Osteoporosis International

, Volume 7, Issue 4, pp 331–337

Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women

  • A. Bérard
  • G. Bravo
  • P. Gauthier
Original Article

Abstract

A meta-analysis was done to measure the effect of physical activity on the bone mass of healthy postmenopausal women. All studies published between 1966 and 1996, in French or English, were reviewed for inclusion from Medline search, bibliographies of relevant studies, review articles and books. Studies had to be prospective intervention trials, randomized or not, evaluating the effectiveness of an exercise program of any duration, frequency and intensity, with a control group. Studies had to measure bone parameters and involve healthy postmenopausal women over 50 years of age who were free of symptomatic osteoporosis at the time of study entry. Effect sizes (ES) were calculated for each bone parameter and site measured in every eligible study according to Hedges and Olkin. DerSimonian and Laird's model was used to estimate overall effect sizes when combining studies. All analyses were bone parameter and site specific. Of 217 papers extracted from the literature, 187 did not meet eligibility criteria and 12 others were rejected. The two main reasons for rejection were that both genders were combined in the analyses and no exercise group without drag interaction was present. Eighteen studies were included for meta-analysis. Taking into account the frequency, duration, compliance rate and average age of the subjects, the programs were judged of moderate intensity and focused on walking, running, physical conditioning and aerobics. A significant effect of physical activity was detected on the bone mineral density at the L2–4 level of the lumbar column in studies published after 1991 (ES=0.8745,p<0.05). No effect could be seen, however, on forearm and femoral bone mass. Although applied to a small number of studies, this meta-analysis suggests that exercise programs in a population of postmenopausal women over 50 years of age are effective for preventing spinal bone mineral density loss at the L2–4 level. However, such programs do not have any effect on the forearm or femoral bone mass.

Keywords

Bone mass Effect size Meta-analysis Osteoporosis prevention Physical activity Postmenopausal women 

