width were reduced, while Z was only increased in AG compared with SW and CON. Reduced bone remodeling was observed in RG compared with AG only when groups were subdivided according to menarcheal status. All groups showed similar OPG concentrations, while RANKL concentrations increased with age and were decreased in SW. CONCLUSION High-impact activity clearly had a favorable effect on aBMD and bone geometry during the growth period, although the bone health benefits seem to be more marked after menarche.
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Affiliation(s)
- Laurent Maïmoun
- Département d'Hormonologie, Hôpital Lapeyronie, CHU Montpellier, 191 avenue Doyen Gaston Giraud, 34295 Montpellier, France.
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Erlandson MC, Kontulainen SA, Chilibeck PD, Arnold CM, Faulkner RA, Baxter-Jones ADG. Former premenarcheal gymnasts exhibit site-specific skeletal benefits in adulthood after long-term retirement. J Bone Miner Res 2012; 27:2298-305. [PMID: 22714629 DOI: 10.1002/jbmr.1689] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Young female gymnasts have greater bone strength compared to controls; although possibly due to selection into gymnastics, it is thought that their loading activity during growth increases their bone mass, influencing both bone geometry and architecture. If such bone mass and geometric adaptations are maintained, this may potentially decrease the risk of osteoporosis and risk of fracture later in life. However, there is limited evidence of the persisting benefit of gymnastic exercise during growth on adult bone geometric parameters. Therefore, the purpose of this study was to determine whether adult bone geometry, volumetric density, and estimated strength were greater in retired gymnasts compared to controls, 10 years after retirement from the sport. Bone geometric and densitometric parameters, measured by peripheral quantitative computed tomography (pQCT) at the radius and tibia, were compared between 25 retired female gymnasts and 22 controls, age range 22 to 30 years, by multivariate analysis of covariance (covariates: age, height, and muscle cross-sectional area). Retired gymnasts had significantly greater adjusted total and trabecular area (16%), total and trabecular bone mineral content (BMC) (18% and 22%, respectively), and estimated strength (21%) at the distal radius (p < 0.05) than controls. Adjusted total and cortical area and BMC, medullary area, and estimated strength were also significantly greater (13% to 46%) in retired gymnasts at the 30% and 65% radial shaft sites (p < 0.05). At the distal tibia, retired gymnasts had 12% to 13% greater total and trabecular BMC and volumetric bone mineral density as well as 21% greater estimated strength; total and cortical BMC and estimated strength were also greater at the tibial shaft (8%, 11%, and 10%, respectively) (p < 0.05). Former female gymnasts have significantly better geometric and densitometric properties, as well as estimated strength, at the radius and tibia 10 years after retirement from gymnastics compared to females who did not participate in gymnastics in childhood and adolescence.
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Affiliation(s)
- Marta C Erlandson
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Pang MYC, Cheng AQ, Warburton DE, Jones AYM. Relative impact of neuromuscular and cardiovascular factors on bone strength index of the hemiparetic distal radius epiphysis among individuals with chronic stroke. Osteoporos Int 2012; 23:2369-79. [PMID: 22310956 DOI: 10.1007/s00198-012-1899-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
Abstract
UNLABELLED The objective of this study was to examine the associations of neuromuscular and cardiovascular impairments with the bone strength index of the hemiparetic distal radius epiphysis in chronic stroke survivors. The results showed that grip strength is the most predominant predictor of the bone strength index. INTRODUCTION The purpose of the study was to examine the associations of neuromuscular and cardiovascular impairments with the bone strength index of the hemiparetic distal radius epiphysis in chronic stroke survivors. METHODS Sixty-five chronic stroke survivors and 34 healthy control subjects underwent scanning of the distal radius epiphyseal site on both sides using peripheral quantitative computed tomography to measure trabecular volumetric bone mineral density (vBMD) (mg/cm(3)), total vBMD (mg/cm(3)), total area (mm(2)), and compressive bone strength index (cBSI) (g(2)/cm(4)). Various indicators of neuromuscular (grip strength, spasticity) and cardiovascular function (vascular elasticity, oxygen consumption during 6-min walk test) were evaluated. RESULTS Analysis of variance revealed a significant main effect of side (p < 0.001) and group × side interaction (p < 0.05) for total BMC, total vBMD, trabecular vBMD, and cBSI (p < 0.05), with the stroke group showing greater side-to-side difference in these variables. However, no significant side-to-side difference in total area was detected in either group (p > 0.05). Sex-specific analysis yielded similar results. Multiple regression analyses revealed that the cBSI of the hemiparetic distal radius epiphysis had a stronger association with neuromuscular factors than cardiovascular factors. Overall, grip strength was the strongest determinant of the cBSI of the hemiparetic distal radius epiphysis (p < 0.01). CONCLUSIONS Muscle weakness is the most predominant determinant of cBSI in the hemiparetic distal radius epiphysis among chronic stroke patients. Future studies should investigate the efficacy of different muscle-strengthening strategies in enhancing bone strength of this skeletal site in the chronic stroke population.
