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Open Access 01-08-2020 | Review

Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters

Authors: M. Shojaa, S. von Stengel, M. Kohl, D. Schoene, W. Kemmler

Published in: Osteoporosis International | Issue 8/2020

Abstract

This systematic review and meta-analysis set out to determine the effect of dynamic resistance exercise (DRT) on areal bone mineral density (aBMD) in postmenopausal women and derive evidence-based recommendations for optimized training protocols. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) of isolated DRT with at least one exercise and one control group, (c) with intervention durations ≥ 6 months, (d) aBMD assessments at lumbar spine or proximal femur, (e) in cohorts of postmenopausal women. We searched eight electronic databases up to March 2019 without language restrictions. The meta-analysis was performed using a random-effects model. Standardized mean differences (SMD) for BMD changes at lumbar spine (LS), femoral neck (FN), and total hip (TH) were defined as outcome measures. Moderators of the exercise effects, i.e., “intervention length,” “type of DRT,” “training frequency,” “exercise intensity,” and “exercise volume,” were addressed by sub-group analyses. The study was registered in the international prospective register of systematic reviews (PROSPERO) under ID: CRD42018095097. Seventeen articles with 20 exercise and 18 control groups were eligible. SMD average is 0.54 (95% CI 0.22–0.87) for LS-BMD, 0.22 (0.07–0.38) for FN-BMD, and 0.48 (0.22–0.75) for TH-BMD changes (all p ≤ 0.015). While sub-group analysis for FN-BMD revealed no differences within categories of moderators, lower training frequency (< 2 sessions/week) resulted in significantly higher BMD changes at LS and TH compared to higher training frequency (≥ 2 sessions/week). Additionally, free weight training was significantly superior to DRT devices for improving TH-BMD. This work provided further evidence for significant, albeit only low–moderate, effects of DRT on LS-, FN-, and TH-BMD. Unfortunately, sub-analysis results did not allow meaningful exercise recommendations to be derived. This systematic review and meta-analysis observed a significant low–moderate effect of dynamic resistance exercise on bone mineral density changes in postmenopausal women. However, sub-group analyses focusing on exercise characteristics found no results that enable the derivation of meaningful exercise recommendations in the area of exercise and osteoporosis prevention or therapy.

We do not exclude studies with participants that were not community dwelling

One study reported CI and 8 studies utilized SE.

…considering participants attendance rate.

> 30% of bone tissue loss as determined by X-ray assessment at LS or hip.

In addition to the DRT, Kohrt et al. [26] applied 2–3 × 10 min bouts of intense rowing exercise.

This relates to the high intensity exercise groups of three studies [19, 25, 32]. Further, one study [30] prescribed sets of 20–30 reps for two exercises.

E.g. 10 reps at 30% maximum isometric back muscle strength [34] or 14–16 reps at 40% 1RM [19, 32]. The same might be true for some exercises of the protocol of Woo et al. [35].

Comparing Pedro Score categories (low < 5 vs. moderate 5–6 vs. high ≥ 7 score points; [14]) did not indicate significant BMD differences (p > 0.416) at LS-, FN-, and TH-ROI.

Of importance, femoral neck ROI is a usually 15 mm slide across the middle-distal end of the femoral neck, while total hip ROI started slightly below the trochanter minor and include intertrochanter, trochanter, ward, and femoral neck ROI.

…nor the results of higher effects on femoral neck ROI compared to total hip ROI.

At least when bearing in mind that initial conditioning phases conducted by most studies might further shorten the period of over-threshold strain application…

Apart from two studies, all the RT studies included progressively increased exercise intensity during the intervention (Table 2).

LS-BMD: 5 (low ExFr) vs. 13 (high ExFr) study groups TH: 2 vs. 9 study groups (see “Results”).

Ashe et al. [55]: 0–2 sessions/w.(s/w); Bailey et al. [56]: 0–7 s/w; Bemben et al. [57]: 2 vs. 3 s/w. However, studies did not adjust for subjects’ attendance; therefore, results should be interpreted with caution.

While exercise protocols of studies that did not detect difference for TrFr were 6, 8, and 12 months, the lengths of studies that detected significant higher BMD changes in favor of the higher TrFr were 1.5, 4, 12, and 16 years.

In detail, the subgroup analysis on this issue was inconsistent, with higher effects of low intensity for TH-BMD and moderate intensity for FN- and LS-BMD.

This might be the main difference to meta-analysis in the area of pharmaceutic agents or supplements (e.g. [75, 76], with their limited number of inherent modulators.

In contrast to other researchers (e.g. [77]), we do solely include studies that apply progression (i.e. progressive resistance training as defined as “exercise in which a load is increased in predetermined steps” [78]).

By definition “strength” started at 30% 1RM [10]; relative intensity of 10 min of rowing (at least ≥ 250 reps) is below this cutoff.

E.g., as defined according to the set endpoint approach of Steele et al. [38].

as reported in time under tension in different sections of the movement (e.g., concentric–isometric–eccentric).

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Title: Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters
Authors: M. Shojaa
S. von Stengel
M. Kohl
D. Schoene
W. Kemmler
Publication date: 01-08-2020
Publisher: Springer London
Published in: Osteoporosis International / Issue 8/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05441-w

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Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters

Abstract

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Abstract

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