Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women

Exploration of the miR-187-3p/CNR2 pathway in modulating osteoblast differentiation and treating postmenopausal osteoporosis through mechanical stress

This study aimed to explore how mechanical stress affects osteogenic differentiation via the miR-187-3p/CNR2 pathway. To conduct this study, 24 female C57BL/6 mice, aged 8 weeks, were used and divided into four groups. The Sham and OVX groups did not undergo treadmill exercise, while the Sham + EX and OVX + EX groups received a 8-week treadmill exercise. Post-training, bone marrow and fresh femur samples were collected for further analysis. Molecular biology analysis, histomorphology analysis, and micro-CT analysis were conducted on these samples. Moreover, primary osteoblasts were cultured under osteogenic conditions and divided into GM group and CTS group. The cells in the CTS group underwent a sinusoidal stretching regimen for either 3 or 7 days. The expression of early osteoblast markers (Runx2, OPN, and ALP) was measured to assess differentiation. The study findings revealed that mechanical stress has a regulatory impact on osteoblast differentiation. The expression of miR-187-3p was observed to decrease, facilitating osteogenic differentiation, while the expression of CNR2 increased significantly. These observations suggest that mechanical stress, miR-187-3p, and CNR2 play crucial roles in regulating osteogenic differentiation. Both in vivo and in vitro experiments have confirmed that mechanical stress downregulates miR-187-3p and upregulates CNR2, which leads to the restoration of distal femoral bone mass and enhancement of osteoblast differentiation. Therefore, mechanical stress promotes osteoblasts, resulting in improved osteoporosis through the miR-187-3p/CNR2 signaling pathway. These findings have broad prospect and provide molecular biology guidance for the basic research and clinical application of exercise in the prevention and treatment of PMOP.

Treadmill exercise promotes bone tissue recovery in rats subjected to high + Gz loads

INTRODUCTION

High + Gz loads, the gravitational forces experienced by the body in hypergravity environments, can lead to bone loss in pilots and astronauts, posing significant health risks.

MATERIALS AND METHODS

To explore the effect of treadmill exercise on bone tissue recovery, a study was conducted on 72 male Wistar rats. These rats were subjected to four weeks of varying levels of periodic high + Gz loads (1G, 8G, 20G) experiments, and were subsequently divided into the treadmill group and the control group. The treadmill group underwent a continuous two-week treadmill experiment, while the control group rested during this period. The mechanical properties, microstructure, and molecular markers of their tibial bone tissue were measured using three-point bending, micro-CT, and PCR.

RESULTS

The results showed that treadmill exercise improved the elastic modulus, ultimate deflection, and ultimate load of rat bone tissue. It also increased the number, density, and volume fraction of bone trabeculae, and decreased their separation. Moreover, treadmill exercise enhanced osteogenesis and inhibited osteoclastogenesis.

CONCLUSION

This study demonstrates that treadmill exercise can promote the recovery of bone tissue in rats subjected to high + Gz loads, providing a potential countermeasure for bone loss in pilots and astronauts.

Effect of COVID-19 pandemic on lifestyle and bone mineral density in young adults

OBJECTIVES

This study investigates the relationships between the COVID-19 pandemic, lifestyle factors, and their impact on bone mineral density in the radius forearm bone and the total bone mineral content in young adults from Slovakia.

METHODS

We assessed 773 Slovak young adults aged 18 to 30 years, divided into subgroups on their pandemic status. Bone mineral density (BMD) was analyzed by the QUS device (Sunlight MiniOmni™), and bone mineral content (BMC) and fat mass (FM) were measured by InBody 770 bioimpedance analyzer. Finally, linear regression analysis tested the associations.

RESULTS

Statistically significant lower speed of sound (SOS) along the length of the forearm radius bone and Z-score values was determined in participants during the COVID-19 pandemic than before it, and statistically significant lower BMC values were observed in the male group during COVID-19 than beforehand. Regression analysis confirmed the negative pandemic effect in the following indices: SOS (p < .001 for women and p = .035 for men), Z-score (p < .001 for women and p = .003 for men), and BMC (p = .024 for men). Vitamin D was a further significant SOS predictor in women at p = .029, but this association was not detected in men. In contrast, the significant male BMC predictors were pandemic presence (p = .028), physical activity (p = .028), and fat mass percentage (p = .001).

CONCLUSIONS

Significant COVID-19 pandemic effects on bone tissue were determined on bone mass density in the radius forearm bone and the total bone mineral content. These effects establish that the pandemic had a negative impact on both their bone quality and health.

Exploring the Nexus between Moderate-to-Vigorous Physical Activity, Self-Disclosure, Social Anxiety, and Adolescent Social Avoidance: Insights from a Cross-Sectional Study in Central China

Objectives: Psychological issues among adolescents represent a prevalent challenge in today's society. The purpose of this study is to explore the associations among moderate-to-vigorous physical activity, self-disclosure, social anxiety, and social avoidance in adolescents. Methods: This study collected cross-sectional data from 427 students in eight provincial key junior and senior high schools in the central China region of three provinces using snowball sampling and convenience sampling from July to August 2023. A structural equation model was employed to investigate the relationship between moderate-to-vigorous physical activity and social avoidance among adolescents. Results: The findings indicate that moderate-to-vigorous physical activity is negatively correlated with social anxiety (standardized coefficient = -0.219, p < 0.001) and positively correlated with self-disclosure (standardized coefficient = 0.454, p < 0.001). Social anxiety is negatively correlated with self-disclosure (standardized coefficient = -0.220, p < 0.001). Social avoidance is positively correlated with social anxiety (standardized coefficient = 0.461, p < 0.001) and negatively correlated with self-disclosure (standardized coefficient = -0.331, p < 0.001). Conclusions: The chain-mediated dual-path model between moderate-to-vigorous physical activity and social avoidance is facilitated by social anxiety and self-disclosure. In other words, adolescents who engage in more moderate to high-intensity physical activities exhibit lower levels of social anxiety, and those who have a stronger inclination for self-disclosure tend to demonstrate lower levels of social avoidance. In light of these findings, it is recommended that the government, society, schools, and families collaborate synergistically to promote the holistic well-being of adolescents and advance the development of a healthier China.

The Relationship between Self-Rated Health and Physical Fitness in Polish Youth

Self-rated health (SRH) is a tool for assessing a population's health across the lifetime, and seems to be a dynamic assessment of current health status and a strong predictor of cardiovascular disease and mortality, whereas insufficient levels of physical fitness in adolescence are a significant health problem and may contribute to the development of many disorders in adulthood. In this cross-sectional study, we attempted to assess the relationship between SRH and the physical fitness of adolescents. Two hundred and thirty-five adolescents (eighty-five boys and one hundred and fifty girls) aged 16-17 were recruited for this study. The study procedures included a short author questionnaire and physical fitness assessment (Zuchora's Physical Fitness Index). Boys declared better health states and reported less frequent morbidity of seasonal diseases (p < 0.05). No differences were found in physical fitness, the incidence of postural disorders, lower limb malalignments, foot deformities, sleep duration, and perception of physical activity on physical condition and well-being in boys and girls (p > 0.05). The comparison of physical fitness levels in adolescents with different SRH, sleep duration, perceptions of physical activity on physical condition and well-being also showed significant differences (p < 0.05). Positive SRH and perception of physical activity on physical condition and well-being, proper sleep duration (7-8 h/night), and a lack of foot deformities are associated with a better physical fitness in adolescents. Physical fitness seems to be a good predictor of SRH only in Polish boys, but not girls and the entire population. The lack of significance in the entire population could be attributed to the substantial number of girls in the study group. Despite that, it is recommended to encourage adolescents to engage in regular exercises, sleep routines and healthy lifestyles. Further research should be based on a more representative group, with a comparable number of girls and boys in the study group and potential confounders, but also they should be focused on SRH predictors to improve SRH in Polish girls.

Drynaria Naringin alleviated mechanical stress deficiency-caused bone loss deterioration via Rspo1/Lgr4-mediated Wnt/β-catenin signalling pathway

Osteoporosis is a metabolic condition distinguished by the degradation of bone microstructure and mechanical characteristics. Traditional Chinese medicine (TCM) has been employed in China for the treatment of various illnesses. Naringin, an ingredient found in Drynariae TCM, is known to have a significant impact on bone metabolism. For this research, we studied the precise potential effect of Drynaria Naringin on protecting against bone loss caused by stress deficiency. In this study, a tail-suspension (TS) test was performed to establish a mouse model with hind leg bone loss. Some mice received subcutaneous injections of Drynaria Naringin for 30 d. Trabecular bone microarchitecture was evaluated using micro-computed tomography analysis and bone histological analysis. Bone formation and resorption markers were quantified in blood samples from mice or in the supernatant of MC3T3-E1 cells by ELISA analysis, Western blotting, and PCR. Immunofluorescence was utilized to visualize the location of β-catenin. Additionally, siRNA was employed to knockdown-specific genes in the cells. Our findings highlight the efficacy of Drynaria Naringin in protecting against the deterioration of bone loss and promoting bone formation and Rspo1 expression in a mouse model following the TS test. Specifically, in vitro experiments also indicated that Drynaria Naringin may promote osteogenesis through the Wnt/β-catenin signalling pathway. Moreover, our results suggest that Drynaria Naringin upregulates the expression of Rspo1/Lgr4, leading to the promotion of osteogenesis via the Wnt/β-catenin signalling pathway. Therefore, Drynaria Naringin holds potential as a therapeutic medication for osteoporosis. Drynaria Naringin alleviates bone loss deterioration caused by mechanical stress deficiency through the Rspo1/Lgr4-mediated Wnt/β-catenin signalling pathway.

