Table 2.

Community-based public health programs incorporating osteoporosis exercise on bone mineral density.

Study reference (n = 5)	Study design and duration; and setting and location	Depictions and description of participants	Details and description of community-based public health program incorporating osteoporosis exercise	Outcome for bone health: bone mineral density (BMD)
Watson et al. (2015) [25]	Experimental Study Trial Period, 8 months. Community; Queensland, Australia	Treatment Group that received intervention and analyzed (n = 28). All postmenopausal women, mean age = 65.3 years old (S.D. ± 3.9); 13 participants had osteoporosis and 15 had osteopenia	Exercise Program (“LIFTMOR (Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation)”): Community-based program: High-intensity progressive resistance training (HiPRT) 30-min sessions, 2 sessions per week. Bodyweight and low-load exercise for the initial 2–4 weeks to learn correct lifting technique. Three HiPRT are introduced and progressed: (1) deadlift, (2) squat, and (3) overhead press, in addition to jumping chin-ups and drop landings. Two sets of 5 repetitions of deadlifts at 50–70% 1RM are performed as a warm-up, and for the 3 HiPRT exercises, each of the 3 exercises are performed at 5 sets of 5 repetitions progressively increasing to 80–85% 1RM. Impact loading is applied to the jumping chin-ups and drop landings	At Final Analysis (87.2% completed program) – (1) BMD (via dual x-ray absorptiometry [DXA]): significant increases at femoral neck (p = 0.016) and lumbar spine (p = 0.005) in the treatment group, no significant difference in the control group. (2) Other-Back extensor strength: significant increase (p = 0.007) in the treatment group, no significant difference in the control group
Duckham et al., 2015 [26]	Experimental Study, 6 months/24 weeks. Home and Community; Nottinghamshire and Derbyshire, United Kingdom	Treatment groups that received an intervention and analyzed at follow-up: Otago Exercise Program (OEP) (n = 75), Fall Management Exercise (FaME) (n = 94). Article included description and demographic information for all groups before losing participants at follow-up. Before follow-up: OEP – 68.2% women, 98.9% White, mean age = 71.4 years old (S.D. ± 4.9), 5.7% on osteoporosis medication; FaME – 60.0% women, 97.1% White, mean age = 71.8 years old (S.D. ± 5.5), 10.5% on osteoporosis medication	Exercise Programs (ProAct65 + trial): Home-based (OEP) and Community-Based (FaME). OEP: (3) 30-min home exercise sessions with at least (2) 30-min walking sessions. Home exercise included progressive leg strengthening and balance exercises with instruction booklet and ankle cuff weights. FaME: Same as the OEP, including (1) 60-miniute exercise class. Exercise class included progressive leg, arm and trunk muscle strengthening using ankle cuff weights and Therabands, flexibility training, functional floor skills, and adapted Tai Chi	At Follow-Up (OEP: 87.5% completed program, FaME: 92.4% completed program) – (1) BMD (DXA): significant decrease at the distal radius for FaME (p = 0.042) although likely not due to intervention but other medical condition or medications, but no significant difference in the OEP, and no significant differences in both groups at the femoral neck, trochanter, total hip, upper neck, lumbar spine, and total body, as well as in section modulus and in femoral strength
Bello et al., 2014 [27]	Experimental Study, 32 weeks. Community; Joao Pessoa City in Paraiba, Brazil	Treatment Group that received intervention and analyzed at follow-up (n = 7). Article included description and demographic information for total participants in the study, but did not include separate description and demographic information for the treatment and control group. All were postmenopausal women diagnosed with either pre-diabetes or Type 2 diabetes in the last 6 months, were non-smoker, non-regular exercisers; no history of stroke, myocardial infarction or other serious disease that prevents exercise safety, and mean age = 61.3 years old (S.D. ± 6.0)	Exercise Program: Multicomponent training including moderate-to-vigorous intensity exercise (rating of perceived exertion (RPE) of 12–15 on the 6–20 Borg scale). 2 sessions per week. Monday: aerobic exercise – 40 min of walking. Wednesday: weight-bearing exercise – circuit with dumbbells and ankle weights (both 2–3 kg), including 6 main muscle group exercises (3 sets, 15–20 repetitions); and 1 aquatic session of static stretching (4 exercises, 3 sets, 10 s) and muscular endurance exercises with water dumbbells on major muscle groups (4 exercises, 3 sets, 15–20 repetitions)	At Follow-Up (70% completed program and adhered to an average of 85% of sessions) – (1) BMD (via DXA): significant increase at Ward's triangle (p = 0.043), but no significant difference in BMD for the femoral neck, greater trochanter, total hip and whole body
