Effects of moderate- to high-impact exercise training on bone structure across the lifespan:​ a systematic review and meta-analysis of randomized controlled trials

Ng, Carrie-Anne; Gandham, Anoohya; Mesinovic, Jakub; Owen, Patrick J.; Ebeling, Peter R.; Scott, David

Affiliations

¹Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia

²Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia

³Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Australia

⁴Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia

Abstract and keywords

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.

Keywords: AGING; BONE QCT/μCT; CLINICAL TRIALS; EXERCISE; RADIOLOGY

Links

DOI: 10.1002/jbmr.4899

PubMed: 37555459

WoS: 001060905700001

History

Received: 2023-03-14

Revised: 2023-07-19

Accepted: 2023-08-04

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