Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.
J Bone Miner Res. 2023 Nov;38(11):1612-1634. doi: 10.1002/jbmr.4899. Epub 2023 Sep 4.
Moderate- to high-impact exercise improves bone mineral density (BMD) across the lifespan, but its effects on bone structure, which predicts fracture independent of areal BMD, are unclear. This systematic review and meta-analysis investigated effects of impact exercise on volumetric BMD (vBMD) and bone structure. Four databases (PubMed, Embase, SPORTDiscus, Web of Science) were searched up to March 2022 for randomized controlled trials (RCTs) investigating the effects of impact exercise, with ground reaction forces equal to or greater than running, compared with sham or habitual activity, on bone vBMD and structure. Bone variables were measured by quantitative computed tomography or magnetic resonance imaging at the tibia, radius, lumbar spine, and femur. Percentage changes in bone variables were compared among groups using mean differences (MD) and 95% confidence intervals (CI) calculated via random effects meta-analyses. Subgroup analyses were performed in children/adolescents (<18 years), adults (18-50 years), postmenopausal women, and older men. Twenty-eight RCTs (n = 2985) were included. Across all studies, impact exercise improved trabecular vBMD at the distal tibia (MD = 0.54% [95% CI 0.17, 0.90%]), total vBMD at the proximal femur (3.11% [1.07, 5.14%]), and cortical thickness at the mid/proximal radius (1.78% [0.21, 3.36%]). There was no effect on vBMD and bone structure at the distal radius, femoral shaft, or lumbar spine across all studies or in any subgroup. In adults, impact exercise decreased mid/proximal tibia cortical vBMD (-0.20% [-0.24, -0.15%]). In postmenopausal women, impact exercise improved distal tibia trabecular vBMD (0.79% [0.32, 1.25%]). There was no effect on bone parameters in children/adolescents in overall analyses, and there were insufficient studies in older men to perform meta-analyses. Impact exercise may have beneficial effects on bone structure and vBMD at various skeletal sites, but additional high-quality RCTs in different age and sex subgroups are needed to identify optimal exercise protocols for improving bone health across the lifespan. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
中等至高冲击力的运动可以改善整个生命周期中的骨密度 (BMD)，但其对骨结构的影响（骨结构可独立于面积 BMD 预测骨折）尚不清楚。本系统评价和荟萃分析研究了冲击运动对体积 BMD (vBMD) 和骨结构的影响。四个数据库（PubMed、Embase、SPORTDiscus、Web of Science）在 2022 年 3 月之前搜索了比较冲击力运动与假运动或习惯性活动对胫骨、桡骨、腰椎和股骨的 vBMD 和结构影响的随机对照试验 (RCT)。使用定量计算机断层扫描或磁共振成像测量骨变量。通过随机效应荟萃分析计算各组之间骨变量的百分比变化，使用平均值差异 (MD) 和 95%置信区间 (CI) 进行比较。在儿童/青少年（<18 岁）、成年人（18-50 岁）、绝经后妇女和老年男性中进行了亚组分析。纳入了 28 项 RCT（n=2985）。在所有研究中，冲击运动改善了胫骨远端的小梁 vBMD（MD=0.54% [95%CI 0.17, 0.90%]）、股骨近端的总 vBMD（3.11% [1.07, 5.14%]）和桡骨中/近端的皮质厚度（1.78% [0.21, 3.36%]）。在所有研究或任何亚组中，桡骨远端、股骨干和腰椎的 vBMD 和骨结构均无影响。在成年人中，冲击运动降低了胫骨中/近端的皮质 vBMD（-0.20% [-0.24, -0.15%]）。在绝经后妇女中，冲击运动改善了胫骨远端小梁 vBMD（0.79% [0.32, 1.25%]）。在总体分析中，儿童/青少年的骨参数没有影响，在老年男性中进行荟萃分析的研究不足。冲击运动可能对各种骨骼部位的骨结构和 vBMD 有有益的影响，但需要在不同的年龄和性别亚组中进行更多高质量的 RCT，以确定改善整个生命周期骨健康的最佳运动方案。© 2023 作者。骨与矿物质研究杂志由 Wiley 期刊公司代表美国骨与矿物质研究协会 (ASBMR) 出版。
