GENUD-Growth, Exercise, NUtrition and Development Research Group, Universidad de Zaragoza, Huesca, Spain.
Sports Med. 2012 Apr 1;42(4):301-25. doi: 10.2165/11597670-000000000-00000.
It is widely recognized that the risk of fractures is closely related to the typical decline in bone mass during the ageing process in both women and men. Exercise has been reported as one of the best non-pharmacological ways to improve bone mass throughout life. However, not all exercise regimens have the same positive effects on bone mass, and the studies that have evaluated the role of exercise programmes on bone-related variables in elderly people have obtained inconclusive results. This systematic review aims to summarize and update present knowledge about the effects of different types of training programmes on bone mass in older adults and elderly people as a starting point for developing future interventions that maintain a healthy bone mass and higher quality of life in people throughout their lifetime. A literature search using MEDLINE and the Cochrane Central Register of Controlled Trials databases was conducted and bibliographies for studies discussing the effect of exercise interventions in older adults published up to August 2011 were examined. Inclusion criteria were met by 59 controlled trials, 7 meta-analyses and 8 reviews. The studies included in this review indicate that bone-related variables can be increased, or at least the common decline in bone mass during ageing attenuated, through following specific training programmes. Walking provides a modest increase in the loads on the skeleton above gravity and, therefore, this type of exercise has proved to be less effective in osteoporosis prevention. Strength exercise seems to be a powerful stimulus to improve and maintain bone mass during the ageing process. Multi-component exercise programmes of strength, aerobic, high impact and/or weight-bearing training, as well as whole-body vibration (WBV) alone or in combination with exercise, may help to increase or at least prevent decline in bone mass with ageing, especially in postmenopausal women. This review provides, therefore, an overview of intervention studies involving training and bone measurements among older adults, especially postmenopausal women. Some novelties are that WBV training is a promising alternative to prevent bone fractures and osteoporosis. Because this type of exercise under prescription is potentially safe, it may be considered as a low impact alternative to current methods combating bone deterioration. In other respects, the ability of peripheral quantitative computed tomography (pQCT) to assess bone strength and geometric properties may prove advantageous in evaluating the effects of training on bone health. As a result of changes in bone mass becoming evident by pQCT even when dual energy X-ray absortiometry (DXA) measurements were unremarkable, pQCT may provide new knowledge about the effects of exercise on bone that could not be elucidated by DXA. Future research is recommended including longest-term exercise training programmes, the addition of pQCT measurements to DXA scanners and more trials among men, including older participants.
人们普遍认为，骨折的风险与女性和男性在衰老过程中典型的骨量下降密切相关。运动被认为是改善一生中骨量的最佳非药物方法之一。然而，并非所有的运动方案都对骨量有相同的积极影响，而且评估运动方案对老年人与骨相关变量的作用的研究得出的结果并不一致。本系统综述旨在总结和更新目前关于不同类型的训练方案对老年人骨量的影响的知识，为制定未来的干预措施提供一个起点，这些干预措施可以维持人们一生中的健康骨量和更高的生活质量。使用 MEDLINE 和 Cochrane 对照试验中心注册数据库进行了文献检索，并对截至 2011 年 8 月讨论运动干预对老年人影响的研究的参考文献进行了检查。纳入标准符合 59 项对照试验、7 项荟萃分析和 8 项综述。本综述中包括的研究表明，通过特定的训练方案，可以增加与骨相关的变量，或者至少可以减缓衰老过程中骨量的常见下降。散步可以使骨骼承受的负荷超过重力，因此，这种类型的运动在预防骨质疏松症方面效果较差。力量训练似乎是改善和维持衰老过程中骨量的有力刺激。力量、有氧、高冲击和/或负重训练的多成分运动方案，以及单独或与运动结合使用的全身振动（WBV），可能有助于增加或至少防止随年龄增长而导致的骨量减少，尤其是绝经后妇女。因此，本综述提供了涉及老年人（尤其是绝经后妇女）训练和骨测量的干预研究概述。一些新的发现是，WBV 训练是预防骨折和骨质疏松症的一种很有前途的替代方法。由于这种类型的运动在处方下是潜在安全的，因此它可以被认为是一种低影响的替代方法，以对抗目前导致骨骼恶化的方法。在其他方面，外周定量计算机断层扫描（pQCT）评估骨强度和几何特性的能力可能在评估训练对骨骼健康的影响方面具有优势。由于 pQCT 甚至在双能 X 射线吸收法（DXA）测量无明显变化时也能显示骨量的变化，因此 pQCT 可能会提供关于运动对骨骼影响的新的知识，而这些知识是无法通过 DXA 来阐明的。建议进行未来的研究，包括长期运动训练方案、在 DXA 扫描仪上增加 pQCT 测量以及更多的男性试验，包括老年参与者。