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Affiliation(s)
- M Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
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Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodríguez G. Effects of training on bone mass in older adults: a systematic review. Sports Med 2012; 42:301-25. [PMID: 22376192 DOI: 10.2165/11597670-000000000-00000] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It is widely recognized that the risk of fractures is closely related to the typical decline in bone mass during the ageing process in both women and men. Exercise has been reported as one of the best non-pharmacological ways to improve bone mass throughout life. However, not all exercise regimens have the same positive effects on bone mass, and the studies that have evaluated the role of exercise programmes on bone-related variables in elderly people have obtained inconclusive results. This systematic review aims to summarize and update present knowledge about the effects of different types of training programmes on bone mass in older adults and elderly people as a starting point for developing future interventions that maintain a healthy bone mass and higher quality of life in people throughout their lifetime. A literature search using MEDLINE and the Cochrane Central Register of Controlled Trials databases was conducted and bibliographies for studies discussing the effect of exercise interventions in older adults published up to August 2011 were examined. Inclusion criteria were met by 59 controlled trials, 7 meta-analyses and 8 reviews. The studies included in this review indicate that bone-related variables can be increased, or at least the common decline in bone mass during ageing attenuated, through following specific training programmes. Walking provides a modest increase in the loads on the skeleton above gravity and, therefore, this type of exercise has proved to be less effective in osteoporosis prevention. Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process. Multi-component exercise programmes of strength, aerobic, high impact and/or weight-bearing training, as well as whole-body vibration (WBV) alone or in combination with exercise, may help to increase or at least prevent decline in bone mass with ageing, especially in postmenopausal women. This review provides, therefore, an overview of intervention studies involving training and bone measurements among older adults, especially postmenopausal women. Some novelties are that WBV training is a promising alternative to prevent bone fractures and osteoporosis. Because this type of exercise under prescription is potentially safe, it may be considered as a low impact alternative to current methods combating bone deterioration. In other respects, the ability of peripheral quantitative computed tomography (pQCT) to assess bone strength and geometric properties may prove advantageous in evaluating the effects of training on bone health. As a result of changes in bone mass becoming evident by pQCT even when dual energy X-ray absortiometry (DXA) measurements were unremarkable, pQCT may provide new knowledge about the effects of exercise on bone that could not be elucidated by DXA. Future research is recommended including longest-term exercise training programmes, the addition of pQCT measurements to DXA scanners and more trials among men, including older participants.
