Skip to main content
Log in

Evidence for an Interaction Between Exercise and Nutrition for Improving Bone and Muscle Health

  • Nutrition, Exercise, and Lifestyle in Osteoporosis (C Weaver and S Ferrari, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Regular exercise and adequate nutrition, particularly dietary calcium, vitamin D, and protein, are prescribed as strategies to optimize peak bone mass and maintain bone and muscle health throughout life. Although the mechanism of action of exercise and nutrition on bone and muscle health are different—exercise has a site-specific modifying effect, whereas nutrition has a permissive generalized effect—there is evidence that combining calcium (or calcium rich dairy foods) or dietary protein with exercise can have a synergetic effect on bone mass and muscle health, respectively. However, many questions still remain as to whether there is a threshold level for these nutrients to optimize the exercise-induced gains. Further studies are also needed to investigate whether other dietary factors, such as vitamin D, soy isoflavones or omega-3 fatty acids, or a multinutrient supplement, can enhance the effects of exercise on bone and muscle health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Bijlsma AY, Meskers CGM, Westendorp RGJ, et al. Chronology of age-related disease definitions: osteoporosis and sarcopenia. Ageing Res Rev. 2012;11(2):320–4.

    Article  CAS  PubMed  Google Scholar 

  2. Binkley N, Buehring B. Beyond FRAX: it’s time to consider “sarco-osteopenia.”. J Clin Densitom. 2009;12(4):413–6.

    Article  PubMed  Google Scholar 

  3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Sirola J, Kroger H. Similarities in acquired factors related to postmenopausal osteoporosis and sarcopenia. J Osteoporos. 2011;2011:536735.

    PubMed Central  PubMed  Google Scholar 

  5. Specker B, Vukovich M. Evidence for an interaction between exercise and nutrition for improved bone health during growth. Med Sport Sci. 2007;51:50–63.

    Article  PubMed  Google Scholar 

  6. Koopman R, Saris WH, Wagenmakers AJ, et al. Nutritional interventions to promote post-exercise muscle protein synthesis. Sports Med. 2007;37(10):895–906.

    Article  PubMed  Google Scholar 

  7. Daly RM. Independent and combined effects of exercise and vitamin d on muscle morphology, function and falls in the elderly. Nutrients. 2010;2(9):1005–17.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Iuliano-Burns S, Saxon L, Naughton G, et al. Regional specificity of exercise and calcium during skeletal growth in girls: a randomized controlled trial. J Bone Miner Res. 2003;18(1):156–62.

    Article  PubMed  Google Scholar 

  9. Bass SL, Naughton G, Saxon L, et al. Exercise and calcium combined results in a greater osteogenic effect than either factor alone: a blinded randomized placebo-controlled trial in boys. J Bone Miner Res. 2007;22(3):458–64.

    Article  CAS  PubMed  Google Scholar 

  10. Aoe S, Toba Y, Yamamura J, et al. Controlled trial of the effects of milk basic protein (MBP) supplementation on bone metabolism in healthy adult women. Biosci Biotechnol Biochem. 2001;65(4):913–8.

    Article  CAS  PubMed  Google Scholar 

  11. Toba Y, Takada Y, Matsuoka Y, et al. Milk basic protein promotes bone formation and suppresses bone resorption in healthy adult men. Biosci Biotechnol Biochem. 2001;65(6):1353–7.

    Article  CAS  PubMed  Google Scholar 

  12. Specker B, Binkley T. Randomized trial of physical activity and calcium supplementation on bone mineral content in 3- to 5-year-old children. J Bone Miner Res. 2003;18(5):885–92.

    Article  CAS  PubMed  Google Scholar 

  13. Stear SJ, Prentice A, Jones SC, et al. Effect of a calcium and exercise intervention on the bone mineral status of 16-18-y-old adolescent girls. Am J Clin Nutr. 2003;77(4):985–92.