What are the Effects of Exercise on Trabecular Microarchitecture in Older Adults? A Systematic Review and Meta-analysis of HR-pQCT Studies

The objective of this review was to determine the effects of exercise on high-resolution peripheral quantitative computed tomography (HR-pQCT) derived trabecular microarchitecture parameters in older adults. Five electronic databases were systematically searched by two independent reviewers. Inclusion criteria were adults age ≥ 50, any type of exercise as part of the intervention, and trabecular microarchitecture assessed via HR-pQCT. Data was extracted from included studies, and where suitable, included in a meta-analysis. Quality of included studies was appraised. Seven studies (397 participants) were included. All participants were postmenopausal women. Interventions included jumping, whole-body vibration, and power/plyometric training. All studies were rated as either weak or moderate quality. Meta-analysis (5 studies) showed no significant changes in any parameters when considering all exercise or sub-analysing based on type. Exercise was not found to have significant effects on trabecular microarchitecture in postmenopausal women over the age of 50. These findings should be interpreted with caution due to the small number of studies investigating few modes of exercise, their weak to moderate quality, and risk of bias. High-quality studies are needed to determine the effects of additional types of exercise in a more diverse population of older adults, including men.

Associations of physical activity types and intensity with cardiovascular diseases by age and gender among 18,730 Chinese adults

The associations of physical activity (PA) intensity and types with CVD (cardiovascular diseases) in different population are inconsistent and remains not very clear. A total of 7854 males and 10,876 females over 15 years were selected by multistage random sampling methods. In males, moderate-intensity physical activity (MPA) had no effect, while vigorous-intensity physical activity (VPA) played a significant protective role (OR = 1.319 and 0.615). However, in females, both MPA and VPA had significant protective effects (OR = 0.593 and 0.537). VPA presented as a significant protective factor in stroke patients and combined CVDs for males in all age groups; however, in females, the results suggested that, for those aged over 60-74 years, MPA was a protective factor. Furthermore, for the middle-aged or younger participants, the area under the curves (AUCs) of work, housework, and leisure activity were generally higher than that of other types, while for patients aged over 60 years, the AUCs of sedentary time and sleep activity seemed much higher. VPA had a better protective effect for preventing cardiovascular events, while the young and female population could benefit from MPA as well. Regardless of the types of PA, leisure activities were strongly recommended, and young people were much more likely to benefit from exercise than older people.

MiRNAs Expression Modulates Osteogenesis in Response to Exercise and Nutrition

In recent years, many articles have been published describing the impact of physical activity and diet on bone health. This review has aimed to figure out the possible epigenetic mechanisms that influence bone metabolism. Many studies highlighted the effects of macro and micronutrients combined with exercise on the regulation of gene expression through miRs. The present review will describe how physical activity and nutrition can prevent abnormal epigenetic regulation that otherwise could lead to bone-metabolism-related diseases, the most significant of which is osteoporosis. Nowadays, it is known that this effect can be carried out not only by endogenously produced miRs, but also through those intakes through the diet. Indeed, they have also been found in the transcriptome of animals and plants, and it is possible to hypothesise an interaction between miRNAs produced by different kingdoms and epigenetic influences on human gene expression. In particular, the key to the activation pathways triggered by diet and physical activity appears to be the activation of Runt-related transcription factor 2 (RUNX2), the expression of which is regulated by several miRs. Among the main miRs involved are exercise-induced miR21 and 21-5p, and food-induced miR 221-3p and 222-3p.

Predisposing factors for a second fragile hip fracture in a population of 1130 patients with hip fractures, treated at Oulu University Hospital in 2013-2016: a retrospective study

OBJECTIVE

The life-time risk of a second fragile hip fracture is 8.4%, but the risk factors that predispose to a second hip fracture remain unresolved. This study aimed to define risk factors that predisposed patients to a second hip fracture.

METHODS

For this retrospective study, we retrieved clinical data on 1130 patients with fragile hip fractures (67.2% female, mean age: 79.3 years) that underwent surgery at the Oulu University Hospital in 2013-2016. These data included the fracture risk assessment score (measured with the FRAX tool), the bone-mass T-score, laboratory values, ambulatory capacity, and the time of death.

RESULTS

In this population, 12.4% of patients sustained a second hip fracture. The predisposing factors for a second hip fracture were: female (p = 0.016), a high FRAX score (p = 0.020), and low physical capacity (p < 0.001). The vitamin D level recommended for treating osteoporosis (i.e., vitamin D > 75 nmol/l) was observed in only 24% of patients, and 42% of patients had ionized calcium levels below the reference range. According to the level of the cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), 37% of patients did not have high bone turnover. We found a positive correlation between age and ICTP (p = 0.001). The risk of death was higher after the second hip fracture (p = 0.005), but we found no difference in age between patients with first and second hip fractures (p = 0.11).

CONCLUSION

After a hip fracture, a second hip fracture is a well-known risk. Nevertheless, we found that only one-third of patients with a second hip fracture had used anti-osteoporosis medication at any time previously. These findings suggested that second hip fractures were most likely to occur in patients with osteopenic T-score values, in women more often than men, and in patients with high FRAX scores and low ambulatory capacity.

Influence of Coaching on Effectiveness, Participation, and Safety of an Exercise Program for Postmenopausal Women with Osteoporosis: A Randomized Trial

Purpose

We compared two different strategies providing professional coaching to administer an exercise program for women with postmenopausal osteoporosis (POP): individual training (IT) at home with trainer's supervision provided by telephone contacts at regular time-intervals or group training (GT) with trainer's live supervision. Our working hypothesis was that IT is a valid alternative to GT when GT is not feasible.

Patients and Methods

This was a single-blind, randomized study. We recruited 52 women with POP, without significant comorbidity, and no participation in any structured exercise program within the previous 6 months. They were assigned randomly to IT or GT groups (n = 26 each). Distribution of age (IT: 68±4, GT: 67±8 years) and body mass index (IT: 23.0±2.5, GT: 21.4±5.1) was similar between groups. Each group performed the exercise program in two 1-hour sessions per week for 18 months. Primary outcome measure was Health-Related Quality of Life (HRQoL), as measured by the Short Osteoporosis Quality of Life Questionnaire. Secondary outcome measures focused on domains acknowledged to influence HRQoL (disability, fear of falling, weekly physical activity, physical function) or the effectiveness of the exercise program (retention, adherence, and safety). Significance level was set at p < 0.05.

Results

No significant differences were observed between IT and GT groups for any domain. Retention, adherence, and safety were also similar. HRQoL, disability and fear of falling did not change between baseline and follow-up for either group. However, for both groups, physical function (knee flexion, shoulder mobility) and functional capacity (6-minute walking test) improved. Weekly physical activity levels increased from moderate range at baseline to intense at final assessment for both groups.

Conclusion

IT and GT supervised exercise programs for women with POP provide similar effectiveness, participation and safety. Hence, both modalities should be considered for future translation in clinical practice of exercise recommendations for POP.

The Role of High-intensity and High-impact Exercises in Improving Bone Health in Postmenopausal Women: A Systematic Review

Postmenopausal osteoporosis is a chronic condition with decreased bone mass and altered bone structure, leading to a greater risk of fractures among older women. Exercise has been proposed as a potentially effective non-pharmacological method to prevent this condition. In this systematic review, we investigate the effects and safety of high-impact and high-intensity exercises in improving bone density at popular sites of fragility fractures, namely, the hip and spine. This review also highlights the mechanism of these exercises in improving bone density and other aspects of bone health in postmenopausal women.  This study is done adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After applying the eligibility criteria, we selected 10 articles from PubMed and Google Scholar to be included in our study.  Based on the findings from the studies, we established that high-intensity and high-impact exercises are effective in improving, or at the very least maintaining, bone density in the lumbar spine and femur in postmenopausal women. An exercise protocol including high-intensity resistance exercises and high-impact training is shown to be most effective in improving bone density and other parameters of bone health. These exercises were found to be safe in older women, however, careful supervision is recommended. All limitations considered, high-intensity and high-impact exercises are an effective strategy to enhance bone density, and potentially reduce the burden of fragility as well as compression fractures in postmenopausal women.

The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review

BACKGROUND

The aim of this systematic review was to determine whether strength exercises improve the symptoms of menopause and to provide an update on the most recent scientific evidence on the type and regimen of exercise that help reduce the symptoms.

METHODS

An electronic search of scientific databases was performed from 2015 to 2022. Randomized clinical trials that analyzed the effects of strength exercises versus other types of interventions, considering all the outcome measures of interest, were included in this review.

RESULTS

We found 5964 potential articles. After applying the selection criteria, we selected 12 of the articles. The studies compared strength exercises versus other therapies or compared strength exercises versus no intervention in one of the groups. The results showed improvements in the strength of the legs and pelvic floor, physical activity, bone density, metabolic and hormonal changes, heart rate and blood pressure and a change in hot flashes.

