Table 3.
Description of included studies investigating the association between different doses of physical activity on osteoporosis prevention
| 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 |
|---|---|---|---|---|---|---|---|
| bAshe 2013 [77] |
RCT 155/147 |
Setting: Community; Canada Health status: Healthy A. Balance and tone (BT) Not relevant for this comparison 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% |
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 Primary exercise type: Resistance Duration of the interventions (wks): 52 Delivered by: Certified fitness instructors |
B vs C |
1. Tibial volumetric cortical density (CovBMD) 2. Total area (ToA) midtibia 3. Tibial bone strength |
12 |
Final score (mean ± SD) 1. Tibial CovBMD B. -1.81 ± -0.17 C. -4.67 ± -0.45 2. Total area (ToA) midtibia B. 0.86 ± 0.21 C. 0.93 ± 0.22 3. Tibial bone strength B. 124.83 ± 0.64 C. 9.94 ± 0.05 |
|
cBemben 2011 4/10 [91] |
RCT 160/124 |
Setting: Community; United States Health Status: Healthy Age: Men 65.2 (0.5); Female 63.8 (0.4) Female: 64% A. 2 days/week high intensity (2HI) group n=39 (randomised); 31 (analysed) B. 2 days/week low intensity (2LI) group n=41 (randomised); 34 (analysed) C. 3 days/week high intensity (3HI) group n=34 (randomised); 24 (analysed) D. 3 days/week low intensity (3LI) n= 46 (randomised); 35 (analysed) |
Training included five upper body and seven lower body exercise A. 2HI: Frequency: 2 times/week Intensity: 80% of 1RM, 3 sets of 8 reps Session duration: 60 min Delivered by: NR Duration of the intervention (wks): 40 Primary exercise type: Resistance B. 2LI: Frequency: 2 times/week Intensity: 40% of 1RM, 3 sets of 16 reps Session duration: 60 min Delivered by: NR Duration of the intervention (wks): 40 Primary exercise type: Resistance C. 3HI: Frequency: 3 times/week Intensity: 80% of 1RM, 3 sets of 8 reps Session duration: 60 min Delivered by: NR Duration of the intervention (wks): 40 Primary exercise type: Resistance D. 3LI: Frequency: 3 times/week Intensity: 40% of 1RM, 3 sets of 16 reps Session duration: 60 min Delivered by: NR Duration of the intervention (wks): 40 Primary exercise type: Resistance |
A vs B A vs C C vs D B vs D |
1. Lumbar spine (L2-4) BMD 2. Femoral neck BMD 3. Trochanter BMD 4. Total hip BMD 5. Total body BMD |
10 |
Final score (mean ± SD) 1. Lumbar spine BMD A. 2HI: 1.155 ± 0.034 B. 2LI: 1.195 ± 0.034 C. 3HI: 1.190 ± 0.034 D. 3LI: 1.190 ± 0.031 2. Femoral neck BMD A. 2HI: 0.902 ± 0.020 B. 2LI: 0.904 ± 0.019 C. 3HI: 0.889 ± 0.021 D. 3LI: 0.932 ± 0.027 3. Trochanter BMD A. 2HI: 0.792 ± 0.025 B. 2LI: 0.781 ± 0.019 C. 3HI: 0.800 ± 0.025 D. 3LI: 0.811 ± 0.031 4. Total hip BMD A. 2HI: 0.949 ± 0.022 B. 2LI: 0.943 ± 0.019 C. 3HI: 0.956 ± 0.025 D. 3LI: 0.984 ± 0.031 5. Total body BMD A. 2HI: 1.172 ± 0.014 B. 2LI: 1.175 ± 0.015 C. 3HI: 1.199 ± 0.020 D. 3LI: 1.177 ± 0.017¥ |
|
Kemmler 2010 6/10 [54] |
RCT 246/227 |
Setting: Community; Germany Health status: Healthy A. Multi-component exercise training n= 123 (randomised); 115 (analysed) Age: 68.9 (3.9) B. Low intensity multicomponent programme n= 123 (randomised); 112 (analysed) Age: 69.2 (4.1) Female: 100% |
A. Two 60-minute supervised group sessions: warm-up/ aerobic dance (20 min), balance training (5 min); functional gymnastics, isometric strength training with 1-3 sets of isometric floor exercises for trunk flexors and extensors hip flexors and extensors and leg abductors and adductors; upper body exercises. Two home training session that includes strength and flexibility training. Frequency: 4 sessions/week Intensity: Aerobic dance: 70%-85% of maximum heart rate; Upper body exercise: 10-15 reps x 2-3sets; Home training session: 1-2 sets of 6-8 isometric exercise and 10-15 reps x 2 sets of belt exercises Session duration: 60 min/group class & 20 min/home training session Delivered by: Certified trainer Duration of the intervention (wks): 72 Primary exercise type: Multiple (balance and function plus resistance) B. Low intensity multicomponent programme including walking, muscular relaxation, endurance and strength training Frequency: 1 session/week Intensity: Walking at 50-60 % maximum heart rate Endurance and strength training: low to moderate intensity Session duration: 60 min Delivered by: Certified trainer Duration of the intervention (wks): 72 [every 10 weeks of training was followed by 10 weeks of rest] Primary exercise type: Multiple (balance and function plus endurance) |
A vs B |
1. Lumbar spine BMD 2. Femoral neck BMD |
18 |
Mean difference (95% CI) 1. Lumbar spine BMD: 0.014 (0.006 to 0.021) 2. Femoral neck BMD: 0.015 (0.008 to 0.021)¥ |
|
bPruitt 1995 4/10 [64] |
RCT 40/26 |
