Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials

Abstract

The purpose of the study was to assess the effects of exercise interventions with different impact loading characteristics on lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) in older adults. We searched electronic databases and hand searched selected journals up to February 2011 for randomized controlled trials (RCTs) investigating the effects of impact exercise interventions on LS and FN BMD in older adults. Exercise protocols were categorized according to impact loading characteristics. Weighted mean difference (WMD) meta-analyses were undertaken. Heterogeneity amongst trials and publication bias was tested. Random-effects models were applied. Trial quality assessment was also undertaken. Nineteen RCTs, including 1577 subjects, met the inclusion criteria. Twenty-two study group comparisons reported BMD data at the LS. Meta-analysis showed a significant change in BMD at this site (WMD 0.011 g/cm(2), 95% CI 0.003 to 0.020; p = 0.007), although results were moderately inconsistent (I(2) = 52.2%). BMD data at the FN were available from 19 study group comparisons among older adults. Results were inconsistent (I(2) = 63.6%) in showing a significant positive effect of exercise on BMD at this site (WMD 0.016 g/cm(2), 95% CI 0.005 to 0.027; p = 0.004). Combined loading studies of impact activity mixed with high-magnitude joint reaction force loading through resistance training were effective at LS (WMD 0.016 g/cm(2), 95% CI 0.002 to 0.036; p = 0.028), and no inconsistency existed among these trials. Odd-impact protocols were also effective in increasing BMD at LS (WMD 0.039 g/cm(2), 95% CI 0.002 to 0.075; p = 0.038) and FN (WMD 0.036 g/cm(2), 95% CI 0.012 to 0.061; p = 0.004), although heterogeneity was evident (I(2) = 87.5% and I(2) = 83.5%, respectively). We found consistency among results for low-impact and resistance exercise studies on LS and FN, although non-significant BMD changes were evident amongst these types of protocols at any site and amongst the RCTs that provided a combined loading impact exercise at FN. Funnel plots showed no evidence of publication bias. Trial quality was moderate to high. The findings from our meta-analysis of RCTs support the efficacy of exercise for increasing LS and FN BMD in older adults.

Fig. 1

Flow chart depicting the trial flow for selection of randomized controlled trials (RCTs) to be included

Fig. 2

Risk of bias summary

Fig. 3

Forest plot for lumbar spine BMD. Diamonds represent overall weighted mean difference (WMD, grams per square centimeter) calculated by random-effect model with 95% CI. *Absolute change values. RVT rotational vibration training, VVT vertical vibration training, d-wk days-week, H high, L low, Vib vibration, RE resistance exercise, TC Tai Chi

Fig. 4

Forest plot for femoral neck BMD. Diamonds represent overall weighted mean difference (WMD, grams per square centimeter) calculated by random-effect model with 95% CI. *Absolute change values. RE resistance exercise, AE aerobic exercise, RVT rotational vibration training, VVT vertical vibration training, H high, L low

Fig. 5

Funnel plot test exploring publication bias (random-effects model). Black circles represent the studies imputed when the trim-and-fill method was applied

Fig. 6

Funnel plot test exploring publication bias (random-effects model). Black circle represents the study imputed when the trim-and-fill method was applied