CONCLUSIONS

There is evidence that strength exercises can be beneficial for improving strength, physical activity, bone density and hormonal and metabolic levels. In terms of the appropriate type of strength training, the evidence is still unclear given that the same benefits are achieved by various types of exercises.

[Impact of osteoporosis on physical performance parameters of middle-aged and elderly individuals-a cross-sectional study]

BACKGROUND

Osteoporosis (OP) in the elderly is accompanied by reduced muscle mass and reduced muscle strength, also known as sarcopenia. This results in functional limitations and a high risk of falls and injuries. The determination of physical performance parameters such as grip strength and trunk strength on the one hand, and balance abilities on the other, provide information about the individual's general neuromuscular condition and serve as an indicator of physical performance in the elderly. The extent to which previous osteoporotic vertebral fractures (VFs) restrict an individual's physical performance has not been adequately investigated yet.

MATERIAL AND METHODS

In total, 118 persons, with a mean age of 71.5 ± 9 years, participated in the clinical trial (ethics committee approval number A2020-0041). Patients were divided into an OP group (58 patients) and a control group (CG; 60 patients). OP patients with (VFs) and without vertebral fractures (0VFs) were viewed separately in the subgroup analysis. Data concerning physical status, including hand grip strength (HGS), the chair-rising test (CRT), tandem stance (TS), tandem gait (TG), and single-leg stance (SLS) were available for all patients. All data were analyzed using SPSS, Version 23.0.

RESULTS

No significant difference (p > 0.05) was registered between the OP and CG groups with regard of HGS, CRT, TG, TS, and SLS. In the subgroup analysis, OP patients with VFs had a lower HGS than OP patients without 0 VFx (VFs 24.3 ± 10.2 kg vs. 0 VFs 29.7 ± 9.5 kg, p = 0.026). TS was maintained longer by OP patients 0 VFs (VFs 7.8 ± 3.2 s vs. 0 VFs 9.5 ± 1.8 s, p = 0.008). The latter were also able to maintain their balance in TG over more numerous steps (VFs 4.8 ± 3.0 vs. 0 VFs 6.7 ± 2.4, p = 0.011). In a regression analysis, body size, gender, and age were shown to be independent factors influencing HGS (p < 0.001).

CONCLUSION

Patient age, constitution, and gender have a relevant influence on HGS, with baseline conditions after diagnosed OP at comparable levels in this age group. In a subgroup of OP patients with VFs, there is a close relationship between bone and muscle with an increasing deterioration of the musculoskeletal system. For prophylaxis of osteosarcopenia, early training seems reasonable.

The effects on type 2 diabetes mellitus mouse femoral bone achieved by anti-osteoporosis exercise interventions

Purpose

Exercise therapy and key regulators of bone quality exert anti-hyperglycemic effects on type 2 diabetes mellitus (T2DM) mice. A number of programs have been reported to have an effect on bone disease in T2DM. Major unanswered questions concern the potential correlation of exercise with the improvement of bone quality in T2DM mice and how the nonlinear optical properties of bone are correlated with changes to its crystal structure.

Methods

Subjects were randomly divided into six groups: 1) control (C) group, which was fed a normal diet (n = 8); 2) T2DM quiet group, which was given a high-fat diet and quiet (n = 8); 3) T2DM plus swimming (T2DM+S) group, which received T2DM and swim training (n = 8); 4) T2DM plus resistance exercise (T2DM+RE) group, which was given T2DM and resistance exercise (n = 8); 5) T2DM plus aerobic exercise (T2DM+AE) group, with T2DM and medium-intensity treadmill exercise (n = 8); and 6) T2DM plus high-intensity interval training (T2DM+HIIT), with T2DM and high-intensity variable-speed intervention (n = 8). The levels of runt-related transcription factor 2 (RUNX2), osterix (OSX), and alkaline phosphatase (ALP), as well as the bone microstructure and morphometry, were measured at the end of the 8-week exercise intervention.

Results

Compared with the C group, the bone microstructure indexes [bone mineral density (BMD), bone volume/tissue volume (BV/TV), cortical thickness (Ct.Th), and connectivity density (Conn.D)], the bone biomechanical properties (maximum load, fracture load, yield stress, and elastic modulus), and the osteogenic differentiation factors (RUNX2, OSX, and BMP2) of the T2DM group were significantly decreased (all p < 0.05). Compared with the T2DM group, there were obvious improvements in the osteogenic differentiation factor (OSX) and Th.N, while the separation of trabecular bone (Tb.Sp) decreased in the T2DM+AE and T2DM+HIIT groups (all p < 0.05). In addition, the bone microstructure indicators BV/TV, tissue mineral density (TMD), Conn.D, and degree of anisotropy (DA) also increased in the T2DM+HIIT group, but the yield stress and Ct.Th deteriorated compared with the T2DM group (all p < 0.05). Compared with the T2DM+S and T2DM+RE groups, the BV/TV, trabecular number (Tb.N), Tb.Sp, and Conn.D in the T2DM+AE and T2DM+HIIT groups were significantly improved, but no significant changes in the above indicators were found between the T2DM+S and T2DM+RE groups (all p < 0.05). In addition, the BMD and the expression of ALP in the T2DM+AE group were significantly higher than those in the T2DM+HIIT group (all p < 0.05).

Conclusion

There was a significant deterioration in femur bone mass, trabecular bone microarchitecture, cortical bone geometry, and bone mechanical strength in diabetic mice. However, such deterioration was obviously attenuated in diabetic mice given aerobic and high-intensity interval training, which would be induced mainly by suppressing the development of T2DM. Regular physical exercise may be an effective strategy for the prevention of not only the development of diabetes but also the deterioration of bone properties in patients with chronic T2DM.

Body weight influences musculoskeletal adaptation to long-term voluntary wheel running during aging in female mice

Frailty is the hallmark of aging that can be delayed with exercise. The present studies were initiated based on the hypothesis that long-term voluntary wheel running (VWR) in female mice from 12 to 18 or 22 months of age would have beneficial effects on the musculoskeletal system. Mice were separated into high (HBW) and low (LBW) body weight based on final body weights upon termination of experiments. Bone marrow fat was significantly higher in HBW than LBW under sedentary conditions, but not with VWR. HBW was more protective for soleus size and function than LBW under sedentary conditions, however VWR increased soleus size and function regardless of body weight. VWR plus HBW was more protective against muscle loss with aging. Similar effects of VWR plus HBW were observed with the extensor digitorum longus, EDL, however, LBW with VWR was beneficial in improving EDL fatigue resistance in 18 mo mice and was more beneficial with regards to muscle production of bone protective factors. VWR plus HBW maintained bone in aged animals. In summary, HBW had a more beneficial effect on muscle and bone with aging especially in combination with exercise. These effects were independent of bone marrow fat, suggesting that intrinsic musculoskeletal adaptions were responsible for these beneficial effects.

Self-reported Resistance Training Is Associated With Better HR-pQCT-derived Bone Microarchitecture in Vegan People

CONTEXT

A plant-based lifestyle is a global trend; lower bone mineral density and increased fracture risk in vegan people are reported.

OBJECTIVE

The primary objective was to assess trabecular and cortical bone microarchitecture in vegans and omnivores. Secondary objectives were to evaluate relationships between bone microarchitecture, nutrition parameters, and physical activity.

METHODS

This was an observational study at the Medical Department II, St. Vincent Hospital (tertiary referral center for gastrointestinal, metabolic, and bone diseases, and teaching hospital of the Medical University of Vienna), including 43 healthy nonobese female and male subjects on a plant-based diet for at least 5 years, and 45 healthy nonobese female and male subjects on an omnivore diet for at least 5 years. The main outcome measures were the parameters of trabecular and cortical bone microarchitecture (high-resolution peripheral quantitative computed tomography), serum markers of bone turnover, nutrient intake (nutrition protocol), and self-reported resistance training (physical activity questionnaires).

RESULTS

In the vegan group, trabecular and cortical structure were altered compared with omnivores. Vegans not reporting resistance training had diminished bone microarchitecture compared with omnivores not reporting resistance training. In vegans and omnivores reporting resistance training, bone structure was similar. In both vegan subgroups (resistance training and not resistance training), a small number of correlations between nutrient intake and bone microarchitecture were observed without a conclusive pattern.

CONCLUSION

Bone microarchitecture in vegans differed from matched omnivores but could not be explained solely by nutrient uptake. These differences were attenuated between the subgroups reporting resistance training. In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle.

Current Status of the Diagnosis and Management of Osteoporosis

Osteoporosis has been defined as the silent disease of the 21st century, becoming a public health risk due to its severity, chronicity and progression and affecting mainly postmenopausal women and older adults. Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. The treatment of this pathology focuses on different aspects. On the one hand, pharmacological treatments are characterized by the use of anti-resorptive drugs, as well as emerging regenerative medicine treatments such as cell therapies and the use of bioactive hydrogels. On the other hand, non-pharmacological treatments are associated with lifestyle habits that should be incorporated, such as physical activity, diet and the cessation of harmful habits such as a high consumption of alcohol or smoking. This review seeks to provide an overview of the theoretical basis in relation to bone biology, the existing methods for diagnosis and the treatments of osteoporosis, including the development of new strategies.

