Table 2.
Description of included studies comparing two or more forms of physical activity
| Reference PEDro score |
Study design Allocated/Analysed |
Participants (n, age mean (SD), % women, setting, health status) | Intervention Primary exercise type according to ProFANEa |
Relevant comparison | Outcomes | Follow up (mo) | Results |
|---|---|---|---|---|---|---|---|
|
dArmamento-Villareal 2020 7/10 [87] |
RCT 160/141 |
Setting: Community; United States Health status: Obese older adults A. Aerobic exercise n= 40 (randomised); 35 (analysed) Age: 70 (4) Female: 65% B. Resistance exercise n= 40 (randomised); 35 (analysed) Age: 70 (5) Female: 63% C. Combination n= 40 (randomised); 35 (analysed) 40 Age: 70 (5) Female: 60% D. Control [control group not relevant for this review question] |
A. Aerobic exercise Frequency: 3 times/week Intensity: ~65% of peak heart rate, gradually increased to 70% to 85%. Session duration: ~60 min Delivered by: Exercise physiologists Duration of the intervention (wks): 26 Primary exercise type: Endurance B. Resistance exercise: nine upper-body and lower-body exercises using weightlifting machines Frequency: 3 times/week Intensity: 1 to 2 sets of 8 to 12 reps at 65% of the 1 RM and increased progressively to 2 to 3 sets at ~85% of the 1-RM. Session duration: ~60 min Delivered by: Exercise physiologists Duration of the intervention (wks): 26 Primary exercise type: Resistance C. Combination: Aerobic and resistance exercise training sessions Frequency: 3 times/week Intensity: Aerobic exercise: ~65% of their peak heart rate, gradually increased to 70% to 85%. Resistance exercise: 1 to 2 sets of 8 to 12 reps at 65% of the 1 RM and increased progressively to 2 to 3 sets at ~85% of the 1-RM Session duration: 75 to 90 min Delivered by: Exercise physiologists Duration of the intervention (wks): 26 Primary exercise type: Multiple (endurance plus resistance) |
A vs B A vs C B vs C |
1. Total hip BMD 2. Femoral neck BMD 3. Trochanter BMD 4. Intertrochanter BMD 5. Lumbar spine BMD 6. Whole body BMD 7. One-third radius BMD |
6 |
Change score (mean ± SD) 1. Total hip BMD A. Aerobic: -0.027 ± 0.004¥ B. Resistance: -0.006 ± 0.004 C. Combination: -0.012 ± 0.004 2. Femoral neck BMD A. Aerobic: -0.020 ± 0.003¥ B. Resistance: -0.003 ± 0.003 C. Combination: -0.008 ± 0.003 3. Trochanter BMD A. Aerobic: -0.035 ± 0.007¥ B. Resistance: -0.006 ± 0.007 C. Combination: -0.016 ± 0.007 4. Intertrochanter A. Aerobic: -0.035 ± 0.007¥ B. Resistance: -0.006 ± 0.007 C. Combination: -0.016 ± 0.007 5. Lumbar spine BMD A. Aerobic: 0.002 ± 0.006 B. Resistance: 0.008 ± 0.006 C. Combination: 0.008 ± 0.005 6. Whole body BMD A. Aerobic: -0.003 ± 0.005 B. Resistance: 0.005 ± 0.005 C. Combination: 0.002 ± 0.005 7. One-third radius BMD A. Aerobic: -0.001 ± 0.001 B. Resistance: -0.0020 ± 0.001 C. Combination: -0.001 ± 0.002 |
| Ashe 2013 [77] |
RCT 155/135 |
Setting: Community; Canada Health status: Healthy A. Balance and tone (BT) n= 49 (randomised); 42 (analysed) Age: 69.9 (3.1) B. Once a week resistance training (RT1) n= 54 (randomised); 47 (analysed) Age: 69.4 (3.0) C. Twice a week resistance training (RT2) n= 52 (randomised); 46 (analysed) Age: 69.2 (3.0) Female: 100% |
A. BT: Group-based supervised intervention consisting of balance and tone training with the use of body weight. Frequency: 2 times/week Intensity: NR Session duration: NR Primary exercise type: Balance and functional B. RT1: Low-frequency, group-based supervised resistance training for upper and lower body with the use of resistance equipment. Frequency: 1 time/week Intensity: 2 sets of 8 RM Session duration: NR Primary exercise type: Resistance C. RT2: High-frequency, group-based supervised resistance training for upper and lower body with the use of resistance equipment. Frequency: 2 times/week Intensity: 2 sets of 8 RM Session duration: NR Primary exercise type: Resistance Duration of the interventions (wks): 52 Delivered by: Certified fitness instructors |
