Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.
The Bone Clinic, Brisbane, Queensland, Australia.
Bone. 2020 Jul;136:115362. doi: 10.1016/j.bone.2020.115362. Epub 2020 Apr 11.
Few data exist on the effects of bone-targeted exercise on geometric and biomechanical indices of bone strength in men. The Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) trial was designed to compare the efficacy and safety of two novel, supervised, twice-weekly, high-intensity exercise programs in middle-aged and older men with osteopenia and osteoporosis on musculoskeletal health and risk factors related to falls and fractures. The current report includes secondary outcomes of the LIFTMOR-M exercise intervention trial.
Our goal was to determine the effects of two supervised, twice-weekly, high-intensity exercise programs on bone geometry and strength of the proximal femur, and distal and proximal sites of the tibia and radius in middle-aged and older men with osteopenia and osteoporosis.
Generally-healthy men (≥45 years), with low lumbar spine (LS) and/or proximal femur areal bone mineral density (aBMD), were recruited from the community. Eligible participants were randomised to either eight months of twice-weekly supervised high-intensity progressive resistance and impact training (HiRIT) or supervised machine-based isometric axial compression (IAC) exercise training. Intervention group outcomes were compared at baseline and eight months with a matched but non-randomised control group (CON) who self-selected to usual activities. DXA scans (Medix DR, Medilink, France) of the skeletally non-dominant proximal femur were analysed using 3D hip software (DMS Group, France) to derive femoral neck (FN) and total hip (TH) bone mineral content (BMC), volume, and volumetric bone mineral density (vBMD) for total, trabecular and cortical bone compartments. Total FN cortical thickness was determined as well as anterior, posterior, lateral and medial subregions. pQCT scans (XCT-3000, Stratec, Germany) of the 4 and 38% sites of the tibia, and 4 and 66% sites of the radius were conducted to determine a range of geometric and bone structural strength indices. Intervention effects were examined using univariate ANCOVA of percent change, and repeated measures ANCOVA of raw baseline and follow-up data, controlling for initial values, using intention-to-treat and per-protocol approaches.
Ninety-three men (67.1 ± 7.5 yrs, 175.2 ± 6.7 cm, 82.1 ± 11.6 kg, 26.7 ± 3.5 kg/m) with lower than average aBMD (LS T-score -0.06 ± 1.04, FN T-score -1.58 ± 0.58, TH T-score -1.00 ± 0.58) were recruited, and designated CON (n = 26) or randomised to HiRIT (n = 34) or IAC (n = 33). Compliance to the supervised exercise programs did not differ (HiRIT 77.8 ± 16.6% versus IAC 78.5 ± 14.8%, p = 0.872). HiRIT improved medial FN cortical thickness compared with CON (5.6 ± 1.7% versus -0.1 ± 1.9%, p = 0.028) and IAC (5.6 ± 1.7% versus 0.7 ± 1.7%, p = 0.044). Distal tibia total BMC, vBMD, area and bone strength index, and trabecular BMC and bone strength index all declined for CON compared with maintenance for both HiRIT and IAC (all p < 0.05). HiRIT maintained distal tibia trabecular area compared with a loss in CON (0.2 ± 0.5% versus -1.6 ± 0.5%, p = 0.013). HiRIT and IAC maintained distal radius total BMC compared with loss in CON (-0.1 ± 0.7% versus -3.7 ± 0.8%, p = 0.001; 1.3 ± 0.7% versus -3.7 ± 0.8%, p < 0.001, respectively). HiRIT and IAC maintained distal radius total bone strength index compared with loss in CON (1.4 ± 1.4% versus -6.0 ± 1.6%, p = 0.001; 0.2 ± 1.3% versus -6.0 ± 1.6%, p = 0.004, respectively). HiRIT reduced proximal radius cortical area compared with CON (-3.1 ± 1.0% versus 1.1 ± 1.2%, p = 0.011) and IAC (-3.1 ± 1.0% versus -0.2 ± 1.0%, p = 0.042). No between-group differences were detected in any pQCT-derived bone outcome at the diaphyseal tibia 38% site.
