Swimming as Treatment for Osteoporosis: A Systematic Review and Meta-analysis

Abstract

Osteoporosis is a chronic disease that seriously affects human health and quality of life. This study is aimed at determining whether swimming had an effect on the bone mineral density (BMD) of the spine and femoral neck in postmenopausal and premenopausal osteoporosis patients. We retrieved relevant literature and analyzed data from randomized controlled trials to assess the effect of swimming on BMD in postmenopausal and premenopausal women. Relevant studies, with no language restrictions, from inception to September 2019, were retrieved from the PubMed, Cochrane, EMBASE, and EBSCO databases independently by two investigators. The keywords used for the literature search were “osteoporosis” and “swimming.” The main results included BMD and T-score. We searched 256 relevant articles and finally screened five articles, including 263 participants. Lumbar spine density was mentioned in three articles. Although the heterogeneity of lumbar vertebral density is moderate, the analysis of swimmers to nonswimmers shows that the lumbar vertebral density in swimmers is improved [heterogeneity: chi2=5.16, df=2 (P=0.08); I2=61%]. We analyzed the following heterogeneous subgroups: subgroup 1 (3–6 hours) and subgroup 2 (<3 hours). The BMD in subgroup 1 was significantly higher than that in the placebo, while no effect on BMD was found in subgroup 2 [heterogeneity: chi2=0.15, df=3 (P=0.70); I2=0%]. According to the current evidence, swimming may improve the BMD of postmenopausal women participants, if the swimming time is between 3 and 6 hours, especially in long-term swimmers. However, the effectiveness of swimming does require further investigation.

The Effect of Professional Sports Participation on Bone Content and Density in Elite Female Athletes

“…In order to answer the first main goal of the study, the results of the Z score definitely proved that swimming is effective for bone density improvement compared to nonathletes. Recently, a systematic review provided limited evidence on the benefits of swimming to improve BMD values, which is inconsistent with the results of the present study (12), while another systematic review was completely consistent with this study and found the mentioned sport useful for improving the bone health in comparison to non-athletes (11). Nonetheless, most of the research that is done in this context is contrary to the present reports, and the neutral or ineffective results of swimming on BMC and BMD had been suggested by them (10,17,18,21,(29)(30)(31)(32).…”

“…There are extensive studies in this context, and they have certainly suggested weight-bearing sports as the stimulator of bone formation in comparison to non-weight-bearing sports such as swimming (9,10). Although water modulates gravity, there are ambiguities about the effects of swimming on the growth of bone, even in comparison to non-athletes (11,12). Since osteoporosis, despite the risk of fracture, is usually accompanied by cardiovascular and cerebrovascular diseases (12,13), which are the most important limiting factors for high-intensity or weightbearing exercises of patients and older people.…”

“…Although water modulates gravity, there are ambiguities about the effects of swimming on the growth of bone, even in comparison to non-athletes (11,12). Since osteoporosis, despite the risk of fracture, is usually accompanied by cardiovascular and cerebrovascular diseases (12,13), which are the most important limiting factors for high-intensity or weightbearing exercises of patients and older people. Therefore besides its high therapeutic benefits, swimming is considered the best option for them, and it is not ignorable (12).…”

Current Status of the Diagnosis and Management of Osteoporosis

“…On the other hand, aquatic exercises, despite not being the best option to increase BMD due to their low or even null impact on bone, do allow for the generation of muscle tension while minimizing any risk of falling, which, for older adults, is a clear advantage [ 206 ]. Previously, it was believed that aquatic exercises decreased BMD; however, studies such as that by Su, Chen and Xie [ 207 ] show the opposite. Although these types of exercises are not the best for increasing BMD, they do have positive effects on it.…”

Rethinking of osteoporosis through a sex- and gender-informed approach in the COVID-19 era

“…81 Thus, guidelines recommended for the prevention of osteoporosis and fractures multimodal exercise programs that include weight bearing activities, progressive resistance training and balance/mobility training. 82 Therefore, in summary, most of studies and meta-analysis regarding the role of exercise in OP treatment were performed in female population 75,78,[82][83][84] some in both sexes 76 , few in men and 70 many do not specify the population enrolled 77 80 . To our knowledge, whether sex and gender can modify the effect of exercise on OP management have not been investigated yet.…”