A vs B A vs C |
1. Tibial volumetric cortical density (CovBMD) 2. Total area (ToA) midtibia 3. Tibial bone strength |
12 |
Adjusted mean difference (95% CI) 1. Tibial CovBMD B – A 0.76 (-5.32 to 6.85) C – A -2.09 (-8.22 to 4.05) 2. Total area (ToA) midtibia B – A 0.10 (-2.72 to 2.92) C – A -0.49 (-3.34 to 2.35) 3. Tibial bone strength B – A 23.32 (-248.86 to 295.5) C – A -91.56 (-366.5 to 183.28) |
|
bBlumenthal 1991 6/10 [44] |
RCT 101/85 |
Setting: NR Health status: Healthy A. Aerobic Training n= 33 (randomised) B. Yoga and flexibility n= 34 (randomised) C. Control: Not relevant for this comparison. Age: (whole sample) 67 (min-max: 60-83) Female: NR |
A. Aerobic training: Endurance training involving bicycle ergometry, brisk walking/jogging, and arm ergometry. Frequency: 3 times/week Intensity: 70% heart rate reserve Session duration: 60 min Delivered by: NR Duration of intervention (wks): 16 Primary exercise type: Endurance training B. Yoga: Supervised non-aerobic yoga programme. Frequency: at least 2 times/week Intensity: NR Session duration: 60 min Delivered by: NR Duration of intervention (wks): 16 Primary exercise type: Balance and function |
A vs B | 1. Distal radius BMD | 14 |
1. Distal radius BMD: no between-group differences. Quantitative estimates not reported for between-group comparisons. |
|
dChan 2018 7 /10 [92] |
RCT 110/54 |
Setting: Community; Taiwan Health Status: Increased risk for falls and fracture A. Integrated care (IC) n= 55 (randomised); 31 (analysed) Age: 74.6 (7.4) Female: 69% B. Lower extremity exercise (LEE) n= 55 (randomised); 23 (analysed) Age: 73.08 (6.57) Female: 69% |
Both groups: 1-hour educational course related to osteoporosis, sarcopenia and 1-hour exercise intervention including warm up, brisk walking and gentle stretching. Subjects encouraged to conduct exercise at least 3 times per week. A. Integrated care (IC): Basic intervention, 15-minute warm-up exercise, 30-minute resistance exercise and 10-minute balance exercise Frequency: 1 time/week Intensity: Resistance training using rubber band and bottled water (0.6–1 L) as weight for upper and lower limbs. Delivered by: NR Session duration: 55 min Duration of the intervention (wks): 12 Primary exercise type: Multiple (resistance plus balance and functional) B. Lower extremity exercise (LEE): Basic intervention and machine based lower extremity resistance exercise Frequency: 2 times/week Intensity: 60-80% of 1 RM Delivered by: NR Session duration: 30 min Duration of the intervention (wks): 12 Primary exercise type: Resistance |
A vs B |
1. Lumbar spine BMD 2. Hip BMD |
3 |
Change score (% change) 1. Lumbar spine BMD A. IC: 1.26% B. LEE: 2.08% 2. Hip BMD A. IC: -1.73% B. LEE: -0.88% |
|
bHelge 2014 5/10 [50] |
RCT 27/23 |
Setting: Community; Denmark Health status: Healthy A. Football group n= 9 (randomised); 9 (analysed) Age: 68.0 (4.0) B. Resistance training n= 9 (randomised); 8 (analysed) Age: 69.1 (3.1) C. Control: Not relevant for this comparison. Female: 0% |
A. Football group: Supervised progressive football training Frequency: 1.7 (0.3) times/week (range: 1.2-2.2) Intensity: 82% of maximum heart rate (range 64 to 90%) Session duration: 45 to 60 min Delivered by: NR Duration of the intervention (wks): 52 Primary exercise type: Balance and function (football) B. Resistance training: Progressive resistance training for core and upper and lower body Frequency: 1.9 (0.2) times/week (range: 1.4-2.2) Intensity: Started from 3 sets of 16-20 RM to 4 sets of 8 RM Session duration: 45 to 60 min Delivered by: NR Duration of the intervention (wks): 52 Primary exercise type: Resistance (seated) |
A vs B |