Baduanjin exercise: A potential promising therapy toward osteoporosis

Purpose

Baduanjin (BDJ) exercise is a traditional exercise that combines breathing, body movement, meditation and awareness to help delay the onset and progression of senile degenerative musculoskeletal diseases, such as osteoporosis (OP). The aim of this meta-analysis is to evaluate the efficacy of BDJ exercise, and preliminarily infer its effective mechanism in the treatment of OP.

Methods

We identified relevant randomized controlled trials (RCTs) through eight databases, and compared BDJ exercise with the control groups (including blank control and conventional treatment intervention). The main outcome measure was bone mineral density (BMD), the additional outcome measures were visual analogue scale (VAS), Berg balance scale (BBS), serum Calcium (Ca), serum Phosphorus (P), serum Alkaline phosphatase (ALP), and serum bone gla protein (BGP). Meta-analysis and trial sequence analysis (TSA) were performed using RevMan 5.4, Stata 16.0, and TSA 0.9.

Results

In total, 13 RCTs involving 919 patients were included in the analysis. For postmenopausal osteoporosis, BDJ exercise alone and BDJ exercise combined with conventional treatment can improve the BMD of lumbar spine. BDJ exercise alone can influence serum Ca and ALP. BDJ exercise combined with conventional treatment can improve balance (BBS) and influence serum BGP. For senile osteoporosis, BDJ exercise alone and BDJ exercise combined with conventional treatment can improve balance (BBS). BDJ exercise combined with conventional treatment can improve the BMD of hip and pain relieve (VAS). For primary osteoporosis, BDJ exercise combined with conventional treatment can improve the BMD of lumbar spine and femoral neck.

Conclusion

Baduanjin exercise may be beneficial to improve BMD, relieve pain, improve balance ability, influence serum BGP and serum ALP in patients with OP, but differences occur due to various types of OP. Due to the low quality of research on the efficacy and mechanism of BDJ exercise in the treatment of OP, high-quality evidence-based research is still needed to provide reliable supporting evidence.

Systematic Review Registration

[http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022329022].

Associations of financial inclusion with physical activity participation in later life

Background

Physical activity (PA) is a vital modifiable psychosocial intervention for promoting healthy longevity but problematically decreases with age. Innovative community-based strategies are recommended by the World Health Organization (WHO) to improve PA but prior research has seldom considered the interactive effect of financial inclusion, social networks, and sex differences on PA. In this study, we examine the role of sex differences and resourceful social networks in relation to the association of financial inclusion with PA among older Ghanaian people.

Methods

The sample included 1201 adults aged ≥50 years who participated in the 2016-17 AgeHeaPsyWel-HeaSeeB study. We assessed financial inclusion with an eight-item Financial Instrument Questionnaire Scale and PA with the International Physical Activity Questionnaire Short Form (IPAQ-SF). Linear regressions and moderation analysis were used to test the hypothesized associations.

Results

The mean financial inclusion and PA scores were 1.9(±1.8) and 9.0(±4.4) respectively. After full adjustment for potential confounders, a unit increase in financial inclusion was significantly and positively associated with increases in PA participation (β = .308, p < .005) and also notable among those aged ≥65 years (β = .413, p = .023). Crucially, the positive association between financial inclusion and PA was significantly modified by social networks (β = .151, p < .001). However, the role of sex in this association was not robust.

Conclusions

Findings emphasize the effect of financial inclusion on PA in old age, particularly when considering social networks. Programs to improve financial inclusion and social integration may benefit the acceptance and participation of PA among older adults.

Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis

Osteoporosis is a major health issue worldwide. This study analyzes the effects of non-supervised osteoporosis prevention programs on bone mineral density. Non-supervised exercise increases femoral neck and lumbar spine bone mineral density in adult women. Thus, it might be effective for preventing or treating osteoporosis or osteopenia in this population.

INTRODUCTION

Osteoporosis is a major health issue worldwide. Social distancing measures due to COVID-19 have hindered the chances to take part in supervised osteoporosis prevention exercise programs. The purpose of the present study is to systematically review and meta-analyze the effects of non-supervised osteoporosis prevention exercise programs on bone mineral density (BMD) in adult women.

METHODS

A comprehensive search of electronic databases (n = 7) was conducted including (a) prospective randomized controlled trials (RCTs) comparing at least one exercise group vs. a control group with sedentary lifestyle or sham exercises; (b) baseline and follow-up BMD values, or BMD changes from baseline, at any skeletal site; (c) women over 30 years old; and (d) non-supervised exercise programs only. Subgroup analyses were performed for menopausal status, intervention duration, type of exercise, and osteopenia/osteoporosis status.

RESULTS

Ten studies were included (n = 668). Random effect analyses showed that unsupervised exercise had beneficial effects on lumbar spine (LS) BMD with standardized mean difference (SMD) = 0.40 (95% confidence interval (CI): 0.03-0.77), and femoral neck (FN) BMD with SMD = 0.51 (95% CI: 0.16-0.85). Unsupervised exercise increased LS (SMD = 0.73 (95% CI: 0.13-1.33)) and FN BMD (SMD = 0.85 (95% CI: 0.33-1.37)) in women with osteopenia/osteoporosis, but not in healthy counterparts.

CONCLUSION

Non-supervised exercise improves FN and LS BMD in adult women. Beneficial effects of exercise on FN and LS BMD might be more pronounced in those with poor bone health compared with healthy counterparts. More RCTs prescribing non-supervised, osteogenic exercise are required in this population. It is necessary to investigate the efficacy of remote/assistive technologies for delivering and monitoring non-supervised exercise interventions.

Influence of Nordic walking with poles with an integrated resistance shock absorber on carbohydrate and lipid metabolic indices and white blood cell subpopulations in postmenopausal women

Background

Regular and individualised physical activities have been shown to prevent adverse changes associated with the aging process. The main purpose of this study was to evaluate changes in carbohydrate and lipid metabolism and white blood cell (WBC) subpopulations in postmenopausal women participating in Nordic walking (NW) training and to compare the use of poles with an integrated resistance shock absorber (RSA) with the use of classic poles.

Materials & Methods

A total of 23 postmenopausal women participated in a 8-week programme of systematic physical activity between February and April. Before and after the training programme, somatic features and serum concentrations of 25-hydroxyvitamin D, glucose, and insulin, were assessed, as well as lipid profile and WBC count and its specific subpopulations.

Results

Analysis of differences in somatic features and biochemical indices before and after training in the group of women who used RSA poles showed significant decreases in fat mass content (p < 0.05), insulin (p < 0.05), homeostatic model assessment of insulin resistance (p < 0.05), triglycerides (p < 0.05), total cholesterol (p < 0.05) and monocytes (p ≤ 0.01). In the group of women who used classic poles (NW), there was a significant decrease in WBC (p ≤ 0.01), lymphocytes (p < 0.05), monocytes (p ≤ 0.01) and granulocytes (p < 0.05).

Conclusion

Increasing the training load through the use of RSA poles resulted in greater changes in carbohydrate and lipid metabolic indices compared to the use of classic NW poles. In turn, the more significant effect on WBC and its specific subpopulations count in the NW, compared to the RSA training programme, may indicate that specificity of training load is an important factor in modifying the immune system response.

The Effects of Whole-Body Vibration Exercise Combined With an Isocaloric High-Fructose Diet on Osteoporosis and Immunomodulation in Ovariectomized Mice

Background

Osteoporosis and immune-associated disorders are highly prevalent among menopausal women, and diet control and exercise exert beneficial effects on physiological modulation in this population. A controlled diet with a low fat content and a balanced caloric intake improves menopausal health, but the health effects of excessive fructose consumption on menopausal women are yet to be confirmed. In addition, whole-body vibration (WBV), a safe passive-training method, has been shown to have multiple beneficial effects on metabolism regulation, obesity, and bone health.

Methods

The ovariectomized (OVX) C57BL/6J model was used to verify the effects of WBV combined with a high-fructose diet (HFrD) for 16 weeks on physiological modulation and immune responses. The mice were randomly allocated to sham, OVX, OVX+HFrD, and OVX+HFrD+WBV groups, which were administered with the indicated ovariectomy, dietary and WBV training treatments. We conducted growth, dietary intake, glucose homeostasis, body composition, immunity, inflammation, histopathology, and osteoporotic assessments (primary outcomes).

Results

Our results showed that the isocaloric HFrD in OVX mice negated estrogen-deficiency–associated obesity, but that risk factors such as total cholesterol, glucose intolerance, osteoporosis, and liver steatosis still contributed to the development of metabolic diseases. Immune homeostasis in the OVX mice was also negatively affected by the HFrD diet, via the comprehensive stimulation of T cell activation, causing inflammation. The WBV intervention combined with the HFrD model significantly ameliorated weight gain, glucose intolerance, total cholesterol, and inflammatory cytokines (interferon gamma [IFN-γ], interleukin [IL]-17, and IL-4) in the OVX mice, although osteoporosis and liver steatosis were not affected compared to the negative control group. These findings indicate that an isocaloric high-fructose diet alone may not result in menopausal obesity, but that some deleterious physiological impacts still exist.

