Effects of High-Intensity Resistance Training on Osteopenia and Sarcopenia Parameters in Older Men with Osteosarcopenia—One-Year Results of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)

Abstract

Dynamic resistance exercise (DRT) might be the most promising agent for fighting sarcopenia in older people. However, the positive effect of DRT on osteopenia/osteoporosis in men has still to be confirmed. To evaluate the effect of low‐volume/high‐intensity (HIT)‐DRT on bone mineral density (BMD) and skeletal muscle mass index (SMI) in men with osteosarcopenia, we initiated the Franconian Osteopenia and Sarcopenia Trial (FrOST). Forty‐three sedentary community‐dwelling older men (aged 73 to 91 years) with osteopenia/osteoporosis and SMI‐based sarcopenia were randomly assigned to a HIT‐RT exercise group (EG; n = 21) or a control group (CG; n = 22). HIT‐RT provided a progressive, periodized single‐set DRT on machines with high intensity, effort, and velocity twice a week, while CG maintained their lifestyle. Both groups were adequately supplemented with whey protein, vitamin D, and calcium. Primary study endpoint was integral lumbar spine (LS) BMD as determined by quantitative computed tomography. Core secondary study endpoint was SMI as determined by dual‐energy X‐ray absorptiometry. Additional study endpoints were BMD at the total hip and maximum isokinetic hip−/leg‐extensor strength (leg press). After 12 months of exercise, LS‐BMD was maintained in the EG and decreased significantly in the CG, resulting in significant between‐group differences (p < 0.001; standardized mean difference [SMD] = 0.90). In parallel, SMI increased significantly in the EG and decreased significantly in the CG (p < 0.001; SMD = 1.95). Total hip BMD changes did not differ significantly between the groups (p = 0.064; SMD = 0.65), whereas changes in maximum hip−/leg‐extensor strength were much more prominent (p < 0.001; SMD = 1.92) in the EG. Considering dropout (n = 2), attendance rate (95%), and unintended side effects/injuries (n = 0), we believe our HIT‐RT protocol to be feasible, attractive, and safe. In summary, we conclude that our combined low‐threshold HIT‐RT/protein/vitamin D/calcium intervention was feasible, safe, and effective for tackling sarcopenia and osteopenia/osteoporosis in older men with osteosarcopenia. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Effects of High Intensity Dynamic Resistance Exercise and Whey Protein Supplements on Osteosarcopenia in Older Men with Low Bone and Muscle Mass. Final Results of the Randomized Controlled FrOST Study

“…In the recent 12-month publication of the present FrOST project [16], we reported positive effects on SMI and integral volumetric BMD at the LS as determined by quantitative computed tomography (QCT); however, we did not determine significant effects on areal BMD at LS and total hip as determined by the less sensitive but nevertheless gold standard DXA-technique. The present (final) analysis after 18 months of progressive DRT added evidence that HIT-DRT supported by WPS (1) significantly improved the sarcopenia complex composed of morphometric (SMI) and functional (handgrip-strength, gait velocity) [19] aspects and (2) areal BMD at the most important fracture sites, i.e., LS and total hip.…”

“…However, one should be aware that handgrip strength is not the most sensitive measure of muscle strength changes during resistance training [71]. Indeed, the highly significant effect on maximum hip-/leg-extensor strength as determined by an isokinetic leg press after one year (~30 ± 15%) [16] might confirm the low sensitivity of handgrip strength for resistance training-induced strength changes. This might also be the case for gait velocity.…”

“…The study was conducted between February 2018 (start of recruitment) and February 2020 (final data analysis). Two recent interim analyses after 6 and 8 months focus on parameters of sarcopenia [14], muscle mass and strength [15], while the 12-month FrOST analysis [16] addressed skeletal muscle mass index and BMD at the lumbar spine (LS) as determined by quantitative computed tomography (QCT).…”

Associations of Muscle Size and Density With Proximal Femur Bone in a Community Dwelling Older Population

“…The novel finding of this study was that gluteus maximus muscle cross-sectional area but not density was associated with trochanter cortical vBMD suggesting that muscle size is at this region, is more important than muscle density to localized bone. This observation indicates the potential value of this muscle being a good target to improve the bone strength via for example appropriate physical exercise (23). We also found the site-specific effects in the associations of muscle and bone density, namely trunk muscle density, and size were not associated with proximal femur bone density.…”

A clinical guide to the pathophysiology, diagnosis and treatment of osteosarcopenia

“…It should be highlighted that while increasing protein intake is effective at increasing muscle mass [55], the effects on sarcopenia-related measure such as strength and functional capacity are less consistent [56][57][58] but the effects of RE are overwhelming [59,60].…”