Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; School of Allied Health Sciences, Griffith University, Gold Coast campus, Gold Coast, QLD, Australia; The Bone Clinic, Brisbane, QLD, Australia.
Bone. 2021 Feb;143:115697. doi: 10.1016/j.bone.2020.115697. Epub 2020 Dec 24.
Previous reviews have concluded that exercise has only modest effects on bone mineral density (BMD) in postmenopausal women. Despite the well-recognized strong positive relationship between load magnitude and bone response observed from animal research, the majority of human trials have examined the effects of only low to moderate intensity exercise on bone. We speculated that meta-analysing according to intensity may reveal a more potent exercise effect at higher intensity.
To determine the effects of low, moderate and high intensity exercise on BMD at the spine and hip in postmenopausal women.
Electronic databases and reference lists were searched for RCTs that examined the effect of exercise compared to control on DXA-derived lumbar spine, femoral neck or total hip BMD in healthy postmenopausal women. Interventions were classified as low, moderate or high intensity and pooled based on classification. Mean differences (MD) were calculated using random effects models and a risk of bias analysis was undertaken. To determine the effect of different exercise types (resistance and impact training) on BMD outcomes, subgroup analyses for all intensity categories and outcomes were conducted. Separate meta-analyses were undertaken to examine the influence of adding exercise to a bone medication intervention and to examine exercise effects on fracture risk.
Fifty-three trials, testing 63 interventions (19 low, 40 moderate, 4 high intensity) were included. At the lumbar spine, high intensity exercise yielded greater BMD effects (MD = 0.031 g/cm 95% CI [0.012, 0.049], p = 0.002) than moderate (MD = 0.012 g/cm 95% CI [0.008, 0.017], p < 0.001) and low intensity (MD = 0.010 g/cm 95% CI [0.005, 0.015], p < 0.001). Low and moderate intensity exercise was equally effective at the femoral neck (low: 0.011 g/cm 95% CI [0.006, 0.016], p < 0.001; moderate: 0.011 g/cm 95% CI [0.007, 0.015], p < 0.001), but no effect of high-intensity exercise was observed. Moderate intensity exercise increased total hip BMD (0.008 g/cm 95% CI [0.004, 0.012], p < 0.001), but low intensity did not. There were insufficient data to meta-analyse the effect of high intensity exercise at the total hip. Resistance training, potentially in combination with impact training, appears to be the most effective osteogenic stimulus at the spine and hip. Findings from meta-regression analyses were not informative and no influence of exercise on medication efficacy was observed. Risk of bias was mainly low or unclear due to insufficient information reported.
High intensity exercise is a more effective stimulus for lumbar spine BMD than low or moderate intensity, but not femoral neck BMD, however, the latter finding may be due to lack of power. While data from high-intensity exercise interventions are limited, the current comprehensive meta-analysis demonstrates the same positive relationship between load magnitude and bone response in humans that is observed in animal research. Findings have implications for optimal exercise prescription for osteoporosis in postmenopausal women.
Registered on PROSPERO (CRD42018117254).
之前的综述结论认为，运动对绝经后妇女的骨密度（BMD）只有适度的影响。尽管动物研究中观察到负荷大小与骨反应之间存在很强的正相关关系，但大多数人体试验仅研究了低强度到中等强度运动对骨骼的影响。我们推测，根据强度进行荟萃分析可能会揭示出更高强度运动的更有效作用。
确定低、中、高强度运动对绝经后妇女脊柱和髋部 BMD 的影响。
电子数据库和参考文献列表中搜索了比较运动与对照组对健康绝经后妇女 DXA 衍生的腰椎、股骨颈或总髋部 BMD 影响的 RCT。干预措施分为低、中、高强度，并根据分类进行汇总。使用随机效应模型计算均值差异（MD），并进行风险偏倚分析。为了确定不同运动类型（抗阻和冲击训练）对 BMD 结果的影响，对所有强度类别和结果进行了亚组分析。分别进行了荟萃分析，以研究在骨药物干预中添加运动的影响，并研究运动对骨折风险的影响。
纳入了 53 项试验，共检测了 63 项干预措施（19 项低强度、40 项中等强度、4 项高强度）。在腰椎部位，高强度运动对 BMD 的影响更大（MD=0.031 g/cm 95% CI [0.012, 0.049], p=0.002），高于中强度（MD=0.012 g/cm 95% CI [0.008, 0.017], p<0.001）和低强度（MD=0.010 g/cm 95% CI [0.005, 0.015], p<0.001）。低强度和中强度运动在股骨颈部位同样有效（低强度：0.011 g/cm 95% CI [0.006, 0.016], p<0.001；中强度：0.011 g/cm 95% CI [0.007, 0.015], p<0.001），但高强度运动没有效果。中强度运动增加了总髋部 BMD（0.008 g/cm 95% CI [0.004, 0.012], p<0.001），但低强度运动没有。由于缺乏数据，无法对高强度运动在总髋部的效果进行荟萃分析。抗阻训练，可能与冲击训练相结合，似乎是脊柱和髋部最有效的成骨刺激。荟萃回归分析的结果没有提供信息，也没有观察到运动对药物疗效的影响。由于报告的信息不足，风险偏倚主要为低或不明确。
高强度运动对腰椎 BMD 的刺激作用强于低强度或中强度运动，但对股骨颈 BMD 没有影响，但后者可能是由于缺乏力量。虽然高强度运动干预的数据有限，但目前的综合荟萃分析表明，在人类中观察到的负荷大小与骨反应之间的正相关关系与动物研究相同。这些发现对绝经后妇女骨质疏松症的最佳运动处方具有重要意义。
在 PROSPERO（CRD42018117254）上注册。