Conclusion

The WBV method may modulate the physiological impacts of menopause and the HFrD diet, and should be considered as an alternative exercise prescription for people with poor compliance or who are unable or unwilling to use traditional methods to improve their health. In future studies, using the WBV method as a preventive or therapeutic strategy, combined with nutritional interventions, medication, and other exercise prescriptions, may prove beneficial for maintaining health in menopausal women.

Regular Exercise Decreases the Risk of Osteoporosis in Postmenopausal Women

Regular exercise can regulate bone maintenance and improve bone health. However, large-scale epidemiological studies on the association between regular exercise and incident osteoporosis in menopausal women are still lacking. We aimed to examine the relationship between exercise and the risk of osteoporosis in menopausal women. In cross-sectional analysis, we enrolled 30,046 postmenopausal women with available information from the database of the Taiwan Biobank (TWB). We divided them into two groups according to their status of regular exercise, i.e., no exercise and regular exercise groups. A t-score of -2.5 or more standard deviations (SDs) below that of a young adult was defined as osteoporosis. Logistic regression after adjusting for confounding factors was used to analyze the association between regular exercise and the prevalence of osteoporosis. Furthermore, the risk of incident osteoporosis development was analyzed in a longitudinal cohort of 6,785 postmenopausal women without osteoporosis at baseline using a Kaplan-Meier analysis and a log-rank test. The mean age of subjects in the cross-sectional cohort was 59 years old. Fifty-six percent of them were exercising regularly. Osteoporosis was observed in 1,886 (14.2%) and 2,254 (13.4%) participants in the no exercise and regular exercise groups. Lower risk of osteoporosis was noted in postmenopausal women with regular exercise when compared with those without regular exercise [odds ratio (OR), 0.76; 95% confidence interval (95% CI), 0.71-0.81]. In the longitudinal cohort, incident osteoporosis was found in 430 (10.5%) women with regular exercise and 299 (11.2%) women without exercise during a mean follow-up of 45 months. Cox regression analysis revealed that the risk for incident osteoporosis was lower in postmenopausal women with regular exercise than those without exercise [hazard ratio (HR), 0.83; 95% CI, 0.71-0.97]. Our study suggests that regular exercise is associated with a reduced risk of osteoporosis in postmenopausal women and strengthens the importance of exercise for the prevention of osteoporosis.

Sex-specific bi‑directional association between osteoporosis and depression from the national representative data of South Korea

Both osteoporosis and depression are major health threats, but their interrelationship is not clear. This study elucidated the associations between osteoporosis and depression while considering the temporal sequence of the diagnoses. In this cross-sectional study, data were extracted from the Korean National Health and Nutrition Examination Surveys (2007–2009 and 2015–2019, n = 29,045). Osteoporosis and depression were defined by diagnoses thereof. The odds ratio (OR) of the incident osteoporosis among depression patients without a history of osteoporosis was calculated by multivariable logistic regression adjusted for potential confounders. A reverse association was also assessed. Participants were additionally stratified by their sex and age. As a result, male depression patients aged under 50 years showed higher ORs for osteoporosis than those without depression (OR 9.16, 95% CI 1.78–47.18). Female osteoporosis patients showed lower ORs for depression than those without osteoporosis (OR 0.71, 95% CI 0.58–0.88), especially in women aged 50 years and older. In the sensitivity analysis, the same results were obtained in women by their menopause status. Depression has a strong positive association with the occurrence of osteoporosis in young male adults, and osteoporosis has a negative association with the occurrence of depression in female adults.

The Relationship Between Usual Daily Physical Activity With Serum Markers Related to Bone Metabolism and Demographic Characteristics in Postmenopausal Women Aged 50-65 Years

BACKGROUND

Bone turnover markers can predict subsequent changes in bone status. This study aimed to investigate the relationship between usual daily physical activity (PA) with bone markers.

METHODS

This cross-sectional study was conducted on 500 postmenopausal women aged 50-65 years in Tabriz-Iran in 2018. The women were recruited by a simple random method. The International Physical Activity Questionnaire was used to assess PA. The laboratory tests of 25-Hydroxyvitamin D3, alkaline phosphatase, calcium, and phosphorus were also used to examine bone function.

RESULTS

The education, income, employment status, sun exposure, and history of exercise were significantly correlated with PA. Among reproductive characteristics, only menopausal age showed a significant relationship with total PA levels (r = .285, P = .048). None of the anthropometric indices showed a statistically significant relationship with total PA. Serum calcium (r = -.242) and phosphorus (r = -.045) levels showed negative and inverse relationships with total PA. The intensity of this association was statistically significant only for the calcium (β = -0.108, 95% confidence interval, -0.117 to 0.098; P = .023). 25-Hydroxyvitamin D3 (r = .007) and alkaline phosphatase (r = .046) were directly and positively but nonsignificantly correlated to the intensity of total PA.

CONCLUSION

Usual daily physical activity with any levels has no effect on bone markers except for calcium. Despite of the beneficial effects of PA, our findings showed that usual daily physical activity without increasing total PA cannot affect bone health. For maximal effects of PA on bone health, it seems that a degree of intensity, continuity, and regularity of PA programs should be considered to stimulate bone formation.

Wheel-Running Exercise Protects Ovariectomized Mice from Bone Loss via IFN-γ-Mediated Suppression of the NF-κB and MAPK Pathways

Physical exercise is recommended as a preventative approach for osteoporosis; however, the effect of physical exercise on bone mass remains controversial. Additionally, the immune regulation of physical exercise on bone mass remains unclear. To determine whether wheel-running (WR) exercise contributes to improving bone mineral density (BMD) and investigate the involved immune mechanism, ovariectomized (OVX) and sham-operated mice were treated with 8 weeks of WR exercise. The distal femurs of the mice were sequentially scanned, reconstructed, and analyzed using microcomputed tomography and related software to assess BMD and bone microarchitecture. Flow cytometry assays were applied to investigate alterations in immune cells and inflammatory cytokines. In vitro, osteoclast differentiation was conducted to determine the effect of IFN-γ on osteoclastogenesis and the underlying mechanism. As a result, trabecular parameters were decreased in the OVX mice compared with the sham group. However, WR exercise significantly improved the deterioration in the bone microarchitecture of the OVX mice with an increase of 60.00% in BMD, 55.18% in bone volume, 66.67% in trabecular number, 32.52% in trabecular thickness, and a decrease of 19.44% in trabecular separation. Similarly, WR exercise increased the proportion of CD8⁺ T cells from 7.26 ± 1.71% to 10.23 ± 1.35% in the spleen and from 1.62 ± 0.54% to 2.38 ± 0.43% in the bone marrow of the OVX mice (P < 0.05). The expression of IFN-γ was also increased in the OVX + WR mice compared with the OVX mice (1.65 ± 0.45% vs. 2.26 ± 0.34%, P < 0.05). In vitro studies demonstrated an inhibitory effect of IFN-γ on osteoclastogenesis in a dose- and time-dependent manner. Meanwhile, the classical NF-κB and MAPK pathways were found to be critical in IFN-γ-mediated inhibition of osteoclast differentiation. In conclusion, our study discovered that WR exercise rescued bone loss in the OVX mice in an IFN-γ-mediated immunomodulatory manner. After WR exercise, IFN-γ expression was restored by activated CD8⁺ T cells, consequently leading to the inhibition of osteoclastogenesis and the recovery from bone loss through the NF-κB and MAPK pathways.

Effects of 8-week High-Intensity Interval Training and Moderate-Intensity Continuous Training on Bone Metabolism in Sedentary Young Females

Objective

High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) have been reported as effective exercise modes on bone metabolism. However, very few studies focused on young women with sedentary behavior. The purpose of this study was to investigate the effects of 8-week HIIT on bone metabolism in sedentary young women.

Methods

26 healthy, sedentary female participants were randomly assigned to either the HIIT (n = 13, age 23.2 ± 2.9 yr, weight 59.2 ± 7.2 kg, height 162.9 ± 3.3 cm, body mass index 22.3 ± 2.7 kg/m²) or MICT (n = 13, age 21.9 ± 1.7 yr, weight 59.3 ± 6.6 kg, height 160.9 ± 4.4 cm, body mass index 21.6 ± 2.4 kg/m²) group. Both groups completed 8 weeks (3 sessions/week) of training on the treadmill, where the HIIT group were asked to complete 6 × 3-min bouts of running at the intensity of 80–90% maximum oxygen uptake (VO_2max) separated by 2-min active recovery at 30–40% VO_2max and the MICT group completed 30-min continuous running at the intensity of 60–70% VO_2max. The body composition, bone mineral density (BMD), calcaneus quantitative ultrasound, bone turnover markers, and lower limb muscle strength were measured pre and post interventions.

Results

After 8-week interventions, 1) The total body BMD (HIIT, +8.5%; MICT, +5.5%) significantly increased (p < 0.05) without difference between the two groups (p > 0.05). The calcaneus broadband ultrasound attenuation (CBUA) (HIIT, +16.0%; MICT, +4.6%) and calcaneus stiffness index (CSI) (HIIT, +16.7%; MICT, +2.5%) significantly increased in HIIT group (p < 0.05), but not in MICT group (p > 0.05). 2) The 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) (HIIT, +42.8%; MICT, +24.9%) level increased in both groups with significantly higher changes in HIIT (p < 0.05). 3) The score of standing long jump (HIIT, +10.3%; MICT, +3.8%) and vertical jump (HIIT, +5.3%; MICT, +2.0%) increased in both groups with significantly higher changes in HIIT (p < 0.05).