Setting: Community; America Healthy status: Healthy A. High intensity resistance training n= 15 (randomised); 8 (analysed) Age: 67.0 (0.5) B. Low intensity resistance training n= 13 (randomised); 7 (analysed) Age: 67.6 (1.4) C. Control: not relevant for this comparison Female: 100% |
A and B. Supervised exercise session comprising bench press, lateral pull down, military press, biceps curl, knee extension, knee flexion, hip abduction and adduction, leg press, back extension. A. Intensity: High 14 reps x 1 set at 40% 1RM for warm up; 7 reps x 2 sets at 80% 1RM B. Intensity: Low 14 reps x 3 sets at 40% 1RM For both A and B: Frequency: 3 times/week Session duration: 50 -55min/lifting time Delivered by: NR Duration of the intervention (wks): 52 |
A vs B |
1. Total hip BMD 2. Femoral neck BMD 3. Ward’s triangle BMD 4. Lumbar spine (L2-L4) BMD |
12 |
Change score (mean ± SD) 1. Total hip BMD A. High intensity: 0.005 ± 0.014 B. Low intensity: 0.008 ± 0.012 2. Femoral neck BMD A. High intensity: -0.002 ± 0.154 B. Low intensity: 0.025 ± 0.008 3. Ward’s triangle BMD A. High intensity: 0.018 ± 0.032 B. Low intensity: 0.022 ± 0.045 4. Lumbar spine (L2-L4) BMD A. High intensity: 0.007 ± 0.018 B. Low intensity: 0.005 ± 0.027 |
|
dTaaffe 1996 4/10 [101] |
RCT 36/21 |
Setting: Community; United States Health status: Healthy A. High intensity resistance training group n= 12 (randomised); 7 (analysed) Age: 67.0 (0.2) B. Low intensity resistance training group n= 13 (randomised); 7 (analysed) Age: 67.6 (0.5) C. Control n= 11 (randomised); 7 (analysed) Age: 69.6 (1.3) Female: 100% |
Supervised exercise training targeted thigh muscle strength including leg press, knee extension and knee flexion. Exercise sessions were bracketed by warm up and cool-down periods A. Intensity: 1 set of 14 reps at an intensity of 40% 1RM and 2 sets of 7 reps at an intensity of 80% of 1RM B. Intensity: 3 sets of 14 reps at an intensity of 40% of 1RM For both groups Frequency: 3 times/week Session duration: NR Delivered by: NR Duration of the intervention (wks): 52 Primary exercise type: Resistance |
A vs B A vs C B vs C |
1. Middle third of the femur BMD 2. Thigh BMD |
12 |
% Change score (mean ± SEM) 1. Middle third of the femur BMD¥ A. High intensity: 1.0± 1.0 B. Low inteisty: -2.2 ± 0.5 C. Control: -1.8 ± 0.6 2. NR |
|
bTaaffe 1999 5/10 [72] |
RCT 53/46 |
Setting: Community; United States Health status: Healthy A. High-intensity resistance training (1 day per week) n= 14 (randomised); 11 (analysed) Age: 68.5 (3.6) Female: 36% B. High-intensity resistance training (2 days per week) n= 14 (randomised); 12 (analysed) Age: 69.4 (3.0) Female: 29% C. High-intensity resistance training (3 days per week) n= 11 (randomised & analysed) Age: 71.0 (4.1) Female: 36% D. Control: not relevant for this comparison |
Training includes the whole body (bench press, military press, latissimus pull-down, biceps curl, and leg press) All trainings were started with a warm up that included stretching and one set each of bench press and leg press (40% of 1-RM, 10 repetitions) and concluded with a cool-down period of stretching. Intensity: started at 60% of the 1RM and gradually increase in intensity A. Frequency: 1 time/week B. Frequency: 2 times/week C. Frequency: 3 times/week Intensity: 8 reps x 3 sets at 80% of 1 RM Session duration: NR Delivered by: NR Duration of the intervention (wks): 24 |
A vs B A vs C B vs C |
1. Lumbar spine (L2-L4) BMD 2. Total hip BMD 3. Midradius BMD 4. Total body BMC |
6 |
Final score (mean ± SD) 1. Lumbar spine (L2-L4) BMD A. Resistance 1x/week: 1.025 ± 0.006 B. Resistance 2x/week: 1.033 ± 0.006 C. Resistance 3x/week: 1.032 ± 0.007 2. Total hip BMD A. Resistance 1x/week: 0.865 ± 0.010 B. Resistance 2x/week: 0.866 ± 0.006 C. Resistance 3x/week: 0.864 ± 0.010 3. Midradius BMD A. Resistance 1x/week: 0.605 ± 0.003 B. Resistance 2x/week: 0.604 ± 0.003 C. Resistance 3x/week: 0.608 ± 0.003 4. Total body BMC A. Resistance 1x/week: 2552 ± 15 B. Resistance 2x/week: 2530 ± 14 C. Resistance 3x/week: 2525 ± 14 |
BMC: bone mineral content (g); BMD: bone mineral density (g/cm2); BMI: body mass index (kg/m2); NR: not reported; RCT: randomised controlled trial. When data was available for more than one time-point, we extracted the post-intervention 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
bIndicate studies also included in the exercise vs control comparison (Table 1) or in the one or more forms of physical activity comparison (Table 2), but only the results for different doses of exercise are presented here
cindicates studies that were found in the expanded search for individual studies conducted in March 2020 in PubMed
dindicates 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 difference at p < 0.05