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Affiliation(s)
- A Gómez-Cabello
- GENUD-Growth, Exercise, NUtrition and Development Research Group, Universidad de Zaragoza, Huesca, Spain
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Polidoulis I, Beyene J, Cheung AM. The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women--a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2012; 23:39-51. [PMID: 21811864 DOI: 10.1007/s00198-011-1734-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 06/22/2011] [Indexed: 12/31/2022]
Abstract
UNLABELLED Inconsistent study findings of exercise on areal bone density highlight the need to include parameters of bone geometry and volumetric bone density measurements. Using a systematic review and meta-analysis, we found a decrease in bone loss through the maintenance of cortical and trabecular volumetric bone mineral density (BMD). Studies with longer exercise durations and larger sample sizes are needed. INTRODUCTION Exercise has long been recommended to prevent age-related loss of bone mass in postmenopausal women. However, inconsistent study findings on the effect of exercise on BMD preservation have highlighted the importance of extending the evaluation of bone to include the parameters of bone geometry. We conducted both a systematic review and meta-analysis of the effects of exercise on bone geometry and volumetric BMD in postmenopausal women. METHODS We searched MEDLINE, PubMed, and EMBASE from 1950 to April 2009 and included prospective, randomized controlled trials of healthy postmenopausal women where the intervention involved exercise or sport and outcomes included quantitative or peripheral quantitative computed tomography bone parameters. Outcome variables included: total volumetric BMD, cortical volumetric BMD (CvBMD), trabecular volumetric BMD (TrvBMD), total bone mineral content, cortical BMC, total bone area, cortical area, polar stress-strain index, and bone strength index. RESULTS Six studies satisfied our inclusion and exclusion criteria. Lower extremity exercises resulted in small (∼0.9%) but significant improvements in TrvBMD of the distal tibia (p = 0.0006) and in CvBMD of the tibial shaft (p = 0.0007). Studies with longer durations of exercise (12 months) and those in early postmenopausal women showed significant changes in CvBMD at the tibial shaft. CONCLUSIONS We conclude that exercise in postmenopausal women may decrease bone loss by maintaining cortical and trabecular volumetric BMD. To better understand the effect of exercise on bone geometric structure and strength, more studies of longer duration and larger sample sizes are needed.
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Affiliation(s)
- I Polidoulis
- Department of Family & Community Medicine, University of Toronto, The Scarborough General Medical Mall, 309-3030 Lawrence Avenue East, Scarborough, Ontario M1P 2T7, Canada.
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Abstract
Although physical therapists commonly manage neuromusculoskeletal disorders and injuries, their scope of practice also includes prevention and wellness. In particular, this perspective article proposes that physical therapists are well positioned to address the client's skeletal health by incorporating fracture prevention into clinical practice with all adults. Fracture prevention consists primarily of maximizing bone strength and preventing falls. Both of these initiatives require an evidence-based, multidimensional approach that customizes interventions based on an individual's medical history, risk factors, and personal goals. The purposes of this perspective article are: (1) to review the role of exercise and nutrition in bone health and disease; (2) to introduce the use of the Fracture Risk Assessment Tool (FRAX®) into physical therapist practice; (3) to review the causes and prevention of falls; and (4) to propose a role for the physical therapist in promotion of bone health for all adult clients, ideally to help prevent fractures and their potentially devastating sequelae.
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42
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Liang MT, Quezada L, Lau WJ, Sokmen B, Spalding TW. Effect of short-term upper-body resistance training on muscular strength, bone metabolic markers, and BMD in premenopausal women. Open Access J Sports Med 2012; 3:201-8. [PMID: 24198603 PMCID: PMC3781915 DOI: 10.2147/oajsm.s33399] [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] [Indexed: 11/23/2022] Open
Abstract
To examine the effect of a 10-week upper-body resistance training program on bone turnover markers and site-specific bone mineral density (BMD) in the wrist and distal half of the ulna and radius in untrained and healthy young premenopausal women.
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Affiliation(s)
- Michael Tc Liang
- Department of Kinesiology and Health Promotion, California State Polytechnic University, Pomona, CA, USA
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43
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Erlandson MC, Kontulainen SA, Chilibeck PD, Arnold CM, Baxter-Jones ADG. Bone mineral accrual in 4- to 10-year-old precompetitive, recreational gymnasts: a 4-year longitudinal study. J Bone Miner Res 2011; 26:1313-20. [PMID: 21308773 DOI: 10.1002/jbmr.338] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Competitive female gymnasts have greater bone mineral measures than nongymnasts. However, less is known about the effect of recreational and/or precompetitive gymnastics participation on bone development. The purpose of this study was to investigate whether the differences previously reported in the skeleton of competitive female gymnasts are also demonstrated in young children with a current or past participation history in recreational or precompetitive gymnastics. One hundred and sixty-three children (30 gymnasts, 61 ex-gymnasts, and 72 nongymnasts) between 4 and 6 years of age were recruited and measured annually for 4 years (not all participants were measured at every occasion). Total-body (TB), lumbar spine (LS), and femoral neck (FN) bone mineral content (BMC) were measured by dual-energy X-ray absorptiometry (DXA). Multilevel random-effects models were constructed and used to predict differences in TB, LS, and FN BMC between groups while controlling for differences in body size, physical activity, and diet. Gymnasts had 3% more TB and 7% more FN BMC than children participating in other recreational sports at year 4 (p < .05). No differences were found at the LS between groups, and there were no differences between ex-gymnasts' and nongymnasts' bone parameters (p > .05). These findings suggest that recreational and precompetitive gymnastics participation is associated with greater BMC. This is important because beginner gymnastics skills are attainable by most children and do not require a high level of training. Low-level gymnastics skills can be implemented easily into school physical education programs, potentially affecting skeletal health.