    CAS  PubMed  Google Scholar 

  14. Specker BL. Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res. 1996;11(10):1539–44.

    Article  CAS  PubMed  Google Scholar 

  15. Kelley GA. Aerobic exercise and bone density at the hip in postmenopausal women: a meta-analysis. Prev Med. 1998;27(6):798–807.

    Article  CAS  PubMed  Google Scholar 

  16. Devine A, Dhaliwal SS, Dick IM, et al. Physical activity and calcium consumption are important determinants of lower limb bone mass in older women. J Bone Miner Res. 2004;19(10):1634–9.

    Article  CAS  PubMed  Google Scholar 

  17. Nurzenski MK, Briffa NK, Price RI, et al. Geometric indices of bone strength are associated with physical activity and dietary calcium intake in healthy older women. J Bone Miner Res. 2007;22(3):416–24.

    Article  PubMed  Google Scholar 

  18. Uusi-Rasi K, Sievanen H, Pasanen M, et al. Influence of calcium intake and physical activity on proximal femur bone mass and structure among pre- and postmenopausal women. A 10-year prospective study. Calcif Tissue Int. 2008;82(3):171–81.

    Article  CAS  PubMed  Google Scholar 

  19. Uusi-Rasi K, Sievanen H, Pasanen M, et al. Associations of calcium intake and physical activity with bone density and size in premenopausal and postmenopausal women: a peripheral quantitative computed tomography study. J Bone Miner Res. 2002;17(3):544–52.

    Article  CAS  PubMed  Google Scholar 

  20. Uusi-Rasi K, Sievanen H, Vuori I, et al. Associations of physical activity and calcium intake with bone mass and size in healthy women at different ages. J Bone Miner Res. 1998;13(1):133–42.

    Article  CAS  PubMed  Google Scholar 

  21. Lau EM, Woo J, Leung PC, et al. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporos Int. 1992;2(4):168–73.

    Article  CAS  PubMed  Google Scholar 

  22. Prince R, Devine A, Dick I, et al. The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res. 1995;10(7):1068–75.

    Article  CAS  PubMed  Google Scholar 

  23. Prince RL, Smith M, Dick IM, et al. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med. 1991;325(17):1189–95.

    Article  CAS  PubMed  Google Scholar 

  24. Lanyon LE, Rubin CT, Baust G. Modulation of bone loss during calcium insufficiency by controlled dynamic loading. Calcif Tissue Int. 1986;38(4):209–16.

    Article  CAS  PubMed  Google Scholar 

  25. Girgis CM, Clifton-Bligh RJ, Hamrick MW, et al. The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev. 2013;34(1):33–83.

    Article  CAS  PubMed  Google Scholar 

  26. Bischoff-Ferrari HA, Willett WC, Orav EJ, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367(1):40–9.

    Article  CAS  PubMed  Google Scholar 

  27. Tang BM, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370(9588):657–66.

    Article  CAS  PubMed  Google Scholar 

  28. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Bunout D, Barrera G, Leiva L, et al. Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects. Exp Geront. 2006;41(8):746–52.

    Article  CAS  Google Scholar 

  30. Kukuljan S, Nowson CA, Bass SL, et al. Effects of a multi-component exercise program and calcium-vitamin-D3-fortified milk on bone mineral density in older men: a randomised controlled trial. Osteoporos Int. 2009;20(7):1241–51.

    Article  CAS  PubMed  Google Scholar 

  31. Kukuljan S, Nowson CA, Sanders KM, et al. Independent and combined effects of calcium-vitamin D3 and exercise on bone structure and strength in older men: an 18-month factorial design randomized controlled trial. J Clin Endocrinol Metab. 2011;96(4):955–63. This study demonstrates that a multi-modal exercise program incorporating resistance training and weight-bearing impact exercises enhanced bone health in older men, but providing additional calcium-Vitamin D to these replete men did not enhance the osteogenic response.

    Article  CAS  PubMed  Google Scholar 

  32. Kukuljan S, Nowson CA, Sanders K, et al. Effects of resistance exercise and fortified milk on skeletal muscle mass, muscle size, and functional performance in middle-aged and older men: an 18-mo randomized controlled trial. J Appl Physiol (1985). 2009;107(6):1864–73.

