Table 1.
Characteristics of included studies
| Study | Country | Subjectsa | Exercise interventionb | Supplementation; supervision | Dropout; compliance | BMD outcomes and device | Comparison groupc |
|---|---|---|---|---|---|---|---|
| Brooke-Wavell et al. 1997 | UK | 78 subjects assigned into an EG (n = 38, mean age = 64.9 y) and a CG (n = 40, mean age = 64.2 y); 100% female | 52 wk of training that consisted of self-monitored walking 3.5 times per week for 14.8 min/day for the first 12 wk, followed by 20.4 min/day of walking, 4.8 days/wk, for the subsequent 40 wk | No additional suppl; supervision: no | 6%; not reported | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control (9 women take up swimming (2 days/wk, 20 min/session)c |
| Chuin et al. 2009 | Canada | 18 subjects assigned into an EG (n = 11, mean age = 65.4 y) and a CG (n = 7, mean age = 67.4 y); 100% female | 24 wk of RT performed 3 days/wk for 60 min/session. Exercise sessions consisted of 15 min warm-up and 3 sets of 8 rep at 80% of 1 RM (45 min), focused on the large and small muscle groups of the upper and lower body | No additional suppl; supervision: yes | 0%; >91.7% | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise placebo |
| Englund et al. 2005 | Sweden | 40 subjects assigned into an EG (n = 21, mean age = 72.8 y) and a CG (n = 19, mean age = 73.2 y); 100% female | 52 wk of training performed 2 days/wk for 50 min/session. Exercise sessions consisted of 10 min warm-up, 10 min aerobic, 12 min strength, 5 min balance and coordination, 11 min cool-down/stretching/relaxation | No additional suppl; supervision: yes | 18.8%; 67% | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control |
| Jessup et al. 2003 | USA | 18 subjects assigned into an EG (n = 9, mean age = 69.1 y) and a CG (n = 9, mean age = 69.4 y); 100% female | 32 wk of training performed 3 days/wk for 60–90 min/session. Exercise sessions consisted of 5 min warm-up, strength exercises; load-bearing walking and stair climbing for 35–40 min and balance exercises while wearing weighted vests (carry up to 10% of the participant’s body weight), 5 min cool-down | 1,000 /day of calcium and 400 IU/day of vitamin D; supervision: yes | 10%; not reported | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Norland) | Non-exercise control |
| Kemmler et al. 2010 | Germany | 227 subjects assigned into an EG (n = 115, mean age = 68.9 y) and a CG (n = 112, mean age = 69.2 y); 100% female | 18 months of training performed 2 days/wk for 60 min/session and 2 days/wk of home sessions (20 min each). Exercise sessions consisted of warm-up/aerobic dance (20 min at 70%–80% maximum HR), balance training (5 min), functional gymnastics, strength exercise for the upper body and unilateral dynamic weight-bearing leg exercises; home exercises emphasized strength and flexibility exercises | Calcium (1,500 mg/day) and vitamin D 500 UI/day; supervision: yes (group sessions) | 7.7%; 76.3% (group sessions) and 42.2% (home sessions) | Lumbar spine (L1–L4) and femoral neck assessed by DXA (Hologic) | Low-intensity wellness program (designed not to cause physical adaptations)c |
| Korpelainen et al. 2006 | Finland | 160 subjects assigned into an EG (n = 84, mean age = 72.9 y) and a CG (n = 76, mean age = 72.8 y); 100% female | 30 months of training that included a 60-min supervise group session (1 day/wk) for a 6-month period each year and home sessions (20 min each) usually performed 3 days/wk. Group sessions included 15 min warm-up and 45 min devoted to jumping and balance exercises including walking, knee bends, leg lifts, heel rises and drops, dancing, stamping, stair climbing and stepping up and down from benches; home exercises were similar to those in the supervised sessions | No additional suppl; supervision: yes (group sessions) | 16.9%; 75% (group sessions) | Femoral neck assessed by DXA (Lunar) | Non-exercise control |