Conclusions

It suggested that 8-week HIIT and MICT interventions could improve bone metabolism. Compared with a similar workload of MICT, HIIT elicited superior benefits on bone metabolism.

Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry-part II (clinical aspects): interpretation, reporting, and special situations

OBJECTIVE

To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice.

MATERIALS AND METHODS

This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals.

CONCLUSION

This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.

Effect of 50-Hertz Sinusoidal Vibration on the Uterus in Ovariectomy-Induced Osteoporotic Rats

Objective

To evaluate the influence of sinusoidal vibration (50-Hertz) stimulation on the uterus of osteoporotic rats.

Methods

We constructed an osteoporosis rat model by ovariectomy (OVX). 36 3-month-old Sprague Dawley rats were randomly divided into the control group, vibrating group, sham operation group, sham operation vibrating group, OVX group, and OVX vibrating group (n = 6 per group). Rats started to vibrate one week after the operation: one 10 minutes 50-Hertz sinusoidal vibration per day, except for Saturday and Sunday. In the second, 8, and 12 week after vibration stimulation, rats were sacrificed in batches. And then, the uteruses were taken out to measure the wet weight and calculate uterus relative wet weight.

Results

Compared with the control group, OVA induced a significant increase in wet weight and relative wet weight in rat uterus. The vibration was to the uterus wet weight and the uterus relative wet weight in ovariectomized rats and at the same time had no significant effect, but the 12-week prolonged vibration can significantly reduce the uterus wet weight and the uterus relative wet weight in ovariectomized rats than 2 weeks.

Conclusions

The uterus wet weight and the uterus relative wet weight were increased in the OVA-induced osteoporosis rats. The 50-Hertz sinusoidal vibration had no significant effect on the uterus wet weight and the uterus relative wet weight in the ovariectomized rats at the same time, but 12 weeks of vibration can significantly reduce the uterine wet weight and uterine relative wet weight of ovariectomized rats. And the uterus relative wet weight can be used as a new indicator of stimulating the uterus.

Body Composition and Physical Fitness: Does This Relationship Change in 4 Years in Young Adults?

(1) Background: There are few studies investigating the relationship between physical fitness and body composition in young adults and, to our knowledge, there are no such reports focusing specifically on physiotherapy students. This observational study aimed to assess the relationship between physical fitness and selected anthropometric measurements as well as body composition in Polish students in the first year and in the final year of a university course in physiotherapy. (2) Methods: A group of 100 randomly selected individuals were recruited among first- and fifth-year students of physiotherapy (50% women), who were assigned to two groups: A (aged 19 years) and B (aged 23 years). Body composition was assessed using a Tanita TBF-300 Analyzer, and physical fitness was measured using Zuchora’s Physical Fitness Index. (3) Results: A higher level of general fitness was identified in students from Group B (p = 0.0261), and lower values of the fat mass index was found in Group A (p = 0.0441). Group A was found with correlations between general level of physical fitness and the following indexes: fat% (R = −0.4; p = 0.0018), FM (R = −0.3; p = 0.0310), FFM (R = 0.3; p = 0.0229) and TBW (R = 0.4; p = 0.0024), whereas Group B was found with correlations between general physical fitness and BMI (R = 0.3; p = 0.0308) as well as FM index (R = 0.3; p = 0.0431). (4) Conclusions: The findings show significant differences between the groups in physical fitness, body composition and selected anthropometric measurements. Older students presented higher level of general fitness, whereas younger students were found with a lower mean value of fat index.

Therapeutic Treatments for Osteoporosis-Which Combination of Pills Is the Best among the Bad?

Osteoporosis is a chronical, systemic skeletal disorder characterized by an increase in bone resorption, which leads to reduced bone density. The reduction in bone mineral density and therefore low bone mass results in an increased risk of fractures. Osteoporosis is caused by an imbalance in the normally strictly regulated bone homeostasis. This imbalance is caused by overactive bone-resorbing osteoclasts, while bone-synthesizing osteoblasts do not compensate for this. In this review, the mechanism is presented, underlined by in vitro and animal models to investigate this imbalance as well as the current status of clinical trials. Furthermore, new therapeutic strategies for osteoporosis are presented, such as anabolic treatments and catabolic treatments and treatments using biomaterials and biomolecules. Another focus is on new combination therapies with multiple drugs which are currently considered more beneficial for the treatment of osteoporosis than monotherapies. Taken together, this review starts with an overview and ends with the newest approaches for osteoporosis therapies and a future perspective not presented so far.

Women's perception about hydrotherapy in postmenopause: a qualitative study

Abstract Introduction: The transition from reproductive to post-reproductive life is part of the female life cycle that impacts well-being, with menopause as a significant milestone. Regular physical activity should be encouraged to mitigate the symptoms of menopause and prevent age-related problems. Hydrotherapy is one such alternative, since immersion in heated water facilitates exercises that would be difficult to perform on land. Objective: Assess women’s perception about the effect of hydrotherapy on the signs and symptoms of postmenopause. Methods: A qualitative study in which participants underwent 48 hydrotherapy sessions and answered a semistructured interview. Results: The participants were eight women, aged 55.75 ± 8.55 years, menopausal for 8.5 ± 7.98 years, with vasomotor symptoms (100%), mood swings (87.5%), sleep disorders (87.5%), vaginal dryness (62.5%), low sex drive (62.5%) and chronic pain (100%). Conclusion: Women’s perception about the effects of hydrotherapy on the signs and symptoms of postmenopause include less pain and muscle tension, a decline in the signs and symptoms, better quality of life and sexual pleasure, and an improvement in biopsychosocial factors such as anxiety and stress through better social interaction.

Sclerostin as a biomarker of physical exercise in osteoporosis: A narrative review

Osteoporosis, a disease of low bone mass, is characterized by reduced bone mineral density (BMD) through abnormalities in the microarchitecture of bone tissue. It affects both the social and economic areas, therefore it has been considered a lifestyle disease for many years. Bone tissue is a dynamic structure exhibiting sensitivity to various stimuli, including mechanical ones, which are a regulator of tissue sclerostin levels. Sclerostin is a protein involved in bone remodeling, showing an anti-anabolic effect on bone density. Moderate to vigorous physical activity inhibits secretion of this protein and promotes increased bone mineral density. Appropriate exercise has been shown to have an osteogenic effect. The effectiveness of osteogenic training depends on the type, intensity, regularity and frequency of exercise and the number of body parts involved. The greatest osteogenic activity is demonstrated by exercises affecting bone with high ground reaction forces (GRF) and high forces exerted by contracting muscles (JFR). The purpose of this study was to review the literature for the effects of various forms of exercise on sclerostin secretion.

Percepção de mulheres sobre a fisioterapia aquática na pós-menopausa: um estudo qualitativo

Resumo Introdução: A transição da vida reprodutiva para a pós-reprodutiva é considerada um dos ciclos da vida feminina que gera impactos no bem-estar da mulher, sendo a menopausa o marco significativo. A prática regular de atividade física deve ser encorajada para reduzir os sintomas da menopausa e prevenir alterações associadas ao envelhecimento. Assim, a fisioterapia aquática é uma opção de atividade física, pois a imersão em água aquecida possibilita a realização de exercícios que seriam difíceis de serem executados no solo. Objetivo: Evidenciar a percepção de mulheres sobre a fisioterapia aquática nos sinais e sintomas da pós-menopausa. Métodos: Trata-se de um estudo qualitativo, com participantes que realizaram 48 sessões de fisioterapia aquática e responderam a uma entrevista semiestruturada. Resultados: Participaram do estudo oito mulheres, 55,75 ± 8,55 anos, menopausadas há 8,5 ± 7,98 anos, com referência de alterações vasomotoras (100%), do humor (87,5%), do sono (87,5%), secura vaginal (62,5%), diminuição da libido (62,5%) e dor crônica (100%). Conclusão: A percepção das mulheres sobre os efeitos da fisioterapia aquática nos sinais e sintomas da menopausa aponta para uma diminuição do quadro álgico e da tensão muscular, diminuição dos sinais e sintomas da pós-menopausa, melhora da qualidade do sono, bem como do prazer sexual, e melhora nos fatores biopsicossociais como ansiedade e estresse, através da melhora da interação social.

Effect of Exercise on Secondary Sarcopenia: A Comprehensive Literature Review

Simple Summary

Sarcopenia is an inevitable component of aging. It is officially recognized as a muscle disease with an ICD-10-MC diagnosis code that can be used to bill for care in some countries. Sarcopenia can be classified into primary or age-related sarcopenia and secondary sarcopenia. The condition is referred to as secondary sarcopenia when any other comorbidities are present in conjunction with aging. Secondary sarcopenia is more prevalent than primary sarcopenia and requires special attention. Exercise interventions may help in our understanding and prevention of sarcopenia with a specific morbidity Glomerular filtration rate that exercise improves muscle mass, quality or physical function in elderly subjects with cancer, type 2 diabetes, kidney diseases and lung diseases. In this review, we summarize recent research that has studied the impact of exercise on patients with secondary sarcopenia, specifically those with one comorbid condition. We did not discover any exercise intervention specifically for subjects with secondary sarcopenia (with one comorbidity). Even though there is a strong argument for using exercise to improve muscle mass, quality or physical function in subjects with cancer, type 2 diabetes, kidney diseases, lung diseases and many more, very few studies have reported baseline sarcopenia assessments. Based on the trials summarized in this review, we may propose but not conclude that resistance, aerobic, balance training or even walking can be useful in subjects with secondary sarcopenia with only one comorbidity due to the limited number of trials. This review is significant because it reveals the need for broad-ranging research initiatives involving secondary sarcopenic patients and highlights a large secondary sarcopenia research gap.