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Affiliation(s)
- Marta C Erlandson
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life. BMC Med 2010; 8:47. [PMID: 20663158 PMCID: PMC2918523 DOI: 10.1186/1741-7015-8-47] [Citation(s) in RCA: 289] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/21/2010] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (> or =6 months) on estimates of lower-extremity bone strength from childhood to older age. METHODS We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase) up to October 2009 and included 10 randomised controlled trials (RCTs) that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood) and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size), we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies. RESULTS Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre- and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32)], but not among pubertal girls [-0.01 (-0.18 to 0.17)], adolescent boys [0.10 (-0.75 to 0.95)], adolescent girls [0.21 (-0.53 to 0.97)], premenopausal women [0.00 (-0.43 to 0.44)] or postmenopausal women [0.00 (-0.15 to 0.15)]. Evidence based on per-protocol analyses of individual trials in children and adolescents indicated that programmes incorporating regular weight-bearing exercise can result in 1% to 8% improvements in bone strength at the loaded skeletal sites. In premenopausal women with high exercise compliance, improvements ranging from 0.5% to 2.5% have been reported. CONCLUSIONS The findings from our meta-analysis of RCTs indicate that exercise can significantly enhance bone strength at loaded sites in children but not in adults. Since few RCTs were conducted to investigate exercise effects on bone strength, there is still a need for further well-designed, long-term RCTs with adequate sample sizes to quantify the effects of exercise on whole bone strength and its structural determinants throughout life.
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Affiliation(s)
- Riku Nikander
- Department of Medicine, The University of Melbourne, Western Hospital, Melbourne, Australia
- Bone Research Group, UKK Institute for Health Promotion Research, Tampere, Finland
- Research Department of Tampere University Hospital, Tampere, Finland
| | - Harri Sievänen
- Bone Research Group, UKK Institute for Health Promotion Research, Tampere, Finland
- Research Department of Tampere University Hospital, Tampere, Finland
| | - Ari Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Robin M Daly
- Department of Medicine, The University of Melbourne, Western Hospital, Melbourne, Australia
| | - Kirsti Uusi-Rasi
- Bone Research Group, UKK Institute for Health Promotion Research, Tampere, Finland
- Research Department of Tampere University Hospital, Tampere, Finland
| | - Pekka Kannus
- Bone Research Group, UKK Institute for Health Promotion Research, Tampere, Finland
- Research Department of Tampere University Hospital, Tampere, Finland
- Division of Orthopaedics and Traumatology, Medical School, University of Tampere, Tampere, Finland
- Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
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Abstract
Mechanical loading is of pivotal importance in the maintenance of skeletal homeostasis, but the players involved in the transduction of mechanical stimuli to promote bone maintenance have long remained elusive. Osteocytes, the most abundant cells in bone, possess mechanosensing appendices stretching through a system of bone canaliculi. Mechanical stimulation plays an important role in osteocyte survival and hence in the preservation of bone mechanical properties, through the maintenance of bone hydratation. Osteocytes can also control the osteoblastic differentiation of mesenchymal precursors in response to mechanical loading by modulating WNT signaling pathways, essential regulators of cell fate and commitment, through the protein sclerostin. Mutations of Sost, the sclerostin-encoding gene, have dramatic effects on the skeleton, indicating that osteocytes may act as master regulators of bone formation and localized bone remodeling. Moreover, the development of sclerostin inhibitors is opening new possibilities for bone regeneration in orthopedics and the dental field.