Findings indicate that supervised HiRIT provides a positive stimulus to cortical bone at the medial FN compared with supervised IAC exercise, and both HiRIT and IAC preserve bone strength at the distal tibia and distal radius. These effects may translate into a reduced risk of lower and upper extremity fracture in middle-aged and older men with low bone mass.
关于骨靶向运动对男性骨强度的几何和生物力学指标的影响，数据很少。设计 Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) 试验是为了比较两种新型、监督、每周两次、高强度运动方案对患有骨质疏松症和骨质疏松症的中年和老年男性的肌肉和骨质疏松症康复的疗效和安全性骨健康和与跌倒和骨折相关的危险因素。目前的报告包括 LIFTMOR-M 运动干预试验的次要结果。
我们的目标是确定两种监督、每周两次、高强度运动方案对中年和老年男性骨质疏松症和骨质疏松症患者的股骨近端、胫骨远端和近端以及桡骨远端和近端的骨几何形状和强度的影响。
从社区招募一般健康的男性（≥45 岁），其腰椎（LS）和/或股骨近端的面积骨矿物质密度（aBMD）较低。符合条件的参与者被随机分配到每周两次监督的高强度渐进式抗阻和冲击训练（HiRIT）或监督的机器基等距轴向压缩（IAC）运动训练组。干预组的结果与匹配但未随机的对照组（CON）进行了比较，对照组自我选择了常规活动。使用 3D 髋关节软件（法国 DMS 集团）对骨骼非优势股骨近端的 DXA 扫描（Medix DR，Medilink，法国）进行分析，得出股骨颈（FN）和总髋（TH）的骨矿物质含量（BMC）、体积和体积骨矿物质密度（vBMD）用于总、小梁和皮质骨室。还确定了总 FN 皮质厚度以及前、后、侧和内侧子区。使用 Stratec 的 XCT-3000（德国）进行胫骨 4%和 38%以及桡骨 4%和 66%部位的 pQCT 扫描，以确定一系列几何形状和骨结构强度指数。使用意向治疗和方案治疗方法，通过对百分比变化的单变量 ANCOVA 以及对基线和随访数据的重复测量 ANCOVA 检查干预效果，控制初始值。
招募了 93 名男性（67.1±7.5 岁，175.2±6.7 厘米，82.1±11.6 千克，26.7±3.5 千克/米），其平均 aBMD 较低（LS T 评分-0.06±1.04，FN T 评分-1.58±0.58，TH T 评分-1.00±0.58），并指定 CON（n=26）或随机分配到 HiRIT（n=34）或 IAC（n=33）。对监督运动方案的依从性没有差异（HiRIT 77.8±16.6%与 IAC 78.5±14.8%，p=0.872）。与 CON（5.6±1.7%对-0.1±1.9%，p=0.028）和 IAC（5.6±1.7%对 0.7±1.7%，p=0.044）相比，HiRIT 改善了内侧 FN 皮质厚度。与 HiRIT 和 IAC 相比，CON 远端胫骨总 BMC、vBMD、面积和骨强度指数以及小梁 BMC 和骨强度指数均下降（均 p<0.05）。与 CON 相比，HiRIT 维持了远端胫骨小梁面积（0.2±0.5%对-1.6±0.5%，p=0.013）。与 CON 相比，HiRIT 和 IAC 维持了远端桡骨总 BMC（-0.1±0.7%对-3.7±0.8%，p=0.001；1.3±0.7%对-3.7±0.8%，p<0.001）。与 CON 相比，HiRIT 和 IAC 维持了远端桡骨总骨强度指数（1.4±1.4%对-6.0±1.6%，p=0.001；0.2±1.3%对-6.0±1.6%，p=0.004）。与 CON（3.1±1.0%对 1.1±1.2%，p=0.011）和 IAC（3.1±1.0%对-0.2±1.0%，p=0.042）相比，HiRIT 减少了近端桡骨皮质面积。在骨干胫骨 38%部位，未检测到任何 pQCT 衍生的骨结果在组间存在差异。
研究结果表明，与监督 IAC 运动相比，监督 HiRIT 对股骨内侧 FN 的皮质骨提供了积极刺激，并且 HiRIT 和 IAC 都可以维持远端胫骨和远端桡骨的骨强度。这些效果可能会降低中年和老年男性低骨量患者下肢和上肢骨折的风险。