Abstract

Background: Sarcopenia has been recognized as an inevitable part of aging. However, its severity and the age at which it begins cannot be predicted by age alone. The condition can be categorized into primary or age-related sarcopenia and secondary sarcopenia. Sarcopenia is diagnosed as primary when there are no other specific causes. However, secondary sarcopenia occurs if other factors, including malignancy or organ failure, are evident in addition to aging. The prevalence of secondary sarcopenia is far greater than that of primary sarcopenia and requires special attention. To date, nutrition and exercise have proven to be the best methods to combat this disease. The impact of exercise on subjects suffering from sarcopenia with a specific morbidity is worthy of examination for understanding and prevention. The purpose of this review, therefore, is to summarize recent research that has investigated the impact of exercise in patients with secondary sarcopenia, specifically with one comorbidity. Methods: Pubmed, Web of Science, Embase and Medline databases were searched comprehensively with no date limit for randomized controlled trials. The literature was specifically searched for clinical trials in which subjects were sarcopenic with only one comorbidity participating in an exercise intervention. The most visible comorbidities identified and used in the search were lung disease, kidney disease, heart disease, type 2 diabetes, cancer, neurological diseases, osteoporosis and arthritis. Results: A total of 1752 studies were identified that matched the keywords. After removing duplicates, there were 1317 articles remaining. We extracted 98 articles for full screening. Finally, we included 21 relevant papers that were used in this review. Conclusion: Despite a strong rationale for using exercise to improve muscle mass, quality or physical function in subjects with cancer, type 2 diabetes, kidney disease, lung disease and many more, baseline sarcopenia evaluation has been reported in very few trials. The limited number of studies does not allow us to conclude that exercise can improve sarcopenia in patients with other comorbidities. This review highlights the necessity for wide-ranging research initiatives involving secondary sarcopenic patients.

Effects of exercise on the expression of long non-coding RNAs in the bone of mice with osteoporosis

Physical activity or exercise are known to promote bone formation and decrease bone resorption to maintain skeletal and bone health both in animal models and in humans with osteoporosis. Previous studies have indicated that long non-coding RNAs (lncRNAs) are able to regulate bone metabolism. Therefore, the present study aimed to evaluate whether lncRNAs responded to exercise by regulating the balance of bone metabolism in order to prevent osteoporosis. To meet this end, ovariectomized mice were used in the present study to establish an osteoporosis model. The exercise treatment groups were subjected to 9 weeks of treadmill running exercise in 4 weeks of the operation was performed Femurs were collected to measure bone mineral density, bone mass, bone formation and resorption. The expression levels of lncRNAs were subsequently measured using microarray and gene function analyses. The pairwise comparison results [ovariectomy (OVX) vs. OVX + exercise (EX); OVX vs. SHAM; SHAM vs. SHAM + EX; OVX + EX vs. SHAM + EX] of the gene microarray analysis revealed that the expression of 2,424 lncRNAs (1718 upregulated and 706 downregulated) were significantly altered in the mouse femurs following treadmill running. Gene Ontology (GO) analysis, incorporating the GO annotations ‘biological processes’, ‘molecular function’ and ‘cellular components’, of osteoporosis revealed that the VEGF, mTOR and NF-κB signaling pathways were potential targets of the lncRNAs. Moreover, it was possible to predict the target microRNAs (miRNAs) of six lncRNAs (LOC105246953, LOC102637959, NONMMUT014677, NONMMUT027251, ri|D130079K21|PX00187K16|1491 and NONMMUT006626), which suggested that the underlying mechanism by which lncRNAs respond to exercise involved bone regulation via lncRNA-miRNA sponge adsorption. Overall, these results suggested that the treadmill running exercise did regulate lncRNA expression in the bone, and that this was involved in the prevention of osteoporosis.

Efficiency of back muscles training and balance therapy in rehabilitation of patients with osteoporotic vertebral fractures

Medical rehabilitation of patients with osteoporotic vertebral fractures (VF) remains an insufficiently developed topic and requires additional research. Aim of the study was to assess the efficiency of back muscles training and balance therapy in rehabilitation of patients with osteoporotic vertebral fractures. Prospective, interventional, open-label, controlled study in two parallel groups, performed in inpatient department settings at “National Medical Research Center of Rehabilitation and Balneology” during 2018. The study involved 120 patients (11 men and 109 women) aged 40-80 (mean age 65.4±9.1 years) who were admitted for medical rehabilitation for systemic OP and VF. The rehabilitation program in the main group included: 1) Mechanotherapy on the Back-Therapy-Center Dr. Wolf complex with biofeedback (Germany); 2) Balance therapy on a double unstable COBS platform, with biofeedback (Germany); 3) Hydrokinesiotherapy in a pool; 4) Gymnastic exercises (Gorinevskaya-Dreving method). Results. The use of the three-week program of physical rehabilitation using mechanotherapy, balance therapy and special complexes of physiotherapy exercises in the gym and in the pool in patients with osteoporotic VF significantly increases the strength of the muscle corset, helps to eliminate the existing muscle deficit in TE and TF and results in a more physiological distribution of the strength ratio between TE and TF. The rehabilitation program improves the function of static and dynamic balance, both with closed and open eyes, which can be observed in the return of the center of gravity to a physiological position and in improved reaction speed to changes in body position. Usage of mechanotherapeutic methods in rehabilitation of patients with osteoporotic VF is effective for basic motor function improvement and disability reduction.

Utilization of Mechanical Stress to Treat Osteoporosis: The Effects of Electrical Stimulation, Radial Extracorporeal Shock Wave, and Ultrasound on Experimental Osteoporosis in Ovariectomized Rats

Current treatment options for osteoporosis primarily involve pharmacotherapies, but they are often accompanied by undesirable side effects. Utilization of mechanical stress which can noninvasively induce bone formation has been suggested as an alternative to conventional treatments. Here, we examined the efficacy of mechanical stress induced by electrical stimulation, radial extracorporeal shock waves, and ultrasound for estrogen-deficient osteoporosis. Female Wistar rats were divided into following five groups: sham-operated group, untreated after ovariectomy, and treated with electrical stimulation, radial extracorporeal shock wave, or ultrasound starting at 8 weeks after ovariectomy for 4 weeks. Trabecular bone architecture of the femur was assessed by micro-CT and its biomechanical properties were obtained by mechanical testing. The femurs were further evaluated by histochemical, immunohistochemical, and real-time PCR analyses. Radial extracorporeal shock wave and ultrasound treatment improved trabecular bone microarchitecture and bone strength in osteoporotic rats, but not electrical stimulation. The shock wave decreased osteoclast activity and RANKL expression. The exposure of ultrasound increased osteoblast activity and β-catenin-positive cells, and they decreased sclerostin-positive osteocytes. These findings suggest that mechanical stress induced by radial extracorporeal shock wave and ultrasound can improve estrogen-deficient bone loss and bone fragility through promoted bone formation or attenuated bone resorption.

Relationship Between Sarcopenia, Obesity, Osteoporosis, and Cardiometabolic Health Conditions and Physical Activity Levels in Korean Older Adults

This study aimed to analyze the status of sarcopenia, obesity, osteoporosis, and cardiometabolic disease according to the level of physical activity (PA) among elderly people in Korea. Among the data obtained from the National Health and Nutrition Survey (2008–2011), we analyzed the data of a total of 3,573 Korean elderly people over 65 years of age who were surveyed for dual X-ray absorptiometry (DXA) and PA. Higher levels of PA were associated with a lower prevalence of cardiometabolic disease (χ² = 33.865, p < 0.001), osteoporosis (χ² = 94.198, p < 0.001), sarcopenia, obesity, and sarcopenic obesity (χ² = 71.828, p < 0.001). Above moderate-active PA was associated with lower body weight (p < 0.001), body fat mass (p < 0.001), and percent body fat (p < 0.001), and higher free-fat mass (p < 0.001) and appendicular skeletal muscle mass (ASM) (p < 0.001) than in low-active PA. In addition, when high-active is the risk factors of cardiometabolic were lower in waist circumference (p = 0.001), total cholesterol (TC) (p = 0.015), and triglyceride (TG) (p < 0.001) than low- and moderate-active PA, and higher in high-density lipoprotein cholesterol (HDL-C) (p < 0.001). The prevalence of cardiometabolic diseases was significantly decreased in high-active PA (odds ratio (OR) 0.60, 95% confidence interval (CI) 0.50–0.71); waist circumference (OR 0.85, 95% CI, 0.73–0.99; OR 0.59, 95% CI, 0.50–0.70) and HDL-C (OR 0.76, 95% CI, 0.65–0.88; OR 0.56, 95% CI, 0.47–0.67) significantly improved in moderate- and high-active PA, respectively, and TG (0.67 95% CI, 0.55–0.80) significantly improved in high-active PA. Osteoporosis (OR 0.62, 95% CI, 0.53–0.74; OR 0.46, 95% CI, 0.38–0.55) and sarcopenia (OR 0.77, 95% CI, 0.60–0.98; OR 0.73, 95% CI, 0.57–0.93) were significantly improved in moderate- and high-active PA, respectively. The incidence of obesity (OR 0.47, 95% CI, 0.39–0.57) and sarcopenic obesity (OR 0.47, 95% CI, 0.30–0.75) were significantly decreased in high-active PA. Therefore, we verified a lower prevalence of sarcopenia, osteoporosis, obesity, and cardiac metabolic disease in Korean elderly with more active PA. This suggests that more active PA maybe reduce the prevalence of sarcopenia, osteoporosis, obesity, and cardiometabolic diseases in older adults.