Gianoudis et al., 2014 [28] and Gianoudis et al., 2012 [31]	Experimental Study, 12 months. Local health and fitness centers; Melbourne, Australia	Treatment Group that received intervention and analyzed at final analysis (n = 76). Article included description and demographic information for both groups before losing participants at follow-up. Before follow-up: 74.1% women, mean age = 67.7 years old (S.D. ± 6.5)	Exercise Program (“Osteo-cise: Strong Bones for Life”): Community-based and multifaceted program: (1) “Osteo-cise” – an osteoporosis and falls prevention exercise program with diverse-loading, moderate impact, weight-bearing exercises (60–180 impacts/session) and high-challenge balance/functional exercises 3 days/week that progressed from 2 sets of 12–15 repetitions at 40–60% 1RM (RPE 3–4 on 1–10 Borg scale) to 2 sets of 8–12 repetitions at 60% 1RM progressivley increasing to 70–80% 1RM (RPE 5–8 on 1–10 Borg scale), used machine and free weights for exercises targeting the hip and spine; included weight-bearing impact exercises such as (a) stationary movements (e.g., stomping, mini tuck jumps), (b) forward/backward movement (e.g., box step-ups, backward/forward pogo jumps), and (c) lateral/multidirectional movements (e.g., side-to-side shuffle, lateral box jumps) and 2 of these 3 were completed each session in 3 sets of 10–20 repetitions which progressed by increasing height of jumps and/or adding weight; also included high-challenge balance and functional exercises such as (a) fit ball exercises (e.g., fit ball sitting with heel lifts), (b) standing balance exercises (e.g., single-leg stands), and (c) dynamic functional exercises (e.g., heel-toe walking) and 2 of these 3 were completed each session with each exercise performed up to 30 s or at a given number of repetitions which progressed to more difficult exercises; (2) “Osteo-Adopt” – behavior change strategies to adopt and maintain lifelong exercise; (3) “Osteo-Ed” – community-based osteoporosis education/awareness seminars to improve osteoporosis knowledge, such as risk factors and exercise/nutrition for bone health; (4) “Osteo-Instruct” – instruction for exercise trainers who provide training for participants	At Final Analysis (93.8% completed program) – (1) BMD (via DXA): Significant increases in lumbar spine (p < 0.05) and femoral neck (p < 0.05) compared to control group, but no significant difference in total hip between groups. (2) Other-Fall Risk: Significant increase in leg strength (p < 0.01), back strength (p < 0.001), functional muscle power (p < 0.05), 30-s sit-to-stand (p < 0.001), four square step test (p < 0.05) and timed stair climb (p < 0.05) compared to the control group, but no significant difference timed up and go test. (3) Other-Fracture Incidence: 1 fracture (wrist) in treatment group due to training accident, 0 in the control group
McNamara & Gunter, 2012 [29]	Experimental Study, 12 months/1 year. Community; Linn County and Benton County, Oregon	Treatment Group that received intervention and analyzed (n = 69). All postmenopausal women, mean age = 70.1 years old (S.D. ± 7.8), with average years of menopause = 18.9 (S.D. ± 8.8)	Exercise Program (“Better Bones and Balance [BBB]”): Community-based exercise program for older adults to reduce hip fractures by enhancing bone health and reducing fall risk with (3) 50-min sessions per week of lower body resistance training with weighted vests, and impact and balance exercises. Includes several main weight-bearing exercises: stepping on to and off of benches, forward and side lunges, squats, heel drops, jumps, and stomps. At least 30 repetitions of each weight-bearing exercise are performed during each session	At Final Analysis (100% completed program, 91.3% of participants attended at least 10 out of 12 sessions/month, 95.7% attended sessions year round) – (1) BMD (via DXA): No significant differences in hip, spine, or bone structural outcomes between groups.