Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Research and Writing Group on Austria/Germany/Suisse S3 Guideline "Exercise and Fracture Prevention", Bonn, Germany.
Osteoporos Int. 2022 Aug;33(8):1643-1657. doi: 10.1007/s00198-022-06329-7. Epub 2022 Mar 18.
The primary objective of the present systematic review and meta-analysis was to determine the effect of differing exercise intensity on (areal) bone mineral density (BMD) at lumbar spine and hip in adults by a comparative meta-analysis.
A systematic review of the literature according to the PRISMA statement included: (a) exercise trials, (b) with ≥two study arms that compared different exercise intensities, (c) intervention ≥6 months, (d) BMD assessments at lumbar spine (LS) or hip. Five electronic databases were scanned without language restrictions up to July 2021. The present analysis of exercise intensity was conducted as a mixed-effect meta-analysis and applied "type of exercise" and "study duration" as moderator in subgroup analyses. Outcome measures were standardized mean differences (SMD) for BMD changes at the LS, and hip.
Eleven exercise studies with 26 study arms were included. Although the effect of high-intensity exercise was more pronounced on LS-BMD (SMD: 0.19, 95%-CI: 0.61 to -0.23) and hip-ROI (0.17, 0.38 to -0.04), we did not observe significant differences between the groups (LS-BMD: p=0.373 and hip-BMD: p=0.109). We observed a substantial level of heterogeneity between the trials for LS- but not for hip-BMD. Applying "type of exercise" and "study duration" as moderators did not significantly modify the differences between low and high exercise intensity on BMD at LS or hip.
There is insufficient evidence for a superior effect of high-intensity exercise on areal BMD at lumbar spine and hip in people aged 50 years and older. Varying exercise intensity with periods of lower exercise intensity intermitted by higher intensity might be a promising option to address the issue of exercise intensities in intervention studies.
本系统评价和荟萃分析的主要目的是通过比较荟萃分析来确定不同运动强度对成年人腰椎和髋部（面积）骨密度（BMD）的影响。
根据 PRISMA 声明进行系统文献回顾，包括：(a) 运动试验，(b) 比较不同运动强度的至少有两个研究组，(c) 干预时间≥6 个月，(d) 腰椎（LS）或髋部的 BMD 评估。在 2021 年 7 月之前，无语言限制地扫描了五个电子数据库。本分析中运动强度的分析采用混合效应荟萃分析，并将“运动类型”和“研究持续时间”作为亚组分析的调节因素。主要结局指标为 LS 和髋部 BMD 变化的标准化均数差（SMD）。
纳入了 11 项运动研究，共有 26 个研究组。尽管高强度运动对 LS-BMD（SMD：0.19，95%CI：0.61 至-0.23）和髋部 ROI（0.17，0.38 至-0.04）的影响更为明显，但我们未观察到两组之间的差异有统计学意义（LS-BMD：p=0.373，髋部 BMD：p=0.109）。我们观察到试验之间 LS-BMD 存在很大的异质性，但髋部 BMD 则没有。应用“运动类型”和“研究持续时间”作为调节因素并没有显著改变低强度和高强度运动对 LS 或髋部 BMD 的差异。
在 50 岁及以上人群中，高强度运动对腰椎和髋部面积 BMD 的效果没有足够的证据表明优于低强度运动。在干预研究中，采用低强度运动和高强度运动间歇的方式来改变运动强度可能是一个有前途的选择。