Mediterranean diet adherence and dietary calcium intake in a group of pregnant women: Results of an Italian survey

Pregnancy is a delicate phase in woman's life that could become a risk factor for osteoporosis in pregnant women who do not meet recommended nutrient standards, especially for calcium and vitamin D. Mediterranean diet (MD) has been demonstrated to be beneficial for adequate nutrient intake. This article aims to evaluate the MD adherence and dietary calcium intake in a group of pregnant Italian women and to investigate how these are linked to each other and to fast glycemia at first trimester of pregnancy. Two hundred and seventy-nine pregnant women were recruited at the gynecology units of two hospitals in Florence. Socio-demographic, clinical information, and results of the first trimester blood sample analysis were collected. Two questionnaires, validated for evaluation of MD adherence and calcium intake, were administered to the pregnant women. Approximately 60% of the women had a high level of MD adherence, with a mean dietary calcium intake of 870.3 ± 335.3. In women with higher MD adherence level, fast glycemia resulted lower. Calcium intake was lower than Population Rate Intake for the Italian population (1,200 mg/daily) and was positively correlated to MD adherence score. The MD proved to be nutritious, as it was related to a higher calcium intake in this group of Italian women.

Role of Physical Activity in Bone-Muscle Crosstalk: Biological Aspects and Clinical Implications

Bone and muscle tissues influence each other through the integration of mechanical and biochemical signals, giving rise to bone-muscle crosstalk. They are also known to secrete osteokines, myokines, and cytokines into the circulation, influencing the biological and pathological activities in local and distant organs and cells. In this regard, even osteoporosis and sarcopenia, which were initially thought to be two independent diseases, have recently been defined under the term "osteosarcopenia", to indicate a synergistic condition of low bone mass with muscle atrophy and hypofunction. Undoubtedly, osteosarcopenia is a major public health concern, being associated with high rates of morbidity and mortality. The best current defence against osteosarcopenia is prevention based on a healthy lifestyle and regular exercise. The most appropriate type, intensity, duration, and frequency of exercise to positively influence osteosarcopenia are not yet known. However, combined programmes of progressive resistance exercises, weight-bearing impact exercises, and challenging balance/mobility activities currently appear to be the most effective in optimising musculoskeletal health and function. Based on this evidence, the aim of our review was to summarize the current knowledge about the role of exercise in bone-muscle crosstalk, highlighting how it may represent an effective alternative strategy to prevent and/or counteract the onset of osteosarcopenia.

The effectiveness of balneotherapy and aquatic exercise on bone metabolism: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the effectiveness of balneotherapy and/or aquatic exercise on bone metabolism.

DESIGN

A systematic literature search was conducted from inception to January 4, 2021. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a fixed-effect model according to study heterogeneity.

RESULTS

Seven articles involving 467 participants were selected. Three balneotherapy studies were qualitatively integrated. The results showed that bone resorption slowed down with or without stimulation of bone formation. A pooled meta-analysis of four studies on aquatic exercise showed significant evidence for a reduction in parathyroid hormone (PTH; SMD = -0.71; 95% CI, -1.04 to -0.38; P < 0.001), and a significant increase in osteocalcin (OC; SMD = 0.60; 95% CI, 0.16 to 1.03; P = 0.007) after aquatic exercise.

CONCLUSION

Balneotherapy and aquatic exercise had significant effects on bone metabolism, reducing bone resorption and/or increasing bone formation. This study highlights the importance of balneotherapy and aquatic exercise for bone health.

Lower Level of Interleukin-6 and Hepcidin Found in Lower Density of Physical Exercise among Athlete During Pandemic of Covid-19

The pandemic of Covid-19 affected entire daily human life worldwide, including sports activities among athletes. An athlete was pushed to suit their routine activities with a new health protocol for Covid-19 prevention. Some of them were programmed to train at home with a moderate density of exercise, but others were still in a high density of exercise. This study compared the serum level of hemoglobin (Hb), interleukin-6 (IL-6), and hepcidin among athletes with a high versus moderate exercise density training program during the pandemic. Thirty-four indoor soccer athletes of a soccer football school in Malang voluntarily registered as a subject. Half of them received moderate exercise density exercise programs, and others received high-density exercise programs during June-July 2020. Interleukin-6 and hepcidin level mean was found significantly lower in the moderate group compared to the high-density group. Hemoglobin level mean was found not different between those groups. The lower density of exercise influenced on IL-6 and hepcidin serum level of athlete, but not on hemoglobin level.

Chinese Soft-Shelled Turtle Oil in Combination With Swimming Training Improves Spatial Memory and Sports Performance of Aging Rats

In this study, waste fat from the Chinese soft-shelled turtle (Pelodiscus sinensis) was used as the raw material, and soft-shelled turtle oil (SSTO) was extracted by water heating. Analysis of the fatty acid composition of SSTO revealed that unsaturated fatty acids (UFAs) comprised more than 70% of the oil, of which more than 20% were omega-3 poly-UFAs. DPPH radical scavenging and cellular ROS assays confirmed the reduction of oxidative stress by SSTO. In D-galactose-induced aging rats, SSTO feeding alone or in combination with swimming training resulted in improved memory and physical strength. In addition, SSTO feeding with swimming intervention significantly increased the SOD level and maintained better blood pressure in the aged rats. The serum DHEAS and soleus muscle glycogen level were also highly correlated with SSTO feeding and swimming training. In conclusion, the results of this study demonstrated that SSTO has the potential to be developed into a health food that exerts anti-aging effects, and those effects are stronger when combined with daily swimming exercise.

Effectiveness of Pilates and Yoga to improve bone density in adult women: A systematic review and meta-analysis

BACKGROUND

The ageing population brings about the appearance of age-related health disorders, such as osteoporosis or osteopenia. These disorders are associated with fragility fractures. The impact is greater among postmenopausal women due to an acceleration of bone mineral density (BMD) loss.

OBJECTIVE

To estimate the effectiveness of Pilates or Yoga on BMD in adult women.

METHODS

Five electronics databases were searched up to April 2021. Randomized controlled trials (RCTs), non-RCTs and pre-post studies were included. The main outcome was BMD. Risk of bias was evaluated using the Cochrane risk of bias tool. A random effects model was used to pool data from primary studies. Subgroup analyses based on the type of exercise were conducted.

RESULTS

Eleven studies including 591 participants aged between 45 and 78 years were included. The mean length of the interventions ranged from 12 to 32 weeks, and two studies were performed for a period of at least one year. The pooled effect size for the effect of the intervention (Pilates/Yoga) vs the control group was 0.07 (95% Confidence interval [CI]: -0.05 to 0.19; I2 = 0.0%), and 0.10 (95% CI: 0.01 to 0.18; I2 = 18.4%) for the secondary analysis of the pre-post intervention.

CONCLUSIONS

Despite of the non-significant results, the BMD maintenance in the postmenopausal population, when BMD detrimental is expected, could be understood as a positive result added to the beneficial impact of Pilates-Yoga in multiple fracture risk factors, including but not limited to, strength and balance.

Effects of Nonpharmacological Interventions on Balance Function in Patients with Osteoporosis or Osteopenia: A Network Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the clinical efficacy of nonpharmacological interventions in improving balance function of patients with osteoporosis or osteopenia using network meta-analysis (NMA).

METHODS

We searched seven databases (PubMed, the Cochrane Library, Embase, CKNI, Wanfang Data, VIP, and CBM) for relevant randomized controlled trials (RCTs) up to August 31, 2020. Berg Balance Scale (BBS) and Time Up and Go Test (TUGT) were used as outcome measures. Two researchers independently screened studies, collected data from the studies, and estimated risk of study bias. Divergence in the evaluation process was settled by consulting a third researcher. We used Stata 15.1 software for network meta-analysis (NMA).

RESULTS

We identified 10 eligible RCTs, with a total of 737 patients and four intervention methods, including traditional Chinese medicine (TCM) exercises, pulsed electromagnetic fields (PEMFs), strength training, and balance and strength training. The results revealed that all nonpharmacological interventions could improve balance function, but the effect of balance and strength training was better than other interventions.

CONCLUSION

Exercise can significantly improve the balance function of patients with osteoporosis and osteopenia, and balance combined with strength training has the best effect, followed by TCM exercises.