The effect of exercise intensity on bone in postmenopausal women (part 2): A meta-analysis

Kistler-Fischbacher, Melanie; Weeks, Benjamin Kurt; Beck, Belinda R.

doi:10.1016/j.bone.2020.115697

Cited by 75 publications

(82 citation statements)

References 96 publications

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“…(9) Exercise is an accepted strategy to prevent bone loss as we age, but high-intensity loading is required to stimulate a positive adaptive response. (10,11) Progressive resistance training combined with weight-bearing impact activity is likely to be most efficacious. (10) Nevertheless, concerns about bone fragility have frequently led to more conservative lower-intensity exercise being prescribed for osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

“…(10,11) Progressive resistance training combined with weight-bearing impact activity is likely to be most efficacious. (10) Nevertheless, concerns about bone fragility have frequently led to more conservative lower-intensity exercise being prescribed for osteoporosis. The latter being less efficacious for bone, the primary application of exercise for osteoporosis for many years was fall prevention.…”

Section: Introductionmentioning

confidence: 99%

“…( 16 ) Meta‐analyzed data suggest a non‐significant benefit of adding exercise to antiresorptive medication treatment for femoral neck bone mineral density (BMD) in postmenopausal women. ( 10 ) However, data are limited to a small number of trials that are heterogeneous with respect to exercise type and intensity as well as bone medication regimens. Consequently, the combined efficacy of first‐line pharmacological therapy and bone‐targeted exercise on bone health in postmenopausal women with low bone mass remained to be determined.…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Bone-Targeted Exercise With and Without Antiresorptive Bone Medication to Reduce Indices of Fracture Risk in Postmenopausal Women With Low Bone Mass: The MEDEX-OP Randomized Controlled Trial

Kistler-Fischbacher

Yong

Weeks

et al. 2020

Journal of Bone and Mineral Research

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The goal of the MEDEX-OP trial was to compare the efficacy of a known effective high-intensity resistance and impact training (HiRIT) with a low-intensity exercise control (Buff Bones ® [BB]), alone or in combination with antiresorptive bone medication, on indices of fracture risk (bone mass, body composition, muscle strength, functional performance), compliance, and safety. Primary study outcomes were 8-month change in lumbar spine (LS) and total hip (TH) bone mineral density (BMD). Healthy postmenopausal women with low bone mass (T-score ≤ À1.0) on or off stable doses (≥12 months) of antiresorptive medication were recruited. A total of 115 women (aged 63.6 AE 0.7 years; body mass index [BMI] 25.5 kg/m 2 ; femoral neck [FN] T-score À1.8 AE 0.1) were randomly allocated to 8-month, twice-weekly, 40-minute HiRIT (5 sets of 5 repetitions, >80% to 85% 1 repetition maximum) or BB (low-intensity, Pilates-based training), stratified by medication intake, resulting in four groups: HiRIT (n = 42), BB (n = 44), HiRIT-med (n = 15), BBmed (n = 14). HiRIT improved LS BMD (1.9 AE 0.3% versus 0.1 AE 0.4%, p < 0.001) and stature (0.2 AE 0.1 cm versus À0.0 AE 0.1 cm, p = 0.004) more than BB. Both programs improved functional performance, but HiRIT effects were larger for leg and back muscle strength and the five times sit-to-stand test (p < 0.05). There was a positive relationship between maximum weight lifted and changes in LS BMD and muscle strength in the HiRIT groups. Exploratory analyses suggest antiresorptive medication may enhance exercise efficacy at the proximal femur and lumbar spine. Exercise compliance was good (82.4 AE 1.3%) and both programs were well tolerated (7 adverse events: HiRIT 4; BB 3). HiRIT improved indices of fracture risk significantly more than Buff Bones ® . More trials combining bone medication and bone-targeted exercise are needed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Comparison of Bone-Targeted Exercise With and Without Antiresorptive Bone Medication to Reduce Indices of Fracture Risk in Postmenopausal Women With Low Bone Mass: The MEDEX-OP Randomized Controlled Trial

Kistler-Fischbacher

Yong

Weeks

et al. 2020

Journal of Bone and Mineral Research

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“…For example, since muscular power (strength × SoM) is an integral component for successful aging [40,41], the larger declines in strength may represent a more modifiable performance attribute towards augmenting muscular power. These suggestions are bolstered by recent systematic review and meta-analytic work illustrating the positive relationship between load magnitude and bone response in postmenopausal women [42,43]. Therefore, prescribing high loads may not only augment muscular adaptations but may also provide an osteoprotective stimulus.…”

