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 Musculoskeletal Disorders

Wendy M Kohrt²  Kristi S Kelley¹  George A Kelley¹ 

[1] Meta-Analytic Research Group, School of Public Health, Department of Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, 26506-9190, WV, USA;Division of Geriatric Medicine, University of Colorado Denver, Anschutz Medical Campus, 12631 East 17th Avenue - L15, PO Box 6511, Mail Stop B179, Aurora, 80045, CO, USA

关键词: Systematic review;    Meta-analysis;    Aging;    Postmenopausal;    Women;    Osteoporosis;    Bone;    Exercise;   

Others  :  1145853
DOI  :  10.1186/1471-2474-13-177

 received in 2012-05-11, accepted in 2012-09-14,  发布年份 2012

【 摘 要 】

Background

Low bone mineral density (BMD) and subsequent fractures are a major public health problem in postmenopausal women. The purpose of this study was to use the aggregate data meta-analytic approach to examine the effects of ground (for example, walking) and/or joint reaction (for example, strength training) exercise on femoral neck (FN) and lumbar spine (LS) BMD in postmenopausal women.

Methods

The a priori inclusion criteria were: (1) randomized controlled trials, (2) exercise intervention ≥ 24 weeks, (3) comparative control group, (4) postmenopausal women, (5) participants not regularly active, i.e., less than 150 minutes of moderate intensity (3.0 to 5.9 metabolic equivalents) weight bearing endurance activity per week, less than 75 minutes of vigorous intensity (> 6.0 metabolic equivalents) weight bearing endurance activity per week, resistance training < 2 times per week, (6) published and unpublished studies in any language since January 1, 1989, (7) BMD data available at the FN and/or LS. Studies were located by searching six electronic databases, cross-referencing, hand searching and expert review. Dual selection of studies and data abstraction were performed. Hedge’s standardized effect size (g) was calculated for each FN and LS BMD result and pooled using random-effects models. Z-score alpha values, 95%confidence intervals (CI) and number-needed-to-treat (NNT) were calculated for pooled results. Heterogeneity was examined using Q and I². Mixed-effects ANOVA and simple meta-regression were used to examine changes in FN and LS BMD according to selected categorical and continuous variables. Statistical significance was set at an alpha value ≤0.05 and a trend at >0.05 to ≤ 0.10.

Results

Small, statistically significant exercise minus control group improvements were found for both FN (28 g’s, 1632 participants, g = 0.288, 95% CI = 0.102, 0.474, p = 0.002, Q = 90.5, p < 0.0001, I² = 70.1%, NNT = 6) and LS (28 g’s, 1504 participants, g = 0.179, 95% CI = −0.003, 0.361, p = 0.05, Q = 77.7, p < 0.0001, I² = 65.3%, NNT = 6) BMD. Clinically, it was estimated that the overall changes in FN and LS would reduce the 20-year relative risk of osteoporotic fracture at any site by approximately 11% and 10%, respectively. None of the mixed-effects ANOVA analyses were statistically significant. Statistically significant, or a trend for statistically significant, associations were observed for changes in FN and LS BMD and 20 different predictors.

Conclusions

The overall findings suggest that exercise may result in clinically relevant benefits to FN and LS BMD in postmenopausal women. Several of the observed associations appear worthy of further investigation in well-designed randomized controlled trials.