| Lau et al. 1992 | China | 23 subjects assigned into an EG (n = 11, mean age = 79 y) and a CG (n = 12, mean age = 75 y); 100% female | 40 wk of training performed 4 days/wk. Exercise sessions consisted of step up and down a block (9 inches/23 cm) 100 times and 15 min of upper trunk exercises while standing | No additional suppl; supervision: yes | 16.7%; not reported | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Norland) | Non-exercise control |
| Lord et al. 1996 | Australia | 138 subjects assigned into an EG (n = 68, mean age = 71.7 y) and a CG (n = 70, mean age = 71.5 y); 100% female | 42 wk of training performed 2 days/wk for 6 min/session. Exercise sessions consisted of 5 min warm-up; 35 min aerobic, balance, coordination and strengthening exercises; 15 min stretching; 5–10 min cool-down period | No additional suppl; supervision: yes | 22.9%; 72.9% | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control |
| Marques et al. 2011a | Portugal | 60 subjects assigned into an EG (n = 30, mean age = 70.1 y) and a CG (n = 30, mean age = 68.2 y); 100% female | 32 wk of training performed 2 days/wk for 60 min/session. Exercise sessions consisted of 10 min warm-up; 15 min weight-bearing activities, 10 min muscular endurance, 10 min balance training, 10 min agility training, 5 min stretching | No additional suppl; supervision: yes | 18.3%; 68.3% | Lumbar spine (L1–L4) and femoral neck assessed by DXA (Hologic) | Non-exercise control |
| Marques et al. 2011b | Portugal 2011 | 71 subjects assigned into an REG (n = 23, mean age = 67.3 y), an AEG (n = 24, mean age 70.3 y) and a CG (n = 24, mean age = 67.9 y); 100% female | 32 wk of training performed 3 days/wk for 60 min/session.RE sessions consisted of 8–10 min warm-up, 30–40 min specific resistance training which included 2 sets of 6–8 rep at 75–80% of 1 RM, focused on quadriceps, hamstrings, gluteus, trunk, arms and abdominal wall muscle groups; 5–10 min cool-down period. AE sessions 10–15 min warm-up, 35–40 min of dynamic aerobic activities (65–85% heart rate reserve), strength exercises (first 6 weeks), 10 min cool-down period | No additional suppl; supervision: yes | 23.9%; 78.4% (RE) and 77.7%(AE) | Lumbar spine (L1–L4) and femoral neck assessed by DXA (Hologic) | Non-exercise control |
| Nichols et al. 1995 | USA | 28 subjects assigned into an EG (n = 14, mean age = 67.8 y) and a CG (n = 14, mean age = 65.2 y); 100% female | 24 wk of isotonic weight training performed 3 days/wk. Exercise sessions consisted of 1 set of 10–12 rep at 50% of 1 RM and progressed to 3 sets at 80% of 1 RM | Calcium intake 800 mg/day; supervision: yes | 17.6%; 86.8% | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control |
| Park et al. 2008 | Japan | 50 subjects assigned into an EG (n = 25, mean age = 68.3 y) and a CG (n = 25, mean age = 68.4 y); 100% female | 48 wk of training performed 3 days/wk for 60 min/session. Exercise sessions consisted of stretching, strength, weight-bearing (at an intensity above 65%–5% of the maximal HR), balance and posture correction training | No additional suppl; supervision: yes | 10%; not reported | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control |
| Rhodes et al. 2000 | Canada | 44 subjects assigned into an EG (n = 20, mean age = 68.8 y) and a CG (n = 18, mean age = 68.2 y); 100% female | 1 year of RT performed 3 /wk for 60 min/session. Exercise sessions consisted of 20 min warm-up and 3 sets of 8 rep at 75% of 1 RM performed in circuit, focused on the large muscle groups of the upper and lower body | No additional suppl; supervision: yes | 13.6%; ≈ 85% | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control |
| von Stengel et al. 2011b | Germany | 96 subjects assigned into a VVTG (n = 34, mean age = 68.1 y), an RVTG (n = 29, mean age = 67.9 y) and a CG (n = 33, mean age = 67.6 y); 100% female | 1 year of whole body vibration training performed 3 days/wk for 15 min/session. Exercise sessions consisted of 7 one-legged or two-legged dynamic leg strengthening exercises, performed on the plates in standing position; VVT G vibrated at a frequency of 35 Hz and the RVTG at 12.5 Hz | Calcium (1,200 mg/day) and vitamin D (800 UI/day); supervision: noc | 11.1%; 73% (VVTG) and 68% (RVTG) | Lumbar spine (L1–L4) and femoral neck assessed by DXA (Hologic) | Low-intensity wellness program (designed to avoid impact on our primary endpoints)4 |
