The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients

Table 1

Systematic reviews and meta-analyses on Exercise and Osteoporosis.

Authors/Title/Source	Main conclusions
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;1;42(4):301-25.[1]	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.
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 Jul 21;8:47. [6]	Epidemiological evidence suggests that moderate to vigorous physical activity performed three to four times per week is associated with considerably lower incidence of fragility fractures in both women and men. The findings from these studies also suggest that exercise regimens that include moderate- to high-magnitude impacts from varying loading directions may represent the optimal mode to enhance bone structure and strength.
Zehnacker CH, Bemis-Dougherty A. Effect of weighted exercises on bone mineral density in post-menopausal women. A systematic review. J Geriatr Phys Ther. 2007;30(2):79-88. [11]	Weighted exercises can help in maintaining BMD in postmenopausal women and increasing BMD of the spine and hip in women with osteopenia and osteoporosis. The exercise program must be incorporated into a lifestyle change and be lifelong due to the chronic nature of bone loss in older women.
McMahon M. What impact does aquatic therapy have on bone density in postmenopausal women? If it has a positive or maintenance effect, what are the programme parameters that facilitate these outcomes? Aqualines 2017;29(1):8-21.[14]	The majority of the studies reviewed support a trend showing that exercising in water can be useful in at least maintaining, or improving, various measures of bone mineral density (BMD).
Howe T, Shea B, Dawson LJ, Downie F, Murray A, Ross C, Harbour RT, Caldwell LM, Creed G. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD000333. [15]	The most effective type of exercise intervention on bone mineral density (BMD) for the neck of femur appears to be non-weight bearing high force exercise such as progressive resistance strength training for the lower limbs. The most effective intervention for BMD at the spine was combination exercise programmes compared with control groups. Our results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups.
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(1):39-51. [16]	We conclude that exercise in postmenopausal women may decrease bone loss by maintaining cortical and trabecular volumetric BMD.
Martyn-St James M1, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Plos one. 2008;43(3):521-31. [17]	We conclude that regular walking has no significant effect on preservation of BMD at the spine in postmenopausal women, whilst significant positive effects at femoral neck are evident. However, diverse methodological and reporting discrepancies are apparent in the published trials on which these conclusions are based. Other forms of exercise that provide greater targeted skeletal loading may be required to preserve bone mineral density in this population.
Ma D, Wu L, He Z. Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause. 2013;20(11):1216-26. [18]	Walking as a singular exercise therapy has no significant effects on BMD at the lumbar spine, at the radius, or for the whole body in perimenopausal and postmenopausal women, although significant and positive effects on femoral neck BMD in this population are evident with interventions more than 6 months in duration.
Bolam KA, van Uffelen JG, Taaffe DR. The effect of physical exercise on bone density in middle-aged and older men: a systematic review. Osteop Int. 2013;24(11):2749-62. [19]	Regular resistance training and impact-loading activities should be considered as a strategy to prevent osteoporosis in middle-aged and older men.
Kelley GA, Kelley KS, Kohrt WM. Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2012; 20;13:177. [20]	The overall findings suggest that exercise may result in clinically relevant benefits to FN and LS BMD in postmenopausal women.
Chow TH, Lee BY, Ang ABF, Cheung VYK, Ho MMC, Takemura S. The effect of Chinese martial arts Tai Chi Chuan on prevention of osteoporosis: A systematic review. J Orthop Translat. 2017; 26;12:74-84. [21]	TCC is beneficial to BMD and may be a cost-effective and preventive measure of osteoporosis. This beneficial effect is better observed in long-term TCC practice.
Sun Z, Chen H, Berger MR, Zhang L, Guo H, Huang Y. Effects of tai chi exercise on bone health in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Osteoporos Int. 2016 Oct;27(10):2901-11. [22]	Tai chi exercise may have benefits on bone health in perimenopausal and postmenopausal women, but the evidence is sometimes weak, poor, and inconsistent.
de Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int. 2009;20(12):2111-25. [23]	Exercise interventions for patients with osteoporosis should include weight-bearing activities, balance exercise, and strengthening exercises to reduce fall and fracture risk.
Martyn-St James M, Carroll S. A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med. 2009; 43(12):898-908. [24]	Mixed loading exercise programmes combining jogging with other low-impact loading activity and programmes mixing impact activity with high-magnitude exercise as resistance training appear effective in reducing postmenopausal bone loss at the hip and spine. Other forms of impact exercise appear less effective at preserving BMD in this population. However, diverse methodological and reporting discrepancies are evident in current published trials.
Varahra A, Rodrigues IB, MacDermid JC, Bryant D, Birmingham T. Exercise to improve functional outcomes in persons with osteoporosis: a systematic review and meta-analysis. Osteoporos Int. 2018;29(2):265-286. [25]	A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes. Due to substantial clinical heterogeneity of the target groups and specific demands of exercise modes, it is unclear which exercise program is optimal.
Zhao R, Zhao M, Xu Z. The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int. 2015; 26(5):1605-18. [26]	Combined resistance exercise protocols appear effective in preserving femoral neck and lumbar spine BMD in postmenopausal women, whereas resistance-alone protocols only produced a nonsignificant positive effect.
Martyn-St James M, Carroll S. Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. J Bone Miner Metab. 2010;28(3):251-67.[27]	Exercise programmes that combine odd- or high-impact activity with high-magnitude resistance training appear effective in augmenting BMD in premenopausal women at the hip and spine. High-impact-alone protocols are effective only on hip BMD in this group. However, diverse methodological and reporting discrepancies are evident in published trials.
Xu J, Lombardi G, Jiao W, Banfi G. Effects of Exercise on Bone Status in Female Subjects, from Young Girls to Postmenopausal Women: An Overview of Systematic Reviews and Meta-Analyses. Sports Med. 2016;46(8):1165-82. [28]	Combined-impact exercise protocols (impact exercise with resistance training) are the best choice to preserve/improve bone mineral density in pre- and postmenopausal women. Whole-body vibration exercises have no beneficial effects on bone in postmenopausal or elderly women.