Abstract
In this sub-analysis of a comprehensive meta-analysis, we aimed to determine the effect of different types of exercise on (areal) bone mineral density (BMD) in postmenopausal women. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) with at least one exercise and one control group, (c) intervention ≥ 6 months, (d) BMD assessments at lumbar spine (LS), femoral neck (FN) or total hip (TH), (e) in postmenopausal women. Eight electronic databases were scanned without language restrictions up to March 2019. The present subgroup analysis was conducted as a mixed-effect meta-analysis with “type of exercise” as the moderator. The 84 eligible exercise groups were classified into (a) weight bearing (WB, n = 30) exercise, (b) (dynamic) resistance exercise (DRT, n = 18), (c) mixed WB&DRT interventions (n = 36). Outcome measures were standardized mean differences (SMD) for BMD-changes at LS, FN and TH. All types of exercise significantly affect BMD at LS, FN and TH. SMD for LS average 0.40 (95% CI 0.15–0.65) for DRT, SMD 0.26 (0.03–0.49) for WB and SMD 0.42 (0.23–0.61) for WB&DRT. SMD for FN were 0.27 (0.09–0.45) for DRT, 0.37 (0.12–0.62) for WB and 0.35 (0.19–0.51) for WB&DRT. Lastly, SMD for TH changes were 0.51 (0.28–0.74) for DRT, 0.40 (0.21–0.58) for WB and 0.34 (0.14–0.53) for WB&DRT. In summary, we provided further evidence for the favorable effect of exercise on BMD largely independent of the type of exercise. However, in order to generate dedicated exercise recommendations or exercise guideline, meta-analyses might be a too rough tool.
Highlights
Exercise is considered a highly relevant component in the prevention and treatment of osteoporosis and fracture reduction [1, 2]
In order to verify the findings of Rahimi et al [6], and to estimate the effects of different roughly classified types of exercise on bone mineral density (BMD) at different regions of interest (ROI), we conducted a sub-analysis based on a recent comprehensive meta-analysis on exercise effects on BMD in postmenopausal women [3]
Twelve studies with fourteen exercise groups [18, 24, 28, 38, 55, 57, 69, 72, 75] focused on cohorts of “early postmenopausal women” (1 to ≤ 8 years post)
Summary
Exercise is considered a highly relevant component in the prevention and treatment of osteoporosis and fracture reduction [1, 2]. Numerous exercise studies (review in [3]) aim to increase bone strength, predominately assessed by (areal) bone mineral density (BMD) in postmenopausal women, as the most prominent and largest cohort at risk for osteoporosis. There are some evidencebased recommendations for exercise protocols [1, 4, 5], the most promising exercise to address BMD still remains unsettled [2]. Apart from exercise parameters and principles, even Our hypotheses were that all types of exercise significantly affect BMD at (1) LS, (2) FN and (3) total hip (TH) (4), albeit without significant differences between the exercise categorizations at any BMD-ROI
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