| Taaffe et al. 1999 | USA | 46 subjects assigned into an EG 1 (n = 12, mean age = 69.4 y), EG 3 (n = 11, mean age = 71.0 y) and a CG (n = 12, mean age = 68.9 y); 36% female | 24 wk of RT performed 2 days/wk (EG1) and 3 days/wk (EG2). Exercise sessions consisted of warm-up, 3 sets of 8 rep at 80% of 1 RM, focused on the large muscle groups of the upper and lower body, and cool-down (stretching) period | No additional suppl; supervision: yes | 10.3%; 99% and 97% | Lumbar spine (L2–L4) assessed by DXA (Hologic) | Non-exercise control |
| Villareal et al. 2004 | USA | 112 subjects assigned into an EG (n = 65, mean age = 83 y) and a CG (n = 47, mean age = 83 y); 53.6% female | 36 wk of training performed 3 days/wk for 90–120 min/session. Exercise sessions consisted of successive phases of physical therapy, resistance (progressed to 3 sets, 8–12 rep at 85–90% of 1 RM) and endurance exercises (progressed to 4 × 5 min at 85–90% of peak HR) | Calcium and vitamin D to adjust intake to 1,200 mg/d and 800 U/d; supervision: yes | 26.9%; 73.3% (exercise) and 96.7% (control) | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Hologic) | Home-exercise group (focused primarily on flexibility)c |
| Vincent and Braith 2002 | USA | 62 subjects assigned into an LEXG (n = 24, mean age = 67.6 y), HEXG (n = 22, mean age = 66.6 y) and a CG (n = 16, mean age = 71 y); not reported | 24 wk of RT performed 3 days/wk for 30 min/session. Exercise sessions included warm-up, 13 exercises on resistance machines and cool-down. LEX sessions consisted 1 set of 13 rep at 50% of 1 RM and HEX sessions consisted of 1 set of 8 rep at 75% of 1 RM | No additional suppl; supervision: yes | 26.2%; >85% (LEX and HEX) | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Lunar) | Non-exercise control |
| von Stengel et al. 2011a | Germany | 141 subjects assigned into an EG (n = 47, mean age = 68.6 y), EG plus vibration group (EVG, n = 46, mean age = 68.8 y) and a CG (n = 48, mean age = 68.1 y); 100% female | 72 wk of training performed 2 days/wk for 60 min/session and 2 days/wk of home sessions (15–20 min each). Controlled exercise sessions consisted of dancing aerobics, balance training, functional gymnastics and dynamic leg-strength training on vibration plates (without vibration). EVG performed an identical exercise regimen with vibration (25–35 Hz) during the leg-strengthening sequence. Home training session included some strength and stretching exercises of the joint session | Calcium and vitamin D to adjust intake to 1,500 mg/d and 400 IE/day; supervision: yes (joint sessions) | 10.6%; 75%/43% (joint sessions/home sessions EG) and 80%/45% (joint sessions/home sessions EVG) | Lumbar spine (L1–L4) assessed by DXA (Hologic) | Low-intensity wellness program4 |
| Woo et al. 2007 | China | 176 subjects assigned into a Tai Chi group (n = 28 W, mean age = 69.7 y/30 M, mean age = 68.2 y), a REG (n = 29 W, mean age = 69.6 y/30 M, mean age = 68.7 y) and a CG (n = 30 W, mean age = 69.6 y/29 M, mean age = 68.1 y); 50% female | 52 wk of training performed 3 days/wk. Tai Chi sessions used the Yang style with 24 forms. RE sessions included 6 exercises repeated 30 times using theraband of medium strength | No additional suppl; supervision: no mention | 2.2%; 81% (tai chi) and 76.6% (RE) | Lumbar spine (L2–L4) and femoral neck assessed by DXA (Hologic) | Non-exercise control |
EG exercise group, CG control group, RT resistance training, rep repetitions, RM one repetition maximum, LEXG low-intensity exercise group, HEXG high-intensity exercise group, REG resistance exercise group, AEG aerobic exercise group, VVTG vertical vibration training group, RVT rotational vibration training group, W women, M men, suppl supplementation, d day(s), wk week(s), y year(s)
aNumber of participants included in the analysis (final sample size)
bExercise protocol, frequency, intensity and duration
cOnly the first 3 sessions, and every 6 weeks an instructor controlled if the exercises were still being executed properly
4Intervention that would not be expected to improve our primary outcome measures