Section: Discussionmentioning

confidence: 99%

Muscle Performance Changes with Age in Active Women

Miller

Freitas

Heishman

et al. 2021

IJERPH

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The purpose of this study was to examine age-related differences in muscle performance in women divided into young (YW, 20–39 years, n = 29) middle-aged (MAW, 40–59 years, n = 33), and older (OW, ≥60 years, n = 40) age groups. Methods: Hand grip strength, vertical jump performance, and knee extensor (KE) strength (0 deg/s, 60 deg/s, and 240 deg/s), speed of movement (SoM; at 1 Nm, 20%, 40%, and 60% isometric strength), and endurance (30-repetition test at 60 degs/s and 240 deg/s) were assessed. Computed tomography-acquired muscle cross-sectional area (mCSA) was measured and included to determine specific strength (KE strength/mCSA). Results: Hand grip strength was similar across groups, while jump performance declined with age (YW and MAW > OW, p < 0.001). KE strength declined significantly with age (all conditions p < 0.01), while specific strength was similar across groups. SoM was significantly higher for YW and MAW compared to OW (both p < 0.01). An age × velocity interaction revealed YW KE endurance was similar between conditions, whereas MAW and OW displayed significantly better endurance during the 60 deg/s condition. OW displayed impaired KE endurance at 240 deg/s (vs. YW and MAW, p < 0.01) but improved at 60 deg/s (vs. YW, p < 0.01). Dynamic torque decline increased with age (YW < OW, p = 0.03) and was associated with intramuscular adipose tissue (r = 0.21, p = 0.04). Conclusions: Performance declines were most evident among OW, but few performance deficits had emerged in MAW. Interestingly, strength declines disappeared after normalizing to mCSA and endurance appears to be velocity-dependent.

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“…By now, screening for sarcopenia and malnutrition is not generally established in clinical routine care for osteoporosis patients, and accordingly, harmonized strategies and large-scale randomized trials of how to approach that additional risk are missing. However, there is growing evidence regarding beneficial effects of nutritional intervention and specifically high-intensity exercise programs on bone health [ 17 , 40 , 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients—A Cross-Sectional Study

Genest

Rak

Bätz

et al. 2021

JCM

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Sarcopenia and malnutrition are important determinants of increased fracture risk in osteoporosis. SARC-F and MNA-SF are well-established questionnaires for identifying patients at risk for these conditions. We sought to evaluate the feasibility and potential added benefit of such assessments as well as the actual prevalence of these conditions in osteoporosis patients. We conducted a cross-sectional, single-center study in female osteoporosis patients ≥ 65 years (SaNSiBaR-study). Results of the sarcopenia (SARC-F) and malnutrition (MNA-SF) screening questionnaires were matched with a functional assessment for sarcopenia and data from patients’ medical records. Out of 107 patients included in the analysis, a risk for sarcopenia (SARC-F ≥ 4 points) and a risk for malnutrition (MNA-SF ≤ 11 points) was found in 33 (30.8%) and 38 (35.5%) patients, respectively. Diagnostic overlap with coincident indicative findings in both questionnaires was observed in 17 patients (16%). As compared to the respective not-at-risk groups, the mean short physical performance battery (SPPB) score was significantly reduced in both patients at risk for sarcopenia (7.0 vs. 10.9 points, p < 0.001) and patients at risk for malnutrition (8.7 vs. 10.5 points, p = 0.005). Still, confirmed sarcopenia according to EWGSOP2 criteria was present in only 6 (6%) of all 107 patients, with only 3 of them having an indicative SARC-F score. Bone mineral density was not significantly different in any of the at-risk groups at any site. In summary, applying SARC-F and MNA-SF in osteoporosis patients appears to be a complementary approach to identify individuals with functional deficits.

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The effect of exercise intensity on bone in postmenopausal women (part 2): A meta-analysis

Cited by 75 publications

References 96 publications

A Comparison of Bone-Targeted Exercise With and Without Antiresorptive Bone Medication to Reduce Indices of Fracture Risk in Postmenopausal Women With Low Bone Mass: The MEDEX-OP Randomized Controlled Trial

A Comparison of Bone-Targeted Exercise With and Without Antiresorptive Bone Medication to Reduce Indices of Fracture Risk in Postmenopausal Women With Low Bone Mass: The MEDEX-OP Randomized Controlled Trial

Muscle Performance Changes with Age in Active Women

Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients—A Cross-Sectional Study

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