    Article  CAS  Google Scholar 

  33. Verschueren SM, Bogaerts A, Delecluse C, et al. The effects of whole-body vibration training and vitamin D supplementation on muscle strength, muscle mass, and bone density in institutionalized elderly women: a 6-month randomized, controlled trial. J Bone Miner Res. 2011;26(1):42–9.

    Article  CAS  PubMed  Google Scholar 

  34. Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Int Med. 2010;170(9):813–20. This factorial design trial in patients with acute hip fracture demonstrated that an extended physiotherapy program reduced falls and treatment with 2000 IU vitamin D reduced hospital re-admissions, but there was no synergetic interaction between the 2 therapies.

    Article  CAS  Google Scholar 

  35. Kerstetter JE, Allen LH. Dietary protein increases urinary calcium. J Nutr. 1990;120(1):134–6.

    CAS  PubMed  Google Scholar 

  36. Darling AL, Millward DJ, Torgerson DJ, et al. Dietary protein and bone health: a systematic review and meta-analysis. Am J Clin Nutr. 2009;90(6):1674–92.

    Article  CAS  PubMed  Google Scholar 

  37. Mangano KM, Sahni S, Kerstetter JE. Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Curr Opin Clin Nutr Metab Care. 2014;17(1):69–74.

    CAS  PubMed  Google Scholar 

  38. Calvez J, Poupin N, Chesneau C, et al. Protein intake, calcium balance and health consequences. Eur J Clin Nutr. 2012;66(3):281–95.

    Article  CAS  PubMed  Google Scholar 

  39. Breen L, Phillips SM. Nutrient interaction for optimal protein anabolism in resistance exercise. Curr Opin Clin Nutr Metab Care. 2012;15(3):226–32.

    Article  CAS  PubMed  Google Scholar 

  40. Cermak NM, Res PT, de Groot LC, et al. Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysis. Am J Clin Nutr. 2012;96(6):1454–64. This meta-analysis provides further evidence that combining protein supplementation with resistance exercise training can enhance muscle mass and strength in young and older adults compared with resistance training alone.

    Article  CAS  PubMed  Google Scholar 

  41. Chevalley T, Bonjour JP, Ferrari S, et al. High-protein intake enhances the positive impact of physical activity on BMC in prepubertal boys. J Bone Miner Res. 2008;23(1):131–42.

    Article  CAS  PubMed  Google Scholar 

  42. Ballard TL, Clapper JA, Specker BL, et al. Effect of protein supplementation during a 6-mo strength and conditioning program on insulin-like growth factor I and markers of bone turnover in young adults. Am J Clin Nutr. 2005;81(6):1442–8.

    CAS  PubMed  Google Scholar 

  43. Ballard TL, Specker BL, Binkley TL, et al. Effect of protein supplementation during a 6-month strength and conditioning program on areal and volumetric bone parameters. Bone. 2006;38(6):898–904.

    Article  CAS  PubMed  Google Scholar 

  44. Holm L, Olesen JL, Matsumoto K, et al. Protein-containing nutrient supplementation following strength training enhances the effect on muscle mass, strength, and bone formation in postmenopausal women. J Appl Physiol (1985). 2008;105(1):274–81.

    Article  CAS  Google Scholar 

  45. Umland EM, Cauffield JS, Kirk JK, et al. Phytoestrogens as therapeutic alternatives to traditional hormone replacement in postmenopausal women. Pharmacotherapy. 2000;20(8):981–90.

    Article  CAS  PubMed  Google Scholar 

  46. Chilibeck PD, Vatanparast H, Pierson R, et al. Effect of exercise training combined with isoflavone supplementation on bone and lipids in postmenopausal women: a randomized clinical trial. J Bone Miner Res. 2013;28(4):780–93. This large-scale 2-year intervention demonstrated that isoflavone supplementation combined with exercise did not enhance bone health in postmenopausal women, and in fact combining the 2 therapies may have an adverse effect on bone.