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Hamilton CJ, Swan VJD, Jamal SA. The effects of exercise and physical activity participation on bone mass and geometry in postmenopausal women: a systematic review of pQCT studies. Osteoporos Int 2010; 21:11-23. [PMID: 19504035 DOI: 10.1007/s00198-009-0967-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 03/31/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
The cumulative risk of fracture for a postmenopausal woman over the age of 50 can reach up to 60%. Exercise has the potential to modify fracture risk in postmenopausal women through its effects on bone mass and geometry; however, these effects are not well characterized. To determine the effects of exercise on bone mass and geometry in postmenopausal women, we conducted a systematic review of the literature. We included all randomized controlled trials, cross-sectional studies, and prospective studies that used peripheral quantitative computed tomography to assess the effects of exercise on bone mass and geometry in this population. Exercise effects appear to be modest, site-specific, and preferentially influence cortical rather than trabecular components of bone. Exercise type also plays a role, with the most prominent mass and geometric changes being observed in response to high-impact loading exercise. Exercise appears to positively influence bone mass and geometry in postmenopausal women. However, further research is needed to determine the types and amounts of exercise that are necessary to optimize improvements in bone mass and geometry in postmenopausal women and determine whether or not these improvements are capable of preventing fractures.
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Inbred strain-specific effects of exercise in wild type and biglycan deficient mice. Ann Biomed Eng 2009; 38:1607-17. [PMID: 20033775 DOI: 10.1007/s10439-009-9881-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 12/16/2009] [Indexed: 10/20/2022]
Abstract
Biglycan (bgn)-deficient mice (KO) have defective osteoblasts which lead to changes in the amount and quality of bone. Altered tissue strength in C57BL6/129 (B6;129) KO mice, a property which is independent of tissue quantity, suggests that deficiencies in tissue quality are responsible. However, the response to bgn-deficiency is inbred strain-specific. Mechanical loading influences bone matrix quality in addition to any increase in bone mass or change in bone formation activity. Since many diseases influence the mechanical integrity of bone through altered tissue quality, loading may be a way to prevent and treat extracellular matrix deficiencies. C3H/He (C3H) mice consistently have a less vigorous response to mechanical loading vs. other inbred strains. It was therefore hypothesized that the bones from both wild type (WT) and KO B6;129 mice would be more responsive to exercise than the bones from C3H mice. To test these hypotheses at 11 weeks of age, following 21 consecutive days of exercise, we investigated cross-sectional geometry, mechanical properties, and tissue composition in the tibiae of male mice bred on B6;129 and C3H backgrounds. This study demonstrated inbred strain-specific compositional and mechanical changes following exercise in WT and KO mice, and showed evidence of genotype-specific changes in bone in response to loading in a gene disruption model. This study further shows that exercise can influence bone tissue composition and/or mechanical integrity without changes in bone geometry. Together, these data suggest that exercise may represent a possible means to alter tissue quality and mechanical deficiencies caused by many diseases of bone.
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Ahola R, Korpelainen R, Vainionpää A, Leppäluoto J, Jämsä T. Time-course of exercise and its association with 12-month bone changes. BMC Musculoskelet Disord 2009; 10:138. [PMID: 19909496 PMCID: PMC2784429 DOI: 10.1186/1471-2474-10-138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 11/12/2009] [Indexed: 11/23/2022] Open
Abstract
Background Exercise has been shown to have positive effects on bone density and strength. However, knowledge of the time-course of exercise and bone changes is scarce due to lack of methods to quantify and qualify daily physical activity in long-term. The aim was to evaluate the association between exercise intensity at 3, 6 and 12 month intervals and 12-month changes in upper femur areal bone mineral density (aBMD) and mid-femur geometry in healthy premenopausal women. Methods Physical activity was continuously assessed with a waist-worn accelerometer in 35 healthy women (35-40 years) participating in progressive high-impact training. To describe exercise intensity, individual average daily numbers of impacts were calculated at five acceleration levels (range 0.3-9.2 g) during time intervals of 0-3, 0-6, and 0-12 months. Proximal femur aBMD was measured with dual x-ray absorptiometry and mid-femur geometry was evaluated with quantitative computed tomography at the baseline and after 12 months. Physical activity data were correlated with yearly changes in bone density and geometry, and adjusted for confounding factors and impacts at later months of the trial using multivariate analysis. Results Femoral neck aBMD changes were significantly correlated with 6 and 12 months' impact activity at high intensity levels (> 3.9 g, r being up to 0.42). Trochanteric aBMD changes were associated even with first three months of exercise exceeding 1.1 g (r = 0.39-0.59, p < 0.05). Similarly, mid-femoral cortical bone geometry changes were related to even first three months' activity (r = 0.38-0.52, p < 0.05). In multivariate analysis, 0-3 months' activity did not correlate with bone change at any site after adjusting for impacts at later months. Instead, 0-6 months' impacts were significant correlates of 12-month changes in femoral neck and trochanter aBMD, mid-femur bone circumference and cortical bone attenuation even after adjustment. No significant correlations were found at the proximal or distal tibia. Conclusion The number of high acceleration impacts during 6 months of training was positively associated with 12-month bone changes at the femoral neck, trochanter and mid-femur. These results can be utilized when designing feasible training programs to prevent bone loss in premenopausal women. Trial registration Clinical trials.gov NCT00697957
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Affiliation(s)
- Riikka Ahola
- Department of Medical Technology, Institute of Biomedicine, University of Oulu, Finland.
