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Does adding exercise or physical activity to pharmacological osteoporosis therapy in patients with increased fracture risk improve bone mineral density and lower fracture risk? A systematic review and meta-analysis.
Schumm, AK, Craige, EA, Arora, NK, Owen, PJ, Mundell, NL, Buehring, B, Maus, U, Belavy, DL
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2023;34(11):1867-1880
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Osteoporosis, a progressive systematic skeletal disease is caused by diminished bone density and strength, which may increase the risk of fragility fractures in the spine, pelvis, femur etc. Women are at greater risk of developing osteoporosis. Osteopenia is an intermediary stage of reduced bone mineral density before progressing into the osteoporosis disease state. Exercise and pharmacological therapies are considered two effective strategies commonly used in the treatment of osteoporosis. Exercise may help to improve bone mineral density, strength and muscle mass and reduce the risk of fractures. This systematic review and meta-analysis of five parallel-arm randomised controlled trials investigated the combined effect of exercise and pharmacological therapy on bone mineral density, bone turnover markers, fractures and fracture healing in patients with osteopenia and osteoporosis. This systematic review and meta-analysis showed a non-significant improvement in bone mineral density in patients with osteopenia and osteoporosis followed by combined pharmacological treatment with exercise. Pharmacological therapy alone showed improvement and maintenance of bone mineral density. There was no evidence for the improvement in fragility fracture healing. Due to the low evidence and high heterogeneity of included studies, further robust studies are required to evaluate the combined effect of exercise and pharmacological therapy in people with systematic skeletal disease. Healthcare professionals can use this study to understand the benefits of pharmacological therapy in improving osteoporosis and osteopenia and the potential of adding exercise as a therapeutic strategy in clinical practice.
Abstract
This prospectively registered systematic review and meta-analysis examines whether exercise (EX) training has an additive effect to osteoanabolic and/or antiresorptive pharmacological therapy (PT) in people with osteoporosis on bone mineral density (BMD), bone turnover markers (BTMs), fracture healing, and fractures. Four databases (inception to 6 May 2022), 5 trial registries, and reference lists were searched. Included were randomized controlled trials comparing the effect of EX + PT vs. PT with regard to BMD, BTM, fracture healing, and fractures. Risk of bias was assessed using the Cochrane RoB2 and certainty of evidence by the GRADE approach. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate standardized mean differences and 95% confidence intervals. Out of 2593 records, five RCTs with 530 participants were included. Meta-analysis showed with very low certainty evidence and wide confidence intervals that EX + PT compared to PT had larger effect sizes for BMD at 12 months at the hip (SMD [95%CI]: 0.18 [- 1.71; 2.06], n = 3 studies), tibia (0.25 [- 4.85; 5.34], n = 2), lumbar spine (0.20 [- 1.15; 1.55], n = 4), and forearm (0.05 [- 0.35; 0.46], n = 3), but not femoral neck (- 0.03 [- 1.80; 1.75], n = 3). Furthermore, no improvement was revealed for BTM such as bone ALP (- 0.68 [- 5.88; 4.53], n = 3), PINP (- 0.74 [- 10.42; 8.93], n = 2), and CTX-I (- 0.69 [- 9.61; 8.23], n = 2), but with very wide confidence intervals. Three potentially relevant ongoing trials were identified via registries. No data were found for fracture healing or fracture outcomes. It remains unclear whether EX has an additive impact to PT in people with osteoporosis. High-quality, adequately powered, targetted RCTs are required. PROTOCOL REGISTRATION PROSPERO CRD42022336132.
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Resistance Training Prevents Muscle Loss Induced by Caloric Restriction in Obese Elderly Individuals: A Systematic Review and Meta-Analysis.
Sardeli, AV, Komatsu, TR, Mori, MA, Gáspari, AF, Chacon-Mikahil, MPT
Nutrients. 2018;10(4)
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Caloric restriction (55% carbohydrate, 15% protein, 30% fat) is associated with increased lifespans and the attenuation of the harmful effects of aging. Furthermore, it has been shown that resistance training increases lean body mass, promotes strength, and attenuates muscle loss and function in elderly people. The aim of the study is to determine the level of lean body mass that can be preserved when resistance training is associated with caloric restriction interventions in elderly obese humans. The study is a meta-analysis, based on data from randomised-controlled trials. The participants were older adults or elderly people with a mean age > 57 year. Results indicate that caloric restriction associated with resistance training prevents 93% lean body mass loss induced by caloric restriction. Authors conclude that caloric restriction with resistance training almost stopped caloric restriction induced lean body mass loss completely.
Abstract
It remains unclear as to what extent resistance training (RT) can attenuate muscle loss during caloric restriction (CR) interventions in humans. The objective here is to address if RT could attenuate muscle loss induced by CR in obese elderly individuals, through summarized effects of previous studies. Databases MEDLINE, Embase and Web of Science were used to perform a systematic search between July and August 2017. Were included in the review randomized clinical trials (RCT) comparing the effects of CR with (CRRT) or without RT on lean body mass (LBM), fat body mass (FBM), and total body mass (BM), measured by dual-energy X-ray absorptiometry, on obese elderly individuals. The six RCTs included in the review applied RT three times per week, for 12 to 24 weeks, and most CR interventions followed diets of 55% carbohydrate, 15% protein, and 30% fat. RT reduced 93.5% of CR-induced LBM loss (0.819 kg [0.364 to 1.273]), with similar reduction in FBM and BM, compared with CR. Furthermore, to address muscle quality, the change in strength/LBM ratio tended to be different (p = 0.07) following CRRT (20.9 ± 23.1%) and CR interventions (−7.5 ± 9.9%). Our conclusion is that CRRT is able to prevent almost 100% of CR-induced muscle loss, while resulting in FBM and BM reductions that do not significantly differ from CR.
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Efficacy of exercise for treating overweight in children and adolescents: a systematic review.
Atlantis, E, Barnes, EH, Singh, MA
International journal of obesity (2005). 2006;30(7):1027-40
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The global number of overweight and obese children/adolescents is increasing at an alarming rate. This systematic review and meta-analysis aimed to assess the impact of exercise for overweight children/adolescents. Fourteen randomised controlled trials (RCTs) were included in the analysis. Overall the reduction in average body weight and central obesity was not significant. However, it was found that exercise did significantly reduce body fat percentage by 0.6% in studies that involved more exercise (more than 3 days a week) for children with an average age of 12. When results were grouped by exercise amount, it was found that higher amounts had greater effect. Additionally, trials with longer intervention length saw greater effects. None of the trials reached the level of exercise recommended for children by UK/US guidelines (at least 60 minutes a day). The author suggested further studies of longer duration in this area are required to clarify exercise amount response.
Abstract
BACKGROUND Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear. OBJECTIVE To determine the efficacy of exercise alone for treating overweight in children/adolescents. DESIGN A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N=481 overweight boys and girls, aged approximately 12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD). RESULTS Few studies were of robust design. The pooled SMD was -0.4 (-0.7, -0.1, P=0.006) for percent body fat, and -0.2 (-0.6, 0.1, P=0.07) for central obesity outcomes, whereas the pooled WMD was -2.7 kg (-6.1 kg, 0.8 kg, P=0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155-180 min/weeks vs 120-150 min/weeks). CONCLUSIONS Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155-180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.