    Article  CAS  PubMed  Google Scholar 

  47. Choquette S, Riesco E, Cormier E, et al. Effects of soya isoflavones and exercise on body composition and clinical risk factors of cardiovascular diseases in overweight postmenopausal women: a 6-month double-blind controlled trial. Br J Nutr. 2011;105(8):1199–209.

    Article  PubMed  Google Scholar 

  48. Evans EM, Racette SB, Van Pelt RE, et al. Effects of soy protein isolate and moderate exercise on bone turnover and bone mineral density in postmenopausal women. Menopause. 2007;14(3 Pt 1):481–8.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Wu J, Oka J, Tabata I, et al. Effects of isoflavone and exercise on BMD and fat mass in postmenopausal Japanese women: a 1-year randomized placebo-controlled trial. J Bone Miner Res. 2006;21(5):780–9.

    Article  CAS  PubMed  Google Scholar 

  50. Calder PC, Ahluwalia N, Brouns F, et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr. 2011;106 Suppl 3:S5–78.

    Article  CAS  PubMed  Google Scholar 

  51. Kruger MC, Horrobin DF. Calcium metabolism, osteoporosis and essential fatty acids: a review. Prog Lipid Res. 1997;36(2–3):131–51.

    Article  CAS  PubMed  Google Scholar 

  52. Barbour KE, Boudreau R, Danielson ME, et al. Inflammatory markers and the risk of hip fracture: the Women’s Health Initiative. J Bone Miner Res. 2012;27(5):1167–76. This nested case control prospective study is one of the first to demonstrate that an increase in inflammatory markers is associated with an increased risk of hip fracture in older women.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Ding C, Parameswaran V, Udayan R, et al. Circulating levels of inflammatory markers predict change in bone mineral density and resorption in older adults: a longitudinal study. J Clin Endocrinol Metab. 2008;93(5):1952–8.

    Article  CAS  PubMed  Google Scholar 

  54. Schaap LA, Pluijm SM, Deeg DJ, et al. Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci. 2009;64(11):1183–9.

    Article  PubMed  Google Scholar 

  55. Verghese J, Holtzer R, Oh-Park M, et al. Inflammatory markers and gait speed decline in older adults. J Gerontol A Biol Sci Med Sci. 2011;66(10):1083–9.

    Article  PubMed  Google Scholar 

  56. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010;411(11–12):785–93.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Petersen AM, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98(4):1154–62.

    Article  CAS  PubMed  Google Scholar 

  58. Tartibian B, Hajizadeh Maleki B, Kanaley J, et al. Long-term aerobic exercise and omega-3 supplementation modulate osteoporosis through inflammatory mechanisms in post-menopausal women: a randomized, repeated measures study. Nutr Metab. 2011;8:71.

    Article  CAS  Google Scholar 

  59. Tartibian B, Maleki BH, Abbasi A. The calciotropic hormone response to omega-3 supple-mentation during long-term weight-bearing exercise training in postmenopausal women. J Sports Sci Med. 2010;9(2):245–52.

    PubMed Central  PubMed  Google Scholar 

  60. Rodacki CL, Rodacki AL, Pereira G, et al. Fish-oil supplementation enhances the effects of strength training in elderly women. Am J Clin Nutr. 2012;95(2):428–36.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

R. M. Daly has received sponsorship from Ostelin and Danone Research; research support from National Health and Medicine Research Council and Meat and Livestock Australia; and payment for the development of educational presentations from Abbott Nutrition, Fonterra, Servier, and Merck Sharpe & Dohme. R. L. Duckham and J. Gianoudis declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All studies by authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robin M. Daly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daly, R.M., Duckham, R.L. & Gianoudis, J. Evidence for an Interaction Between Exercise and Nutrition for Improving Bone and Muscle Health. Curr Osteoporos Rep 12, 219–226 (2014). https://doi.org/10.1007/s11914-014-0207-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11914-014-0207-2

Keywords

Navigation