Department of Kinesiology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
College of Kinesiology, University of Saskatchewan, Saskatoon, SK, S7N 5B2, Canada.
Sports Med. 2021 Jun;51(6):1273-1292. doi: 10.1007/s40279-021-01432-x. Epub 2021 Apr 29.
Exercise is commonly recommended to prevent and manage osteoporosis. High magnitude strains at rapid rate and short bouts should theoretically elicit an osteogenic response; however, the effects of different levels of impact exercises on several outcomes in people at risk of fracture are still unknown.
To report the effect of impact exercise on falls, fractures, adverse events, mortality, bone mineral density (BMD), physical functioning, and health-related quality of life (QoL).
We included randomized controlled trials testing the effect of impact exercise compared with a non-exercise control on outcomes in adults ≥ 50 years with low BMD or fragility fractures. Two reviewers selected studies and extracted data. Where possible, we pooled outcomes using mean difference (MD) with a fixed-effects model and 95% confidence interval (CI). We reported risk of bias using Cochrane and certainty of evidence using GRADE.
We included 29 trials; 19 studies evaluated impact exercise alone, and the remaining trials combined impact with resistance or balance training. Impact exercise alone or combined with resistance training improved Timed Up-and-Go values (MD - 0.95 s, 95% CI - 1.09 to - 0.81, low certainty evidence) and lumbar spine (MD 0.04 g/cm, 95% CI 0.02-0.06, low certainty evidence) and femoral neck BMD (MD 0.04 g/cm, 95% CI 0.02-0.07, low certainty evidence). Impact exercise did not improve health-related QoL assessed with QUALEFFO-41 (MD 0.06, 95% CI - 2.18 to 2.30, moderate certainty evidence). The effects of impact exercise on falls, fractures, and mortality are uncertain due to insufficient data. Many trials had a high risk of bias for two or more items.
There is low certainty evidence that impact exercise may improve physical function and BMD in people at risk of fracture. The effect of impact exercises on falls, fractures, and mortality remains unclear. Our findings should be interpreted with caution due to risk of bias and small sample sizes.
Registered in Prospero (CRD42018115579) on January 30, 2019.
运动通常被推荐用于预防和治疗骨质疏松症。高幅度、快速率和短时间的应变理论上应该引起成骨反应；然而，不同水平的冲击运动对骨折风险人群的多种结果的影响仍不清楚。
报告冲击运动对跌倒、骨折、不良事件、死亡率、骨密度（BMD）、身体功能和健康相关生活质量（QoL）的影响。
我们纳入了随机对照试验，这些试验测试了与非运动对照组相比，冲击运动对 50 岁以上低 BMD 或脆性骨折的成年人的影响。两位审查员选择了研究并提取了数据。在可能的情况下，我们使用固定效应模型和 95%置信区间（CI）来汇总结果。我们使用 Cochrane 评估偏倚风险，使用 GRADE 评估证据确定性。
我们纳入了 29 项试验；19 项研究评估了单独的冲击运动，其余的试验将冲击运动与阻力或平衡训练相结合。单独的冲击运动或与阻力训练相结合，改善了计时起立行走测试值（MD-0.95 秒，95%CI-1.09 至-0.81，低确定性证据）和腰椎（MD0.04 克/厘米，95%CI0.02-0.06，低确定性证据）和股骨颈 BMD（MD0.04 克/厘米，95%CI0.02-0.07，低确定性证据）。冲击运动对使用 QUALEFFO-41 评估的健康相关 QoL 没有改善（MD0.06，95%CI-2.18 至 2.30，中等确定性证据）。由于数据不足，冲击运动对跌倒、骨折和死亡率的影响尚不确定。许多试验在两个或更多项目上存在高偏倚风险。
有低确定性证据表明，冲击运动可能改善骨折风险人群的身体功能和 BMD。冲击运动对跌倒、骨折和死亡率的影响仍不清楚。由于偏倚风险和样本量小，我们的研究结果应谨慎解释。
于 2019 年 1 月 30 日在 Prospero（CRD42018115579）注册。