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References

  1. 1.
    Goldstein SA. The mechanical properties of trabecular bone: dependence on anatomic location and function. J Biomech 1987;20:1055–61.Google Scholar
  2. 2.
    Kennedy MA. Changes in the mechanical and electrical environment and the effect on bone. Orthopedics 1987;10:789–94.Google Scholar
  3. 3.
    Jones HH, Priest JD, Hayes WC, Tichenor CC, Nagel DA. Humeral hypertrophy in response to exercise. J Bone Joint Surg Am 1977; 59:204–8.Google Scholar
  4. 4.
    Marcus R, Cann C, Madvig P, Minkoff J, Goddard M, et al. Menstrual function and bone mass in elite women distance runners: endocrine and metabolic features. Ann Intern Med 1985;102:158–63.Google Scholar
  5. 5.
    Stillman RJ, Lohman TG, Slaughter MH, Massey BH. Physical activity and bone mineral content in women aged 30 to 85 years. Med Sci Sports Exerc 1986;18:576–80.Google Scholar
  6. 6.
    Krolner B, Toft B, Nielsen SP, Tondevold E. Physical exercise as prophylaxis against involutional vertebral bone loss: a controlled trial. Clin Sci 1983;64:541–6.Google Scholar
  7. 7.
    Simkin A, Ayalon J, Leichter I. Increased trabecular bone density due to bone-loading exercises in postmenopausal osteoporotic women. Calcif Tissue Int 1987;40:59–63.Google Scholar
  8. 8.
    Glass GV. Primary, secondary and meta-analysis of research. Educ Res 1976;5:3–8.Google Scholar
  9. 9.
    Gelber RD, Goldhirsch A. The concept of an overview of cancer clinical trials with special emphasis on early breast cancer. J Clin Oncol 1986;4:1696–703.Google Scholar
  10. 10.
    Chalmers TC, Smith H Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A. A method for assessing the quality of a randomized control trial. Controlled Clin Trials 1981; 2:31–49.Google Scholar
  11. 11.
    Hedges L, Olkin I. Statistical methods for meta-analysis. Florida: Academic Press, 1985.Google Scholar
  12. 12.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clin Trials 1986;7:177–88.Google Scholar
  13. 13.
    SAS. Version 6. Cary, NC: SAS Institute Inc., 1990.Google Scholar
  14. 14.
    Smith EL. The effect of physical activity on bone in the aged. In: BB Mazess, editor. International conference on bone mineral measurements. DHEW publication no. 93 Washington, DC: NIH, 1973.Google Scholar
  15. 15.
    Smith EL, Babcock SW. Effects of physical activity on bone loss in the aged. Med Sci Sports 1973; 5:68.Google Scholar
  16. 16.
    Smith EL, Reddan WG. The effects of physical activity on bone in the aged. Med Sci Sports 1975;7:84.Google Scholar
  17. 17.
    Sidney KH, Shephard RJ. Frequency and intensity of exercise training for elderly subjects. Med Sci Sports 1978;10:125–31.Google Scholar
  18. 18.
    White MK, Martin RB, Yeater RA, Butcher RL, Radin EL. The effects of exercise on the bones of postmenopausal women. Int Orthop 1984; 7:209–14.Google Scholar
  19. 19.
    Black-Sandier R, Cauley JA, Horn DL, Sashin D, Kriska AM. The effects of walking on the cross-sectional dimensions of the radius in postmenopausal women. Calcif Tissue Int 1987;41:65–9.Google Scholar
  20. 20.
    Smith EL, Gilligan C, McAdam M, Ensign CP, Smith PE, Deterring bone loss by exercise intervention in premenopausal and postmenopausal women. Calcif Tissue Int 1989;44:312–21.Google Scholar
  21. 21.
    Heikkinen J, Kurttila-Matero E, Kyllonen E, Vuori J, Takala T, Vaananen HK. Moderate exercise does not enhance the positive effect of estrogen on bone mineral density in postmenopausal women. Calcif Tissue Int 1991;49:S83–4.Google Scholar
  22. 22.
    Smidt GL, Lin S-Y, O'Dwyer KD, Blanpied PR. The effect of high-intensity trunk exercise on bone mineral density of postmenopausal women. Spine 1992;17:280–5.Google Scholar
  23. 23.
    Martin D, Notelovitz M. Effects of aerobic training on bone mineral density of postmenopausal women. J Bone Miner Res 1993;8:931–6.Google Scholar
  24. 24.
    Lohman T, Going S, Pamenter R, Hall M, Boyden T, Houtkooper L, et al. Effects of resistance training on regional and total bone mineral density in premenopausal women: a randomized prospective study. J Bone Miner Res 1995;10:1015–24.Google Scholar
  25. 25.
    Prince R, Devine A, Dick I, Criddle A, Kerr D, Kent N, et al. The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res 1995;10:1068–75.Google Scholar
  26. 26.
    Aloia JF, Cohn SH, Ostuni JA, Cane R, Ellis K. Prevention of involutional bone loss by exercise. Ann Intern Med 1978;89:356–8.Google Scholar
