The influence of acute exercise on bone biomarkers: protocol for a systematic review with meta-analysis

Abstract

Background Bone is a plastic tissue that is responsive to its physical environment. As a result, exercise interventions represent a potential means to influence the bone. However, little is currently known about how various exercise and participant characteristics interact to influence bone metabolism. Acute, controlled, interventions provide an in vivo model through which the acute bone response to exercise can be investigated, typically by monitoring circulating bone biomarkers. Currently, substantial heterogeneity in factors such as study design, quality, exercise, and participant characteristics render it difficult to synthesize and evaluate the available evidence. Using a systematic review and meta-analytic approach, the aim of this investigation is to quantify the effect of an acute exercise bout on circulating bone biomarkers as well as examine the potential factors that may moderate this response, e.g., variation in participant, exercise, and sampling characteristics. Methods This protocol was designed in accordance with the PRISMA-P guidelines. Seven databases (MEDLINE, Embase, Sport Discus, Cochrane CENTRAL, PEDro, LILACS, and Ibec) will be systematically searched and supplemented by a secondary screening of the reference lists of all included articles. The PICOS (Population, Intervention, Comparator, Outcomes and Study Design) approach was used to guide the determination of the eligibility criteria. Participants of any age, sex, training, or health status will be considered for inclusion. We will select studies that have measured the bone biomarker response before and after an acute exercise session. All biomarkers considered to represent the bone metabolism will be considered for inclusion, and sensitivity analyses will be conducted using reference biomarkers for the measurement of bone resorption and formation (namely β-CTX-1 and P1NP). Multi-level, meta-regression models within a Bayesian framework will be used to explore the main effect of acute exercise on bone biomarkers as well as potential moderating factors. The risk of bias for each individual study will be evaluated using a modified version of the Downs and Black checklist while certainty in resultant outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Discussion A better understanding of the bone metabolic response to an acute bout of exercise has the potential to advance our understanding of the mechanisms through which this stimulus impacts bone metabolism, including factors that may moderate this response. Additionally, we will identify current gaps in the evidence base and provide recommendations to inform future research. Systematic review registration This protocol was prospectively registered in the Open Science Framework Registry (https://osf.io/6f8dz)

Reduced Serum Levels of Bone Formation Marker P1NP in Psoriasis

“…Among biomarkers of bone metabolism, CTX-1 and P1NP are commonly regarded as reference biomarkers for the measurement of bone resorption and formation (22). Moreover, recent recommendations by the Bone Marker Standards Working Group propose to standardize research and include a specific marker of bone resorption (CTX) and bone formation (P1NP) in all future studies (23).…”

Transcriptional and Epigenetic Response to Sedentary Behavior and Physical Activity in Children and Adolescents: A Systematic Review

“…For acute physical activity studies we used a modified version of the Downs and Black checklist (25). This checklist contains 17 questions and was previously adapted for the risk of bias assessment of articles that reported the acute effects of physical activity on bone biomarkers (26). The quality score per item (%) was calculated by dividing the number of studies that met the quality criteria in one specific item (e.g., answer as yes in item number 1) by the total number of studies (e.g., 5 crosssectional studies).…”

The Effect of Resistance Training on Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis

“…This systematic review and meta-analysis of experimental studies with resistance training intervention followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 21 ] (see Supplementary File S1 ). The high-sensitivity search was elaborate, using descriptors according to population, intervention, comparison, outcome, study design (PICOS) strategy: Populations: “Elderly” AND “Health”; Intervention: “Resistance Exercise” OR “Resistance Training”; Comparator: pre-post difference in the BMD as a result of an RT program (the comparison with the control group was not performed because the studies used comparisons with different types of exercises, e.g., impact, vibration, or aerobic exercise, or did not perform exercises, and this would influence the estimate of the effect size [ 22 ]); Outcomes: “Bone Density” OR “Bone Mineral Content” OR “Bone Remodeling” OR “Bone Metabolism”; and Study design: any study that included an RT intervention in older adults (aged 55+ years and with a body mass index below 30 kg/m 2 ) with relevant outcomes for BMD assessed pre- and post-training was considered for inclusion. The reliability of the search strategy was verified by finding the study by Bemben et al [ 17 ].…”

“…In addition, citation tracking of the included studies was carried out through the databases Pubmed, Scopus, and Google Scholar. Gray literature (e.g., abstracts, conference proceedings, editorials, dissertations, and thesis) was not included [ 22 ]. The selected articles’ references were also searched to add relevant titles.…”