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Open Access 01-12-2010 | Research article

Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life

Authors: Riku Nikander, Harri Sievänen, Ari Heinonen, Robin M Daly, Kirsti Uusi-Rasi, Pekka Kannus

Published in: BMC Medicine | Issue 1/2010

Abstract

Background

Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lower-extremity bone strength from childhood to older age.

Methods

We searched four databases (PubMed, Sport Discus, Physical Education Index, and Embase) up to October 2009 and included 10 randomised controlled trials (RCTs) that assessed the effects of exercise training on whole bone strength. We analysed the results by age groups (childhood, adolescence, and young and older adulthood) and compared the changes to habitually active or sedentary controls. To calculate standardized mean differences (SMD; effect size), we used the follow-up values of bone strength measures adjusted for baseline bone values. An inverse variance-weighted random-effects model was used to pool the results across studies.

Results

Our quality analysis revealed that exercise regimens were heterogeneous; some trials were short in duration and small in sample size, and the weekly training doses varied considerably between trials. We found a small and significant exercise effect among pre- and early pubertal boys [SMD, effect size, 0.17 (95% CI, 0.02-0.32)], but not among pubertal girls [-0.01 (-0.18 to 0.17)], adolescent boys [0.10 (-0.75 to 0.95)], adolescent girls [0.21 (-0.53 to 0.97)], premenopausal women [0.00 (-0.43 to 0.44)] or postmenopausal women [0.00 (-0.15 to 0.15)]. Evidence based on per-protocol analyses of individual trials in children and adolescents indicated that programmes incorporating regular weight-bearing exercise can result in 1% to8% improvements in bone strength at the loaded skeletal sites. In premenopausal women with high exercise compliance, improvements ranging from 0.5% to 2.5% have been reported.

Conclusions

The findings from our meta-analysis of RCTs indicate that exercise can significantly enhance bone strength at loaded sites in children but not in adults. Since few RCTs were conducted to investigate exercise effects on bone strength, there is still a need for further well-designed, long-term RCTs with adequate sample sizes to quantify the effects of exercise on whole bone strength and its structural determinants throughout life.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1741-7015/8/47/prepub

Title: Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life
Authors: Riku Nikander
Harri Sievänen
Ari Heinonen
Robin M Daly
Kirsti Uusi-Rasi
Pekka Kannus
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2010
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/1741-7015-8-47

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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