  27. 27.
    Rudgren A, Aniansson A, Ljungberg P, Wetterqvist H. Effects of a training programme for elderly people on mineral content of the heel bone. Arch Gerontol Geriatr 1984;3:243–8.Google Scholar
  28. 28.
    Cavanaugh DJ, Cann CE. Brisk walking does not stop bone loss in postmenopausal women. Bone 1988;9:201–1Google Scholar
  29. 29.
    Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ Jr. Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 1988;108:824–8.Google Scholar
  30. 30.
    Beverly MC, Rider TA, Evans MJ, Smith R. Local bone mineral response to brief exercise that stresses the skeleton. BMJ 1989;299:233–5.Google Scholar
  31. 31.
    Sinaki M, Wahner HW, Offord KP, Hodgson SF. Efficacy of nonloading exercises in prevention of vertebral bone loss in postmenopausal women: a controlled trial. Mayo Clin Proc 1989;64:762–9.Google Scholar
  32. 32.
    Rikli RE, McManis BG. Effects of exrcise on bone mineral content in postmenopausal women. Res Q Exerc Sport 1990;61:243–9.Google Scholar
  33. 33.
    Nelson ME, Fisher EC, Dilmanian FA, Dallal GE, Evans WJ. A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Nutr 1991;53:1304–11.Google Scholar
  34. 34.
    Prince RL, Smith M, Dick IM, Price RI, Garcia Webb P, Henderson K, Harris MM. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 1991 ; 325:1189–95.Google Scholar
  35. 35.
    Grove KA, Londeree BR. Bone density in postmenopausal women: high impact vs low impact exercise. Med Sci Sports Exerc 1992;24:1190–4.Google Scholar
  36. 36.
    Lau EMC, Woo J, Leung PC, Swaminathan R, Leung D. The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporosis Int 1992;2:168–73.Google Scholar
  37. 37.
    Pruitt LA, Jackson RD, Bartels RL, Lehnhard HJ. Weight-training effects on bone mineral density in early postmenopausal women. J Bone Miner Res 1992;7:179–85.Google Scholar
  38. 38.
    Bloomfield SA, Williams NI, Lamb DR, Jackson RD. Non-weightbearing exercise may increase lumbar spine bone mineral density in healthy postmenopausal women. Am J Phys Med Rehabil 1993;72:204–9.Google Scholar
  39. 39.
    Hatori M, Hasegawa A, Adachi H, Shinozaki A, Hayashi R, Okano H, et al. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcif Tissue Int 1993; 52:411–4.Google Scholar
  40. 40.
    Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial. JAMA 1994;272:1909–14.Google Scholar
  41. 41.
    Tsukahara N, Toda A, Goto J, Ezawa I. Cross-sectional and longitudinal studies on the effect of water exercise in controlling bone loss in Japanese postmenopausal women. J Nutr Sci Vitaminol 1994;40:37–47.Google Scholar
  42. 42.
    Kohrt WM, Snead DB, Slatopolsky E, Birge SJ Jr. Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women. J Bone Miner Res 1995;10:1303–11.Google Scholar
  43. 43.
    Preisinger E, Alacamlioglu Y, Pils K, Saradeth T, Schneider B. Therapeutic exercise in the prevention of bone loss: a controlled trial with women after menopause. Am J Phys Rehabil 1995;74:120–3.Google Scholar
  44. 44.
    Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 1990;132:612–28.Google Scholar
  45. 45.
    Stachenko SJ, Bravo G, Côté R, Boucher J, Battista RN. Aspirin in transient ischemic attacks and minor stroke: a meta-analysis. Fam Pract Res J 1991;11:179–91.Google Scholar
  46. 46.
    Bangert-Drowns RL. Effect of frequent classroom testing. Presented at the 67th Annual Meeting of the American Educational Research Association, San Francisco, CA, 1986.Google Scholar
  47. 47.
    Block JR, Smith R, Friedlander A, Genant HK. Preventing osteoporosis with exercise: a review with emphasis on methodology. Med Hypotheses 1989; 30:9–19.Google Scholar
  48. 48.
    Dalsky GP. Exercise: its effect on bone mineral content. Clin Obstet Gynecol 1987;30:820–32.Google Scholar
  49. 49.
    Dalsky GP. The role of exercise in the prevention of osteoporosis. Compr Ther 1989;15:30.Google Scholar
  50. 50.
    Sinaki M. Exercise and osteoporosis. Arch Phys Med Rehabil 1989;70:220–9.Google Scholar

Copyright information

© European Foundation for Osteoporosis and the National Osteoporosis Foundation 1997

Authors and Affiliations

  • A. Bérard
    • 1
  • G. Bravo
    • 2
  • P. Gauthier
    • 2
  1. 1.Centre for Clinical Epidemiology and Community Studies, SMBD—Jewish General HospitalMcGill UniversityMontrealCanada
  2. 2.Faculty of Medicine, Geriatric Research InstituteSherbrooke UniversitySherbrookeCanada

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