Effekt von additivem körperlichem Training zur Bisphosphonat-Therapie auf die Knochendichte: Eine systematische Übersichtsarbeit und Meta-Analyse

The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16-0.42), 0.27 (95% CI: 0.16-0.39), and 0.41 (95% CI: 0.30-0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I 2 = 20%, TH BMD) to substantial (I 2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur.

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Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators

Mohebbi

Shojaa

Kohl

et al. 2023

Osteoporos Int

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Zusammengefasste Empfehlungen für ein körperliches Training zur Frakturprophylaxe postmenopausaler Frauen und Männer 45 Jahre und älter

et al. 2023

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ZusammenfassungTrainingsprotokolle zur Frakturprophylaxe müssen eine Vielzahl von trainingswissenschaftlichen, logistischen und finanziellen Rahmenbedingungen berücksichtigen, um die erwünschte Effektivität und Anwendbarkeit im Einzel- oder Gruppentraining zu gewährleisten. Basierend auf dem individuellen Risikoprofil ist eine Zuordnung von dedizierten Trainingszielen als Ausgangspunkt der Trainingsplanung zielführend. Die konkrete Adressierung individueller Trainingsziele ermöglicht die Auswahl geeigneter Trainingsinhalte, -mittel und -methoden, die ebenfalls den gesundheitlichen Status und Neigungen des Betroffenen berücksichtigen sollten. Durch die idealerweise überdauernde Trainingsdurchführung kommt der Beachtung nachhaltiger Trainingsprinzipen (progressive Belastungserhöhung, Periodisierung) besondere Relevanz im Trainingsprozess zu. Grundsätzlich ist ein individualisiertes körperliches Training zur Frakturprophlaxe aufgrund der großen Anzahl von Therapieoptionen und Ansatzpunkten in jedem Alter und angepasst an funktionellen Status, gesundheitlichen Beschwerden und potentiellen Kontraindikationen sinnvoll und möglich. Mit Ausnahme von Angebotsstrukturen für ambulante Sturzpräventions-Maßnahmen als Einzelangebote existieren im Gesundheitswesen grundsätzlich belastbare Strukturen, die eine eng supervidierte, qualifizierte und co-finanzierte Trainingsdurchführung unterstützen. Die breite Anwendbarkeit und dichte Struktur von Gesundheitsangeboten zur Frakturprophylaxe für nahezu alle Risiko- und Neigungsgruppen kollidiert allerdings mit dem häufig zu geringen Informationsstand bezüglich Effektivität, Durchführung und Angebotsstruktur von Betroffenen aber auch Entscheidern des Gesundheitswesens.

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The effect of aquatic exercise on bone mineral density in older adults. A systematic review and meta-analysis

et al. 2023

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Introduction: Aquatic or water-based exercise is a very popular type of exercise in particular for people with physical limitations, joint problems and fear of falling. The present systematic review and meta-analysis aimed to provide evidence for the effect of aquatic exercise on Bone Mineral Density (BMD) in adults.Methods: A systematic literature search of five electronic databases (PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science and CINAHL) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted until 2022/01/30, with an update to 2022/10/07. We included controlled trials with a duration of more than 6 months and at least two study groups, aquatic exercise (EG) versus non-training controls (CG) with no language restrictions. Outcome measures were standardized mean differences (SMD) with 95%-confidence intervals (95%-CI) for BMD changes at the lumbar spine (LS) and femoral neck (FN). We applied a random-effects meta-analysis and used the inverse heterogeneity (IVhet) model to analyze the data.Results: Excluding an outlier study with an exceptionally high effect size for LS-BMD, we observed a statistically significant (p = .002) effect (EG vs. CG) of aquatic exercise for the LS-BMD (n = 10; SMD: 0.30; 95%-CI: 0.11–0.49). In parallel, the effect of aquatic exercise on FN-BMD was statistically significant (p = .034) compared to the CG (n = 10; SMD: 0.76, 95%-CI: 0.06–1.46). Of importance, heterogeneity between the trial results was negligible for LS (I2: 7%) but substantial for FN-BMD (I2: 87%). Evidence for risks of small study/publication bias was low for LS-BMD and considerable for FN-BMD.Discussion: In summary, the present systematic review and meta-analysis provides further evidence for the favorable effect of exercise on bone health in adults. Due to its safety and attractiveness, we particularly recommend water-based exercise for people unable, afraid or unmotivated to conduct intense land-based exercise programs.

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Effekt von additivem körperlichem Training zur Bisphosphonat-Therapie auf die Knochendichte: Eine systematische Übersichtsarbeit und Meta-Analyse

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References 52 publications

Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators

Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators

Zusammengefasste Empfehlungen für ein körperliches Training zur Frakturprophylaxe postmenopausaler Frauen und Männer 45 Jahre und älter

The effect of aquatic exercise on bone mineral density in older adults. A systematic review and meta-analysis

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