【 授权许可】

   
2012 Kelley et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Kanis JA, on behalf of the World Health Organization Scientific Group: Assessment of osteoporosis at the primary health-care level. Technical Report. University of Sheffield, UK: World Health Organization Collaborating Centre for Metabolic Bone Diseases; 2007:1-339. Printed by the University of Sheffield
• [2]Johnell O, Kanis JA: An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006, 17:1726-1733.
• [3]Kanis JA: Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002, 359:1929-1936.
• [4]Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A: Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007, 22:465-475.
• [5]Prevention of Osteoporosis. http://www.iofbonehealth.org/patients-public/about-osteoporosis/prevention.html webcite
• [6]National Osteoporosis Foundation: Prevention and Healthy Living. Washington, DC: National Osteoporosis Foundation; 2012.
• [7]Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Report. Washington, DC: U.S. Department of Health and Human Services; 2008.
• [8]Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR: American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc 2004, 36:1985-1996.
• [9]Bassey EJ, Rothwell MC, Littlewood JJ, Pye DW: Pre- and postmenopausal women have different bone mineral density responses to the same high-impact exercise. J Bone Miner Res 1998, 13:1805-1813.
• [10]Bergstrom I, Landgren B, Brinck J, Freyschuss B: Physical training preserves bone mineral density in postmenopausal women with forearm fractures and low bone mineral density. Osteoporos Int 2008, 19:177-183.
• [11]Bocalini DS, Serra AJ, Dos SL, Murad N, Levy RF: Strength training preserves the bone mineral density of postmenopausal women without hormone replacement therapy. J Aging Health 2009, 21:519-527.
• [12]Brentano MA, Cadore EL, da Silva EM, Ambrosini AB, Coertjens M, Petkowicz R, Viero I, Kruel LF: Physiological adaptations to strength and circuit training in postmenopausal women with bone loss. J Strength Cond Res 2008, 22:1816-1825.
• [13]Brooke-Wavell KSF, Jones PRM, Hardman AE: Brisk walking reduces calcaneal bone loss in post-menopausal women. Clin Sci 1997, 92:75-80.
• [14]Chilibeck PD, Davison KS, Whiting SJ, Suzuki Y, Janzen CL, Peloso P: The effect of strength training combined with bisphosphonate (etidronate) therapy on bone mineral, lean tissue, and fat mass in postmenopausal women. Can J Physiol Pharmacol 2002, 80:941-950.
• [15]Choquette S, Riesco E, Cormier E, Dion T, Aubertin-Leheudre M, Dionne IJ: Effects of soya isoflavones and exercise on body composition and clinical risk factors of cardiovascular diseases in overweight postmenopausal women: a 6-month double-blind controlled trial. Br J Nutr 2011, 105:1199-1209.
• [16]Englund U, Littbrand H, Sondell A, Pettersson U, Bucht G: A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women. Osteoporos Int 2005, 16:1117-1123.
• [17]Going S, Lohman T, Houtkooper L, Metcalfe L, Flint-Wagner H, Blew R, Stanford V, Cussler E, Martin J, Teixeira P, et al.: Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy. Osteoporos Int 2003, 14:637-643.
• [18]Grove KA, Londeree BR: Bone density in postmenopausal women:high impact versus low impact exercise. Med Sci Sports Exerc 1992, 24:1190-1194.
• [19]Hong WL: Tai Chi and resistance training exercise: would these really improve the health of the elderly? PhD Thesis 2004. The Chinese University of Hong Kong
• [20]Iwamoto J, Takeda T, Ichimura S: Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis. J Orthop Sci 2001, 6:128-132.
• [21]Jessup JV, Horne C, Vishen RK, Wheeler D: Effects of exercise on bone density, balance, and self-efficacy in older women. Biol Res Nurs 2003, 4:171-180.
• [22]Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA: Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Int Med 2010, 170:179-185.
• [23]Kerr D, Morton A, Dick I, Prince R: Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent. J Bone Miner Res 1996, 11:218-225.
• [24]Kerr D, Ackland T, Maslen B, Morton A, Prince R: Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res 2001, 16:175-181.
• [25]Liu-Ambrose TYL, Khan KM, Eng JJ, Heinonen A, McKay HA: Both resistance and agility training increase cortical bone density in 75- to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom 2004, 7:390-398.
• [26]Marques EA, Mota J, Machado L, Sousa F, Coelho M, Moreira P, Carvalho J: Multicomponent training program with weight-bearing exercises elicits favorable bone density, muscle strength, and balance adaptations in older women. Calcif Tissue Int 2011, 88:117-129.
