Dynamic Resistance Exercise and Bone Mineral Density at the Lumbar Spine in Postmenopausal Women: A systematic review and meta-analysis with special emphasis to exercise parameters

Kemmler W, Shojaa M, Kohl M, Schöne D, von Stengel S (2020)

Publication Type: Journal article

Publication year: 2020

Journal

DOI: 10.1055/a-1177-4031

Abstract

Exercise might be the most promising non-pharmacologic agent in fracture prevention of older people. Dynamic resistance exercise (DRT) is a recognised component of most exercise protocols, be it in fall prevention or bone strengthening exercise protocols. However, the most optimum DRT protocol to address Bone Mineral Density (BMD) in postmenopausal women has yet to be fully validated. Hence the aim of this systematic review and meta-analysis aimed (1) to determine the effect of dynamic resistance exercise (DRT) on BMD at the lumbar spine (LS) in postmenopausal women (b) to identify exercise component particularly effective to trigger favourable LS-BMD changes and (3) to derive evidence-based recommendations for optimised training protocols. A systematic review of the literature according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement included 8 different databases (PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest und Primo) without language restrictions. We included (a) controlled trials of isolated DRT with at least one exercise and one control group, (b) interventions of six months or longer, (c) BMD assessments at the LS at least before and after the study, (d) studies that focused on postmenopausal women and/or reported dedicated results for this group.Primary outcome measure for the meta-analysis was standardised mean difference (SMD) for BMD-changes at lumbar spine (LS). Further we conducted sub-analysis to determine modulators of the exercise effect on BMD using subgroup-analysis. We included 'intervention length', 'type of DRT', 'training frequency', 'exercise intensity' and 'exercise volume' split into two or three meaningful categories in the analyses. In summary, 17 articles with 20 exercise and 18 control groups were eligible. We observed a significant effect (p<.001) of moderate size (SMD: (0.59; 95%-CI: 0.26-0.92) for LS-BMD changes. Apart from one exception we did not observe significant or relevant (p<.20) differences between the categories of the given modulators. Lower training frequency (<2 sessions/week) resulted in significantly higher BMD changes at LS, however, compared to higher training frequency (≥2 sessions/week). The work provided further evidence for a significant, albeit only moderate, DRT effect on LS-BMD in postmenopausal women. We attribute this suboptimum result to the high variation within the eligible studies with trials that did not properly apply basic exercise principle in their research. Unfortunately, sub-analysis did not result in reliable data. In contrast to all present studies, lower training frequency was significantly more favourable to increase BMD at LS compared with higher training frequency. We conclude that sub-analyses of meta-analytical evaluation were unable to identify promising exercise components and thus derive optimum training protocols for bone strengthening due to the close interaction of exercise parameters.

Authors with CRIS profile

Involved external institutions

Hochschule Furtwangen Germany (DE)

How to cite

APA:

Kemmler, W., Shojaa, M., Kohl, M., Schöne, D., & von Stengel, S. (2020). Dynamic Resistance Exercise and Bone Mineral Density at the Lumbar Spine in Postmenopausal Women: A systematic review and meta-analysis with special emphasis to exercise parameters. Osteologie. https://doi.org/10.1055/a-1177-4031

MLA:

Kemmler, Wolfgang, et al. "Dynamic Resistance Exercise and Bone Mineral Density at the Lumbar Spine in Postmenopausal Women: A systematic review and meta-analysis with special emphasis to exercise parameters." Osteologie (2020).

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