Table 2.

Studies included in the review.

Study	Study design	Sample	Intervention	Outcomes	Results	Quality (RoB Tool)
Arazi et al. (33) Rasht, Iran	RCT	N:40 age:30–45 EG-training:10 EG-training + milk:10 EG-milk:10 CG:10	Duration: 10 weeks Type of intervention: EG-training: aerobic exercises 10 weeks × three sessions/week, 90–110 min × session; EG-training + milk: aerobic exercises 10 weeks × three sessions/week, 90–110 min × session + 500 ml daily milk for 10 weeks immediately (250 ml) and 1 hour after training (250 ml). EG-milk: 500 ml daily milk for 10 weeks, milk immediately (250 ml) and 1 h after training (250 ml), CG: standard care.	Primary outcome: ALP and 25OHD Secondary outcome: BMD hip values (right and left) and BMD lumbar spine (L2–L4)	Primary outcome results Statistically significant improvement in ALP: EG-training + milk p < 0.001; EG-training p < 0.001; EG-milk p = 0.01. Statistically significant improvement in 25OHD: EG-training + milk p<0.001; EG-training p < 0.001; EG-milk p = 0.03. Secondary outcome results Statistically significant improvement in BMD hip EG-training+milk: right hip: p < 0.001; left hip: p < 0.001; EG-training: right hip: p = 0.01; left hip: p < 0.001; EG-milk: right hip: p = 0.15; left hip: p = 0.09. Statistically significant improvement in BMD lumbar spine EG-training + milk p = 0.02; EG-training p < 0.001; EG-milk p = 0.10.	Poor
El-Mekawy et al. (34) Cairo, Egypt	RCT	N: 60 womenage:59.03 ± 2.67 EG-A:20 EG-B:20 EG-C:20	Duration: 6 months Frequency: 3 times a week Type of intervention: EG-A: walk daily in the morning in fresh air, 30 min. EG-B: aerobic exercise training for hip and lumbar spine. Sustained muscle contraction for each specific exercise was maintained for 5 s followed by 10 s of relaxation. EG-C: treadmill program for 30 min consisted of 5 min warm-up which involved walking with no resistance and no inclination at the walk way of the treadmill followed by 20 min of walking with 15° inclination at the walk way of the treadmill at 60–75% of the training heart rate and ended by 5 min cool down.	Primary outcome: ALP and calcium (Ca) Secondary outcome: Response of BMD neck and BMD lumbar spine to exercise	Primary outcome results Pre–post change in ALP: EG-A = pre: 175.68 ± 33.48 vs post: 173.00 ± 32.95, change pre:1.53%, p value < 0.91; EG-B = pre: 157.00 ± 35.23 vs post: 154.44 ± 35.92, change: 1.63%, p value < 0.33; EG-C = pre: 153.48 ± 36.44 vs post: 150.96 ± 35.92, change: 1.64%, p value < 0.05. Pre–post change in Ca: EG-A= pre: 8.48 ± 0.31 vs post: 8.66 ± 0.3, change: 2.12%, p-value<0.81; EG-B= pre: 8.45 ± 0.36 vs post: 8.66 ± 0.37, change: 2.49%, p value<0.44; EG-C= pre: 8.48 ± 0.34 vs post: 8.73 ± 0.37, change: 2.95%, p-value<0.66. Secondary outcome results Pre–post change in BMD neck: EG-A= pre: -2.97± 0.64 vs post: -2.66 ± 0.59, change:10.44%, p value<0.05; EG-B = pre: −2.87 ± 0.67 vs post: -2.55 ± 0.65, change: 11.15%, p-value < 0.004; EG-C = pre: 2.71 ± 0.30 vs post: −2.38 ± 0.32, change: 12.18%, p value < 0.002. Pre–post change in BMD lumbar spine: EG-A = pre: −3.59 ± 0.90 vs post: −3.26 ± 0.88, change: 9.19%, p-value < 0.01; EG-B = pre: −3.64 ± 0.65 vs post: −3.29 ± 0.74, change: 9.62%, p value < 0.002; EG-C = pre: −3.44 ± 0.83 vs post: −3.08 ± 0.79, change: 10.47%, p-value < 0.001.	Poor
Roghani et al. (32) Thran, Iran	RCT	N:27 age:45–65 CG:9 EG-aerobic:9 EG-weight:9	Duration: 6 weeks, 18 sessions Frequency: 3 times a week, 30 min each session Type of intervention: EG-Aerobic: treadmill submaximal, increasing the intensity every 2 weeks; EG-Weighted: Aerobic + wearing a vest 4–8% of body weight; CG: usual care	Primary outcome: (tALP), BALP, and NTX levels, calcium (Ca), phosphorus (P). Secondary outcome: Balance: near tandem stand (NTS) and star-excursion (SE) test	Primary outcome results Pre–Post change in tALP (U/L): EG-Aerobic = pre: 218.00 ± 68.32 vs post: 226.12 ± 72.11, change: +8.12, NS; EG-Weighted = pre: 222.44 ± 60.96 vs post: 221.55 ± 80.04, change: −0.89, NS; CG = pre: 181.50 ± 83.36 vs post: 186.70 ± 80.04, change: +5.2, NS. Pre–Post change in BALP (U/L): EG-Aerobic = pre: 156.12 ± 38.08 vs post: 173.37 ± 51.20, change: +10.25%, p = 0.03; EG-Weighted= pre: 154.22 ± 33.73 vs post: 166.44 ± 43.92, change: +7.31%, p = 0.05; CG = pre: 139.70 ± 59.55 vs post: 136.60 ± 57.37, change: −1.93%. Pre–Post change in NTX (nM): EG-Aerobic = pre: 20.80 ± 2.37 vs post:19.51 ± 1.88, change: −5.99%, p = 0.001; EG-Weighted = pre: 21.10 ± 2.33 vs post: 19.72 ± 1.91, change: −6.34%, p = 0.002; CG = pre: 21.08 ± 2.32 vs post: 21.20 ± 2.38, change: +0.60%, p = 0.6. Pre–Post change in P(mg/dl): EG-Aerobic = pre: 3.86 ± 0.40 vs post: 3.84 ± 0.3, change: −0.02, NS; EG-Weighted = pre: 3.33 ± 0.43 vs post: 3.53 ± 0.26, change: +0.2, NS; CG = pre: 3.79 ± 0.42 vs post: 3.83 ± 0.66, change: +0.4, NS. Pre–Post change in Ca (mg/dl): EG-Aerobic = pre: 9.10 ± 0.11 vs post: 9.16 ± 0.25, change: +0.06, NS; EG-Weighted = pre: 8.91 ± 0.16 vs post: 9.23 ± 0.23, change: +0.32, p-value < 0.07; CG = pre: 9.06 ± 0.38 vs post: 9.07 ± 0.20, change: +0.01, NS. Secondary Outcome Results Pre–Post change in SE test (cm): EG-Aerobic = +10.72%, p-value < 0.05; EG-Weighted= +13.43%, p-value < 0.05; CG = −10.43%, p-value < 0.05. Pre–Post change in Near Tandem Stand (NTS) test (s) EG-Aerobic = +49.68%, EG-Weighted= +104.66%, CG = −28.96%.	Poor