• [27]Marques EA, Wanderley F, Machado L, Sousa F, Viana JL, Moreira-Goncalves D, Moreira P, Mota J, Carvalho J: Effects of resistance and aerobic exercise on physical function, bone mineral density, OPG and RANKL in older women. Exp Gerontol 2011, 46:524-532.
• [28]Martin D, Notelovitz M: Effects of aerobic training on bone mineral density of postmenopausal women. J Bone Miner Res 1993, 8:931-936.
• [29]Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ: Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures:a randomized controlled trial. JAMA 1994, 272:1909-1914.
• [30]Newstead A, Smith KI, Bruder J, Keller C: The effect of a jumping exercise intervention on bone mineral density in postmenopausal women. J Geriatr Phys Ther 2004, 27:47-52.
• [31]Prince R, Devine A, Criddle A, Kerr D, Kent N, Price R, Ranell A: The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res 1995, 10:1068-1075.
• [32]Rhodes EC, Martin AD, Taunton JE, Donnelly M, Warren J, Elliot J: Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. Br J Sports Med 2000, 34:18-22.
• [33]Wu J, Oka J, Higuchi M, Tabata I, Toda T, Fujioka M, Fuku N, Teramoto T, Okuhira T, Ueno T: Cooperative effects of isoflavones and exercise on bone and lipid metabolism in postmenopausal Japanese women: a randomized placebo-controlled trial. Metabolism 2006, 55:423-433.
• [34]Hedges LV, Olkin I: Vote-counting methods in research synthesis. Psychol Bull 1980, 88:359-369.
• [35]Sacks HS, Berrier J, Reitman D, Ancona-Berk VA, Chalmers TC: Meta-analysis of randomized controlled trials. N Engl J Med 1987, 316:450-455.
• [36]Berard A, Bravo G, Gauthier P: Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporos Int 1997, 7:331-337.
• [37]Howe TE, 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, 7:CD000333.
• [38]Kelley GA: Aerobic exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis. J Am Geriatr Soc 1998, 46:143-152.
• [39]Kelley GA: Exercise and regional bone mineral density in postmenopausal women: a meta-analytic review of randomized trials. Am J Phys Med Rehabil 1998, 77:76-87.
• [40]Kelley GA: Aerobic exercise and bone density at the hip in postmenopausal women: A meta-analysis. Prev Med 1998, 27:798-807.
• [41]Kelley GA, Kelley KS, Tran ZV: Exercise and bone mineral density in men: a meta-analysis. J Appl Physiol 2000, 88:1730-1736.
• [42]Kelley GA, Kelley KS, Tran ZV: Resistance training and bone mineral density in women: a meta-analysis of controlled trials. Am J Phys Med Rehabil 2001, 80:65-77.
• [43]Kelley GA, Kelley KS, Tran ZV: Exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis of individual patient data. J Gerontol: Med Sci 2002, 57A:M599-M604.
• [44]Kelley GA, Kelley KS: Aerobic exercise and regional bone density in women: a meta-analysis of controlled trials. Am J Med Sports 2002, 4:427-433.
• [45]Kelley GA, Kelley KS, Tran ZV: Efficacy of resistance exercise on lumbar spine and femoral neck bone mineral density in premenopausal women: a meta-analysis of individual patient data. J Womens Health 2004, 13:293-300.
• [46]Kelley GA, Kelley KS: Exercise and bone mineral density at the femoral neck in postmenopausal women: a meta-analysis of controlled clinical trials with individual patient data. Am J Obstet Gynecol 2006, 194:760-767.
• [47]Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Int Med 2009, 151:W65-W94.
• [48]Marques EA, Mota J, Carvalho J: Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age (Dordr) 2011, 1-23.
• [49]Martyn-St JM, Carroll S: High-intensity resistance training and postmenopausal bone loss: a meta-analysis. Osteoporos Int 2006, 17:1225-1240.
• [50]Martyn-St JM, Carroll S: Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone 2008, 43:521-531.
• [51]Martyn-St JM, Carroll S: A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med 2009, 43:898-908.
• [52]Palombaro KM: Effects of walking-only interventions on bone mineral density at various skeletal sites: a meta-analysis. J Geriatr Phys Ther 2005, 28:102-107.
• [53]Wallace BA, Cumming RG: Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif Tissue Int 2000, 67:10-18.
• [54]Wolff I, van Croonenborg JJ, Kemper HCG, Kostense PJ, Twisk JWR: The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopause women. Osteoporos Int 1999, 9:1-12.
• [55]Snow CM, Matkin CC, Shaw JM: Physical Activity and risk for osteoporosis. In Osteoporosis. Edited by Marcus R, Feldman D, Kelsey J. San Diego: Academic Press; 1996:511-528.
• [56]Sinaki M: Exercise and osteoporosis. Arch Phys Med Rehabil 1989, 70:220-229.
• [57]Reference Manager: Reference Manager. Philadelphia, PA: Thompson ResearchSoft; 2009. version 12.0.1
• [58]Microsoft Excel. Redmond: Microsoft Corporation; 2007. (2007)