1. Whole body BMD 2. Right femoral neck BMD 3. Left femoral neck BMD 4. Right femoral shaft BMD 5. Left femoral shaft BMD 6. Total right proximal femur 7. Total left proximal femur |
12 |
Final score (mean ± SD) 1. Whole body BMD A. Football: 1.211 ± 0.036 B. Resistance: 1.225 ± 0.024 2. Right femoral neck BMD A. Football: 0.921 ± 0.034 B. Resistance: 1.000 ± 0.042 3. Left femoral neck BMD A. Football: 0.939 ± 0.034 B. Resistance: 1.006 ± 0.036 4. Right femoral shaft BMD A. Football: 1.156 ± 0.042 B. Resistance: 1.229 ± 0.056 5. Left femoral shaft BMD A. Football: 1.143 ± 0.043 B. Resistance: 1.229 ± 0.057 6. Total right proximal femur A. Football: 0.982 ± 0.031 B. Resistance: 1.066 ± 0.048 7. Total left proximal femur A. Football: 0.989 ± 0.031 B. Resistance: 1.069 ± 0.048 |
|
bKarinkanta 2007c 7/10 [53] |
RCT 149/144 |
Setting: Community; Finland Health Status: Healthy and excluded participants with osteoporosis A. Balance-jumping training n= 37 (randomised); 35 (analysed) Age: 72.9 (2.3) B. Resistance training n= 37 (randomised); 37 (analysed) Age: 72.7 (2.5) C. Combined Balance-jumping and resistance training n= 38 (randomised); 36 (analysed) Age: 72.9 (2.2) D. Control: Not relevant for this comparison Female: 100% |
A. Balance-jumping training: Balance training including static and dynamic balance exercise, agility training, impact exercises and changes of direction exercise. Intensity: NR Primary exercise type: Balance and function including bone loading (jumps) B. Resistance training: Tailored progressive resistance training programme for large muscle groups. Intensity: Initially 2 sets of 10-15 reps at intensity 50-60% of 1RM, progressed to 3 sets of 8-10 reps at 75-80% of 1RM. Rate of perceived exertion: above 18 out of 20 Primary exercise type: Resistance C. Combined Balance-jumping and resistance training: A combination of A & B on alternate weeks. Primary exercise type: Multiple (balance and function plus resistance) For all exercise groups: Frequency: 3 times/week Session duration: 50 min Delivered by: Exercise leaders Duration of the intervention (wks): 52 |
A vs B A vs C B vs C |
1. Femoral neck BMC 2. Distal tibia trabecular density (mg/cm3) |
12 |
Final score (mean ± SD) 1. Femoral neck BMC A. Balance: 2.73 ± 0.40 B. Resistance: 2.71 ± 0.33 C. Combined: 2.65 ± 0.29 2. Distal tibia trabecular density (mg/cm3) A. Balance: 224 ± 34 B. Resistance: 219 ± 26 C. Combined: 215 ± 39 |
|
ebKarinkanta 2009c 5/10 [98] |
RCT 149/126 |
Setting: Community; Finland Health Status: healthy and excluded participants with osteoporosis A. Balance jumping training group n= 37 (randomised); 33 (analysed) Age: 72.9 (2.3) B. Resistance training group n= 37 (randomised); 34 (analysed) Age: 72.7 (2.5) C. Combined resistance and balance jumping training group n= 38 (randomised); 32 (analysed) Age: 72.9 (2.2) D. Non-training control group n= 27 (randomised); 27(analysed) Age: 72.0 (2.1) Female: 100% |
A. Balance-jumping training: Balance training including static and dynamic balance exercise, agility training, impact exercises and changes of direction exercise. Intensity: NR Primary exercise type: Balance and function including bone loading (jumps) B. Resistance training: Tailored progressive resistance training programme for large muscle groups. Intensity: Initially 2 sets of 10-15 reps at intensity 50-60% of 1RM, progressed to 3 sets of 8-10 reps at 75-80% of 1RM. Rate of perceived exertion: above 18 out of 20 Primary exercise type: Resistance C. Combined Balance-jumping and resistance training: A combination of A & B on alternate weeks. Primary exercise type: Multiple (balance and function plus resistance) For all exercise groups: Frequency: 3 times/week Session duration: 50 min Delivered by: Exercise leaders Duration of the intervention (wks): 52 |
A vs D B vs D C vs D |
1. Femoral neck section moduls (Z) (mm3) 2. Tibia midshaft desnity-weighted polar section modulus (BSI) (mm3) |
