University of Waterloo, Waterloo, Canada.
University of Saskatchewan, Saskatoon, Canada.
Phys Ther. 2021 Feb 4;101(2). doi: 10.1093/ptj/pzaa221.
Osteoporosis clinical practice guidelines recommend exercise to prevent fractures, but the efficacy of exercise depends on the exercise types, population studied, or outcomes of interest. The purpose of this systematic review was to assess the effects of progressive resistance training (PRT) on health-related outcomes in people at risk of fracture.
Multiple databases were searched in October 2019. Eligible articles were randomized controlled trials of PRT interventions in men and women ≥50 years with low bone mineral density (BMD) or fracture history. Descriptive information and mean difference (MD) and SD were directly extracted for included trials. A total of 53 studies were included.
The effects of PRT on the total number of falls (incidence rate ratio [IRR] = 1.05; 95% CI = 0.91 - 1.21; 7 studies) and on the risk of falling (risk ratio [RR] = 1.23; 95% CI = 1.00 - 1.51; 5 studies) are uncertain. PRT improved performance on the Timed "Up and Go" test (MD = -0.89 seconds; 95% CI = -1.01 to -0.78; 13 studies) and health-related quality of life (standardized MD = 0.32; 95% CI = 0.22-0.42; 20 studies). PRT may increase femoral neck (MD = 0.02 g/cm2; 95% CI = 0.01-0.03; 521 participants, 5 studies) but not lumbar spine BMD (MD = 0.02 g/cm2; 95% CI = -0.01-0.05; 4 studies), whereas the effects on total hip BMD are uncertain (MD = 0.00 g/cm2; 95% CI = 0.00-0.01; 435 participants, 4 studies). PRT reduced pain (standardized MD = -0.26; 95% CI = -0.37 to -0.16; 17 studies). Sensitivity analyses, including PRT-only studies, confirmed these findings.
Individuals at risk of fractures should be encouraged to perform PRT, as it may improve femoral neck BMD, health-related quality of life, and physical functioning. PRT also reduced pain; however, whether PRT increases or decreases the risk of falls, the number of people experiencing a fall, or the risk of fall-related injuries is uncertain.
Individuals at risk of fractures should be encouraged to perform PRT, as it may have positive effects on femoral neck BMD, health-related quality of life, physical functioning, and pain, and adverse events are rare.
Exercise is recommended for people at risk of osteoporotic fractures. Our study showed that progressive resistance training improves physical functioning, quality of life, and reduces pain. The effects of progressive resistance training on the risk of falling are unclear. Adverse events are rare, and often minor (eg, soreness, pain, musculoskeletal injury). Considering the benefits and safety, people at risk of fractures should engage in progressive resistance training interventions.
骨质疏松临床实践指南建议进行运动以预防骨折，但运动的疗效取决于运动类型、研究人群或关注的结果。本系统评价的目的是评估渐进式抗阻训练（PRT）对有骨折风险人群的健康相关结局的影响。
2019 年 10 月在多个数据库中进行检索。符合条件的文章是针对骨密度（BMD）低或有骨折史的 50 岁及以上男性和女性进行 PRT 干预的随机对照试验。直接提取纳入试验的描述性信息和均数差（MD）和标准差（SD）。共纳入 53 项研究。
PRT 对总跌倒次数（发生率比[IRR]=1.05；95%置信区间[CI]：0.91-1.21；7 项研究）和跌倒风险（风险比[RR]=1.23；95%CI：1.00-1.51；5 项研究）的影响不确定。PRT 可改善计时“起立行走”测试（MD=-0.89 秒；95%CI：-1.01 至-0.78；13 项研究）和健康相关生活质量（标准化 MD=0.32；95%CI：0.22-0.42；20 项研究）的表现。PRT 可能增加股骨颈（MD=0.02 g/cm2；95%CI：0.01-0.03；521 名参与者，5 项研究）但不增加腰椎 BMD（MD=0.02 g/cm2；95%CI：-0.01-0.05；4 项研究），而对总髋部 BMD 的影响不确定（MD=0.00 g/cm2；95%CI：0.00-0.01；435 名参与者，4 项研究）。PRT 可减轻疼痛（标准化 MD=-0.26；95%CI：-0.37 至-0.16；17 项研究）。敏感性分析包括仅 PRT 研究，证实了这些发现。
有骨折风险的个体应鼓励进行 PRT，因为它可能会增加股骨颈 BMD、健康相关生活质量和身体机能。PRT 还可减轻疼痛；然而，PRT 是否增加或降低跌倒风险、跌倒人数或跌倒相关伤害风险尚不确定。
有骨折风险的个体应鼓励进行 PRT，因为它可能对股骨颈 BMD、健康相关生活质量、身体机能和疼痛产生积极影响，且不良事件罕见。
运动被推荐用于有骨质疏松性骨折风险的人群。我们的研究表明，渐进式抗阻训练可改善身体机能、生活质量并减轻疼痛。渐进式抗阻训练对跌倒风险的影响尚不清楚。不良事件罕见，且通常为轻微（例如，酸痛、疼痛、肌肉骨骼损伤）。考虑到益处和安全性，有骨折风险的人群应进行渐进式抗阻训练干预。