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Lespessailles E, Jaffré C, Beaupied H, Nanyan P, Dolléans E, Benhamou CL, Courteix D. Does exercise modify the effects of zoledronic acid on bone mass, microarchitecture, biomechanics, and turnover in ovariectomized rats? Calcif Tissue Int 2009; 85:146-57. [PMID: 19609736 DOI: 10.1007/s00223-009-9269-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 06/03/2009] [Indexed: 11/27/2022]
Abstract
Regular activity has effects on bone size, shape, and density, resulting in an increase in mechanical strength. The mechanism of action that underlies this improvement in bone strength is mainly linked to an increase in bone formation. Zoledronic acid (Z), in contrast, may prevent bone strength changes in ovariectomized (OVX) rodents by its potent antiresorptive effects. Based on these assumptions we hypothesized that combined effects of exercise (E) and Z may produce higher benefits on bone changes resulting from estrogen deficiency than either intervention alone. At 6 months of age, 60 female Wistar rats were OVX or sham operated (SH) and divided into five groups: SH, OVX, OVX-E, OVX-Z, and OVX-ZE. OVX rats were treated with a single IV injection of Z (20 microg/kg) or vehicle and submitted or not to treadmill exercise (15 m/min, 60 min/day, 5 days/week) for 12 weeks. Whole-body BMD and bone turnover markers were analyzed longitudinally. At sacrifice, femurs were removed. BMD by DXA, three-point bending test, and microCT were performed to study biomechanical and trabecular structure parameters, respectively. After 12 weeks, bone volume fraction decreased in OVX rats, whereas bone turnover rate, trabecular spacing, and structure model index increased compared with those in the SH group (P < 0.05). Zoledronic acid prevented the ovariectomy-induced trabecular bone loss and its subsequent trabecular microarchitectural deterioration. Treadmill exercise running was shown to preserve the bone strength and to induce bone turnover changes in favor of bone formation. However, the combined effects of zoledronic acid and running exercise applied simultaneously did not produce any synergetic or additive effects.
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Affiliation(s)
- E Lespessailles
- INSERM U658, Laboratoire de Caractérisation du Tissu Osseux par Imagerie, Techniques et Applications, CHR d'Orleans, Orleans, France.
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Abstract
BACKGROUND Muscle weakness in old age is associated with physical function decline. Progressive resistance strength training (PRT) exercises are designed to increase strength. OBJECTIVES To assess the effects of PRT on older people and identify adverse events. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (to March 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 01, 2008), EMBASE (1980 to February 06 2007), CINAHL (1982 to July 01 2007) and two other electronic databases. We also searched reference lists of articles, reviewed conference abstracts and contacted authors. SELECTION CRITERIA Randomised controlled trials reporting physical outcomes of PRT for older people were included. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed trial quality and extracted data. Data were pooled where appropriate. MAIN RESULTS One hundred and twenty one trials with 6700 participants were included. In most trials, PRT was performed two to three times per week and at a high intensity. PRT resulted in a small but significant improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation measures also showed improvements: e.g. there was a modest improvement in gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme. AUTHORS' CONCLUSIONS This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.
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Affiliation(s)
- Chiung‐ju Liu
- Indiana University at IndianapolisDepartment of Occupational Therapy1140 W Michigan ST CF 303IndianpolisIndianaUSA46202
| | - Nancy K Latham
- Boston UniversityHealth and Disabilty Research Institute, School of Public Health580 Harrison Avenue4th FloorBostonMAUSA02118‐2639
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