To examine the effectiveness of exercise in preventing bone loss and fractures in postmenopausal women
(i) Aerobics, weight bearing, and resistance exercises are effective in increasing BMD of the spine in postmenopausal women. Aerobic exercise is effective in increasing BMD of the wrist. Walking is effective on the hip.
18 RCTs;
(ii) The quality of the reporting of the trials in the meta-analysis was low, in particular, in allocation concealment and blinding.
Critical review of recent studies on strategies to prevent bone loss and fractures after stroke. 1 RCT of exercise in chronic stroke patients,
(i) Emerging evidence that exercise can improve bone health in chronic stroke. Further work is necessary to evaluate early physiotherapy and exercise interventions in acute stroke patients
(ii) Prevention of falls is important in preventing hip fractures. Studies of falls prevention for stroke populations are needed.
158 papers focusing on risk factors or interventions to prevent bone loss or fractures after stroke. 1 RCT of exercise intervention,
(i) Early mobilisation may reduce bone loss & avoid fracture, but evidence is needed. Large, prospective studies are needed to clarify optimum treatments to reduce poststroke bone loss, and test the effects on clinical outcomes.
To assess the effects of prescribed walking programmes on BMD at the hip and spine in postmenopausal women. 5 RCTs, 3 non-RCTs,
(i) Regular walking has no significant effect on preservation of BMD at lumbar spine in postmenopausal women. Inconsistent results observed on BMD of femoral neck.
(ii) Diverse methodological and reporting discrepancies in published trials. Other forms of exercise that provide greater targeted skeletal loading may be required to preserve BMD in this population.
To determine the effects of exercise on bone mass and geometry in postmenopausal women 4 RCTs, 1 non-RCTs, 3 cross-sectional & 4 longitudinal studies,
(i) Exercise appears to positively influence bone mass and geometry in postmenopausal women, with the most prominent changes in response to high-impact loading exercise. Exercise effects appear to be modest, site-specific, and preferentially influence cortical rather than trabecular components of bone.
(ii) Research is needed to determine the types and amounts of exercise required to optimise improvements in bone mass and geometry in postmenopausal women & determine whether these improvements are capable of preventing fractures.
To investigate efficacy of exercise interventions in individuals with low BMD in reducing (1) falls & fractures (2) risk factors for falls & fractures 28 RCTs,
(i) Exercise can reduce falls, fall-related fractures, and several risk factors for falls in individuals with low BMD. Bone strength was improved by weight-bearing aerobic exercise with or without muscle strengthening when interventions were at least a year long.
(ii) Exercise for patients with low BMD or osteoporosis should include weightbearing, balance, and strength training to reduce falls & fracture risk
To assess the effects of impact exercise on postmenopausal bone loss at the hip and spine 10 RCTs & 5 nonrandomised controlled trials,
(i) Mixed loading exercise programmes combining jogging with other low-impact loading activity (walking and stair climbing) and programmes mixing impact activity with high-magnitude resistance training appear effective in reducing postmenopausal bone loss at the hip and spine.
To review relevant studies in adults and animals, highlighting variables like mode of exercise, intensity, duration, endocrine and metabolic factors, and sex differences in the osteogenic response to training.Young men: 4 cross-sectional studies, ; 4 longitudinal, Middle-aged men: 2 longitudinal, Older men: 3 longitudinal, Young women: 4 cross-sectional studies, , 9 longitudinal, Premenopausal women: 4 longitudinal,
(i) Participation in high impact sports, especially before puberty, is important for maximising bone mass and achieving a greater peak bone mass in men and women. Continuing sport practice is associated with fewer fragility fractures in older men and women
(ii) A mix of high impact and weight-lifting exercises may be the best method for enhancing bone mass and preventing OP. Unloaded exercise (swimming and cycling) has no impact on bone mass. Walking & running has limited positive effect.
(iii) For those with OP, WB exercise in general, and resistance exercise in particular, along with balance, mobility and posture exercise should be recommended to reduce the likelihood of falling.
Older women: 8 longitudinal,
(iv) Older men respond better to osteogenic training than women, but RCTs on the effect of exercise on bone mass in older people are lacking.
To evaluate the effects of long-term supervised exercise on estimates of lower-extremity bone strength from childhood to older age.
(i) Exercise can enhance bone strength at loaded sites in children but not in adults. In premenopausal women with high exercise compliance, improvements of 0.5% to 2.5% have been reported.
5 RCTs of children/adolescents,
(ii) There is a need for further well-designed, long-term (>2 year) RCTs with adequate sample sizes to quantify the effects of exercise on whole bone strength and its structural determinants throughout life.
To assess the effects of impact exercise on BMD at the hip and spine in premenopausal women. 6 RCTs, 3 non-RCTs,
(i) Combining odd- or high-impact activity with high magnitude resistance training appears effective in augmenting BMD in premenopausal women at the hip and spine. High-impact-only protocols are effective only on hip BMD in this group.
(ii) Diverse methodological and reporting discrepancies are evident.
