M.d. Pinheiro1, J. Oliveira1, A. Bauman2, N. Fairhall1, W. Kwok1, C. Sherrington1
1Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Sydney, Australia, 2University of Sydney, Sydney School of Public Health, Sydney, Australia
Background: The benefits of physical activity for healthy ageing are well established and various physical activity interventions for prevention and treatment of osteoporosis have been designed and evaluated, but the effect of such interventions on the prevention of osteoporosis in older people is unclear. This review was conducted to fill this gap and assist the World Health Organization (WHO) Guideline Development Group develop the WHO guidelines on physical activity and sedentary behaviour.
Purpose: The aim of this review was to investigate the association between physical activity and osteoporosis prevention in people aged 65 years and above.
Methods: Searches were conducted in PubMed. Records were screened according to the following eligibility criteria:
i) population: adults aged 65 years and older;
ii) exposure: physical activity;
iii) comparison: no physical activity or lesser dose of physical activity;
iv) outcome: osteoporosis related measures (e.g., bone mineral density);
study design: clinical trials or longitudinal studies. We used the Prevention of Falls Network Europe (ProFANE) taxonomy to classify the physical activity and exercise programs in the included studies. The PEDro scale was used to assess the methodological quality of the included trials. Meta-analysis summarised study effects. The GRADE approach was used to rate certainty of evidence.
i) population: adults aged 65 years and older;
ii) exposure: physical activity;
iii) comparison: no physical activity or lesser dose of physical activity;
iv) outcome: osteoporosis related measures (e.g., bone mineral density);
study design: clinical trials or longitudinal studies. We used the Prevention of Falls Network Europe (ProFANE) taxonomy to classify the physical activity and exercise programs in the included studies. The PEDro scale was used to assess the methodological quality of the included trials. Meta-analysis summarised study effects. The GRADE approach was used to rate certainty of evidence.
Results: We included a total of 55 studies, including 37 trials comparing physical activity with control. Physical activity interventions probably improve bone health (pooled standardised effect size 0.15, 95% CI 0.05 to 0.25, 19 trials, moderate-certainty evidence, main outcome of the included studies) and lumbar spine bone mineral density (pooled standardised effect size 0.18, 95% CI 0.04 to 0.31, 11 trials, moderate-certainty evidence) and may improve hip (femoral neck) bone mineral density (pooled standardised effect size 0.09, 95% CI -0.03 to 0.22, 14 trials, low-certainty evidence). Higher doses of physical activity and programmes involving multiple exercise types or resistance exercise appear to be more effective.
Conclusion(s): Physical activity probably plays a role in the prevention of osteoporosis. The level of evidence is higher for lumbar spine bone mineral density. Higher dose programmes and those involving multiple exercises and resistance exercises appear to be more effective.
Implications: In light of the small effects of physical activity on bone health found in this review and the additional benefits of physical activity on other risk factors for fractures (the main clinical manifestation of osteoporosis) in older people, such as falls, poor strength and balance, it is likely that physical activity generates clinically meaningful benefits for the prevention of osteoporosis in older people. Physiotherapists should consider these findings when prescribing exercises to their patients.
Funding, acknowledgements: This review was funded by the WHO, to contribute to the guidelines on physical activity and sedentary behaviour (2020).
Keywords: Physical activity, Prevention, Osteoporosis
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: systematic review
All authors, affiliations and abstracts have been published as submitted.