12 |
Mean change score (95% CI) reported on a graph Quantitative data was only reported between-group differences with control group as a reference. Additional results were reported in a graph. |
|
bKohrt 1997 3/10 [55] |
Quasi-randomised trial 39/30 |
Setting: NR; United States Health Status: Healthy A. Ground reaction forces training n= 14 (randomised); 12 (analysed) Age: 66.0 (1.0) B. Joint reaction forces training n= 13 (randomised); 9 (analysed) Age: 65.0 (1.0) C. Control: Not relevant for this comparison Female: 100% |
A. Ground reaction forces training: Individualised exercise training focusing on activities that involved ground-reaction forces, such as walking, jogging and/or stair climbing. Frequency: 3 to 5 times/week Intensity: 60-70% to 80-85% maximum heart rate Session duration: 30 to 45 min Delivered by: NR Duration of the intervention (wks): 36 Primary exercise type: Multiple (balance and function plus endurance plus flexibility) B. Joint reaction forces training: Individualised exercise training including activities that involved joint-reaction forces, such as weightlifting and rowing. Frequency: 3 to 5 sessions/week Intensity: Weightlifting: 2-3 sets of 8-12 reps; Rowing: 60-70% to 80-85% of maximum heart rate Session duration: NR for the total session duration; however; rowing took 15 to 20 min Delivered by: NR Duration of the intervention (wks): 36 Primary exercise type: Multiple (resistance plus endurance plus flexibility) |
A vs B |
1. Whole body BMD 2. Lumbar spine (L2-L4) BMD 3. Femoral neck BMD 4. Trochanter BMD 5. Ward’s BMD 6. Ultra distal wrist BMD 7. One-third distal wrist BMD |
12 |
Quantitative estimates not reported (chance scores are provided in a graph) 1. Whole body BMD Positive effect towards “A” 2. Lumbar spine (L2-L4) BMD Positive effect towards “A” 3. Femoral neck BMD Positive effect towards “A” 4. Trochanter BMD Positive effect towards “A” 5. Ward’s BMD Positive effect towards “A” 6. Ultra distal wrist BMD Positive effect towards “B” 7. One-third distal wrist BMD Positive effect towards “B” |
|
bRikli 1990 1/10 [67] |
Quasi-randomised trial 37/31 |
Setting: Local retirement community; United States Health Status: Healthy A. General exercise n= 13 (randomised); 10 (analysed) Age: 72.2 (5.57) B. General exercise + weight n= 13 (randomised); 10 (analysed) Age: 71.6 (5.66) C. Control: Not relevant for this comparison Female: 100% |
A. General exercise: Group-based aerobic exercise training for large muscle groups. Frequency: 3 times/week Intensity: 60-70% maximum heart rate Session duration: 30 to 50 min Delivered by: NR Duration of the intervention (wks): 40 Primary exercise type: Endurance B. General exercise + weight: Group-based aerobic exercise training plus upper body progressive resistance training. The resistance training was performed without supervision. Frequency: 3 times/week Intensity: 60-70% maximum heart rate for aerobic activities Session duration: 50 to 70 min Delivered by: Assistants Duration of the intervention (wks): 40 Primary exercise type: Multiple (resistance plus endurance) |
A vs B |
1. Distal radius BMC/BW 2. Distal radius BMC |
10 |
Change score (%) 1. Distal radius BMC/BW A. General exercise: 0.921 B. General exercise and weight: 1.734 2. Distal radius BMC A. General exercise: 1.023 B. General exercise and weight: 1.743 Statistical test not performed between the two intervention groups |
|
Shen 2007 6/10 [69] |
RCT 28/24 |
Setting: Local senior living campus; United States Health Status: Healthy A. Tai chi n= 14 (randomised); 12 (analysed) Age: 78.8 (1.3) Female: 79% B. Resistance exercise n= 14 (randomised); 12 (analysed) Age: 79.4 (2.2) Female: 71% |