• [59]Weeks BK, Beck BR: The BPAQ: a bone-specific physical activity assessment instrument. Osteoporos Int 2008, 19:1567-1577.
• [60]Cochrane handbook for systematic reviews of interventions (version 5.0.2). www.cochrane-handbook.org webcite
• [61]Ahn S, Becker BJ: Incorporating quality scores in meta-analysis. J Educ Behav Stat 2011, 36:555-585.
• [62]Hedges LV, Olkin I: Statistical methods for meta-analysis. San Diego: Academic Press; 1985.
• [63]Follmann D, Elliot P, Suh I, Cutler J: Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 1992, 45:769-773.
• [64]Dersimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials 1986, 7:177-188.
• [65]Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S: Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 2008, 11:75-91.
• [66]Cohen J: A power primer. Psychol Bull 1992, 112:155-159.
• [67]Madsen MV, Gotzsche PC, Hrobjartsson A: Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Br Med J 2009, 338:a3115.
• [68]Kraemer HC, Kupfer DJ: Size of treatment effects and their importance to clinical research and practice. Biol Psychiatry 2006, 59:990-996.
• [69]U.S.Census Bureau PD: Intercensal Estimates of the Resident Population by Sex and Age for the United States: April 1, 2000 to July 1, 2010 (US-EST00INT-01). Washington, DC: U.S.Census Bureau PD; 2011. 2-17-2012
• [70]US Department of Health and Human Services: Healthy People 2020. Washington, DC: US Department of Health and Human Services; 2012.
• [71]Health Indicators Warehouse: Aerobic physical activity and muscle-strengthening activity among adults (percent). Hyattsville: National Center for Health Statistics; 2012. 2-16-2012
• [72]Higgins JPT, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. Br Med J 2003, 327:557-560.
• [73]Higgins JP, Thompson SG, Spiegelhalter DJ: A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A 2009, 172:137-159.
• [74]Kelley GA, Kelley KS: Impact of progressive resistance training on lipids and lipoproteins in adults: another look at a meta-analysis using prediction intervals. Prev Med 2009, 49:473-475.
• [75]Duval S, Tweedie R: Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000, 56:455-463.
• [76]Lau J, Schmid CH, Chalmers TC: Cumulative meta-analysis of clinical trials builds evidence for exemplary medical care: the Potsdam International Consultation on Meta-Analysis. J Clin Epidemiol 1995, 48:45-57.
• [77]Borenstein M, Hedges L, Higgins J, Rothstein H: Introduction to meta-analysis. West Sussex: John Wiley & Sons; 2009.
• [78]Littell JH, Corcoran J, Pillai V: Systematic reviews and meta-analysis. New York: Oxford University Press; 2008.
• [79]Engels EA, Schmid CH, Terrin N, Olkin I, Lau J: Heterogeneity and statistical significance in meta-analysis: an empirical study of 125 meta-analyses. Stat Med 2000, 19:1707-1728.
• [80]Glass GV, McGaw B, Smith ML: Meta-analysis in social research. Newbury Park: Sage; 1981.
• [81]Melton LJ, Crowson CS, O'Fallon WM, Wahner HW, Riggs BL: Relative contributions of bone density, bone turnover, and clinical risk factors to long-term fracture prediction. J Bone Miner Res 2003, 18:312-318.
• [82]Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C, tOMG, and the Osteoporosis Research Advisory Group: IX: Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 2002, 23:570-578.
• [83]MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M, Mojica W, Timmer M, Alexander A, McNamara M, et al.: Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Int Med 2008, 148:197-213.
• [84]Pedersen BK, Saltin B: Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports 2006, 16:3-63.
• [85]Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR: Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull 2011, 22:78-83.
• [86]Sterne JA, Davey SG: Sifting the evidence-what's wrong with significance tests? Br Med J 2001, 322:226-231.
• [87]Barry DW, Kohrt WM: BMD decreases over the course of a year in competitive male cyclists. J Bone Miner Res 2008, 23:484-491.
• [88]Barry DW, Kohrt WM: Acute effects of 2 hours of moderate-intensity cycling on serum parathyroid hormone and calcium. Calcif Tissue Int 2007, 80:359-365.
• [89]Rothman KJ: No adjustments are needed for multiple comparisons. Epidemiol 1990, 1:43-46.
• [90]Bennett JA, Winters-Stone K, Nail LM, Scherer J: Definitions of sedentary in physical-activity-intervention trials: a summary of the literature. J Aging Phys Act 2006, 14:456-477.
• [91]Liu XS, Stein EM, Zhou B, Zhang CA, Nickolas TL, Cohen A, Thomas V, McMahon DJ, Cosman F, Nieves J, et al.: Individual trabecula segmentation (ITS)-based morphological analyses and microfinite element analysis of HR-pQCT images discriminate postmenopausal fragility fractures independent of DXA measurements. J Bone Miner Res 2012, 27:263-272.