A. Tai chi: 24-form simplified Yang style Tai Chi. Frequency: 3 times/week Intensity: NR Session duration: 40 min Delivered by: Experienced Tai Chi instructor Duration of the intervention (wks): 24 Primary exercise type: 3D (Tai Chi) B. Resistance exercise: Low-intensity resistance training for lower and upper extremities using equipment and dumbbells. Frequency: 3 times/week Intensity: 1 set of 10-12 reps at 50% of the 1RM Session duration: 40 min Delivered by: Certified fitness trainer Duration of the intervention (wks): 24 Primary exercise type: Resistance |
A vs B |
1. Bone specific alkaline phosphatase (BAP), concentration change (%) 2. Pyridinoline (PYD), concentration change (%) 3. Parathyroid hormone (PTH), concentration change (%) |
6 |
1. BAP No between-group difference (positive effect towards Tai chi) 2. PYD No between-group difference (positive effect towards Resistance training) 3. PTHP No between-group difference (positive effect towards Resistance training) Quantitative results not provided. Results reported in a graph |
|
bWoo 2007 6/10 [75] |
RCT 180/176 |
Setting: Community; Hong Kong Heath status: Healthy A. Tai Chi n=60 (randomised); 58 (randomised) Age: 68.2 years B. Resistance training n= 60 (randomised); 59 (randomised) Age: 68.7 years C. No Treatment: Not relevant for this comparison Female: 50% |
A. Tai Chi: 24-forms of Tai Chi using Yang style Frequency: 3 times/week Intensity: NR Session duration: NR Delivered by: NR Duration of the intervention (wks): 52 Primary exercise type: 3D (Tai Chi) B. Resistance training: Resistance training with the use of medium strength TheraBand Frequency: 3 times/week Intensity: 30 times with medium strength TheraBand Session duration: NR Delivered by: NR Duration of the intervention (wks): 52 Primary exercise type: Resistance |
A vs B |
1. Total hip BMD 2. Total spine BMD |
12 |
Change score (mean % change ± SE) Men 1. Total hip BMD A. Tai Chi: -0.48 ± 0.37 B. Resistance: -1.20 ± 0.38 2. Total spine BMD A. Tai Chi: 1.35 ± 0.40 B. Resistance: 1.27 ± 0.42 Women 1. Total hip BMD A. Tai Chi: 0.07 ± 0.64 B. Resistance: 0.09 ± 0.62 2. Total spine BMD A. Tai Chi: 0.10 ± 0.50 B. Resistance: 1.98 ± 0.48 |
BMC bone mineral content (g), BMD bone mineral density (g/cm2), BMI body mass index (kg/m2), BW bone width, NR not reported, RCT randomised controlled trial. When data was available for more than one time-point, we extracted the post-intervention and follow-up data. Mean estimates were extracted in the following hierarchical order: mean difference, change score and final score
aExercise is a physical activity that is planned, structured and repetitive and aims to improve or maintain physical fitness. There is a wide range of possible types of exercise, and exercise programmes often include one or more types of exercise. We categorised exercise based on a modification of the Prevention of Falls Network Europe (ProFaNE) taxonomy that classifies exercise type as: i) gait, balance, and functional training; ii) strength/ resistance (including power); iii) flexibility; iv) three- dimensional (3D) exercise (e.g., Tai Chi, Qigong, dance); v) general physical activity; vi) endurance; and vii) other kind of exercises. The taxonomy allows for more than one type of exercise to be delivered within a programme. We also considered whether the exercise explicitly included bone loading eg hopping or heel drops
bIndicates studies also included in the exercise vs control comparison (Table 1), but only the results for exercise comparisons are presented here
cindicates articles reporting results from the same study
dindicates studies that were found in the expanded search for individual studies conducted in March 2020 in PubMed
eindicates studies that were found in the updated search for systematic reviews conducted in July 2020 in PubMed, Embase, CINAHL, SPORTDiscus
¥ indicates statistically significant between-group differences at p < 0.05.