Osteoporosis International

, Volume 20, Issue 4, pp 665–674 | Cite as

Maintenance of exercise-induced benefits in physical functioning and bone among elderly women

  • S. Karinkanta
  • A. Heinonen
  • H. Sievänen
  • K. Uusi-Rasi
  • M. Fogelholm
  • P. Kannus
Original Article



This study showed that about a half of the exercise-induced gain in dynamic balance and bone strength was maintained one year after cessation of the supervised high-intensity training of home-dwelling elderly women. However, to maintain exercise-induced gains in lower limb muscle force and physical functioning, continued training seems necessary.


Maintenance of exercise-induced benefits in physical functioning and bone structure was assessed one year after cessation of 12-month randomized controlled exercise intervention.


Originally 149 healthy women 70–78 years of age participated in the 12-month exercise RCT and 120 (81%) of them completed the follow-up study. Self-rated physical functioning, dynamic balance, leg extensor force, and bone structure were assessed.


During the intervention, exercise increased dynamic balance by 7% in the combination resistance and balance-jumping training group (COMB). At the follow-up, a 4% (95% CI: 1–8%) gain compared with the controls was still seen, while the exercise-induced isometric leg extension force and self-rated physical functioning benefits had disappeared. During the intervention, at least twice a week trained COMB subjects obtained a significant 2% benefit in tibial shaft bone strength index compared to the controls. A half of this benefit seemed to be maintained at the follow-up.


Exercise-induced benefits in dynamic balance and rigidity in the tibial shaft may partly be maintained one year after cessation of a supervised 12-month multi-component training in initially healthy elderly women. However, to maintain the achieved gains in muscle force and physical functioning, continued training seems necessary.


Balance training Bone strength Maintenance Physical functioning Osteoporosis Strength training 



We thank all the study participants for taking part of this study. We also thank statistician Matti Pasanen, MSc, for statistical consultation, Katriina Ojala, MSc, for physical performance measurements, and Virpi Koskue for DXA and pQCT measurements. The work was financially supported by the Finnish Ministry of Education, Medical Research Fund of the Tampere University Hospital, and the Miina Sillanpää foundation.

Conflicts of interest



  1. 1.
    Carter ND, Kannus P, Khan KM (2001) Exercise in the prevention of falls in older people: a systematic literature review examining the rationale and evidence. Sports Med 31:427–438PubMedCrossRefGoogle Scholar
  2. 2.
    Tinetti ME (2003) Preventing of falls in the elderly persons. N Engl J Med 348:42–49PubMedCrossRefGoogle Scholar
  3. 3.
    Cummings SR, Nevitt MC, Browner WS et al (1995) Risk factors for hip structure in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:814–815CrossRefGoogle Scholar
  4. 4.
    Sornay-Rendu E, Bountroy S, Munoz F et al (2007) Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: The OFELY Study. J Bone Miner Res 22:425–433PubMedCrossRefGoogle Scholar
  5. 5.
    Gillespie LD, Gillespie WJ, Robertson MC et al. (2003) Interventions for preventing falls in elderly people. The Cochrane Database of Systematic Reviews, Issue 4Google Scholar
  6. 6.
    Bonaiuti D, Shea B, Iovine R et al. (2002) Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane Database of Systematic Reviews, Issue 2Google Scholar
  7. 7.
    Liu-Ambrose T, Khan KM, Eng JJ et al (2004) Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: A 6-month randomized, controlled trial. J Am Geriatr Soc 52:657–665PubMedCrossRefGoogle Scholar
  8. 8.
    Englund U, Littbrand H, Sondell A et al (2005) A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women. Osteoporos Int 16:1117–1123PubMedCrossRefGoogle Scholar
  9. 9.
    Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J et al (2006) Effect of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30-month intervention. Osteoporos Int 17:109–118PubMedCrossRefGoogle Scholar
  10. 10.
    Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J et al (2006) Effects of exercise on extraskeletal risk factors for hip fractures in elderly women with low BMD: A population-based randomized controlled trial. J Bone Miner Res 21:772–779PubMedCrossRefGoogle Scholar
  11. 11.
    Heinonen A, Kannus P, Sievänen H et al (1999) Good maintenance of high-impact activity-induced bone gain by voluntary, unsupervised exercises: an 8-month follow-up of a randomized controlled trial. J Bone Miner Res 14:125–128PubMedCrossRefGoogle Scholar
  12. 12.
    Häkkinen K, Alen M, Kallinen M et al (2000) Neuromuscular adaptation during prolonged strength training, detraining and re-strength-training in middle-aged and elderly people. Eur J Appl Physiol 83:51–62PubMedCrossRefGoogle Scholar
  13. 13.
    Kontulainen S, Heinonen A, Kannus P et al. (2004) Former exercisers of an 18-month intervention display residual aBMD benefits compared with control women 3.5 years post-intervention: a follow-up of a randomized controlled high-impact trial. 15:248–251Google Scholar
  14. 14.
    Uusi-Rasi K, Sievänen H, Heinonen A et al (2004) Effect of discontinuation of alendronate treatment and exercise on bone mass and physical fitness: 15-month follow-up of a randomized, controlled trial. Bone 35:799–805PubMedCrossRefGoogle Scholar
  15. 15.
    Liu-Ambrose TY, Khan KM, Eng JJ et al (2005) The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: Follow-up after withdrawal of exercise. J Am Geriatr Soc 53:1767–1773PubMedCrossRefGoogle Scholar
  16. 16.
    Karinkanta S, Heinonen A, Sievänen H et al (2007) A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 18:453–462PubMedCrossRefGoogle Scholar
  17. 17.
    Ainsworth BE, Hashell WL, Whitt MC et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–S516PubMedCrossRefGoogle Scholar
  18. 18.
    Carter ND, Khan KM, McKay HA et al (2002) Community-based exercise program reduces risk factors for falls in 65- to 75-year old women with osteoporosis: randomized controlled trial. CMAJ 167:997–1004PubMedGoogle Scholar
  19. 19.
    Uusi-Rasi K, Kannus P, Cheng S et al (2003) Effect of alendronate and exercise on bone and physical performance of postmenopausal women: a randomized controlled trial. Bone 33:132–143PubMedCrossRefGoogle Scholar
  20. 20.
    Heinonen A, Sievänen H, Viitasalo J et al (1994) Reproducibility of computer measurement of maximal isometric strength and electromyography in sedentary middle-aged women. Eur J Appl Physiol 348:1343–1347Google Scholar
  21. 21.
    Hays RD, Donald Sherbourne C, Mazel RM (1993) The RAND 36-item Health Survey 1.0. Health Econ 2:217–227PubMedCrossRefGoogle Scholar
  22. 22.
    Aalto AM, Aro AR, Teperi J (1999) Rand-36 as a measure of health-related quality of life. Reliability, construct validity and reference values in the Finnish general population. (In Finnish with an English summary) Research Reports, The National Research and Development Center for Welfare and Health (STAKES), Helsinki, Finland, vol 101Google Scholar
  23. 23.
    Sievänen H, Kannus P, Nieminen V et al (1996) Estimation of various mechanical characteristics of human bones using dual energy x-ray absorptiometry: Methodology and precision. Bone 18:17S–27SPubMedCrossRefGoogle Scholar
  24. 24.
    Beck TJ, Looker AC, Ruff CB et al (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of third national health and nutrition examination survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304PubMedCrossRefGoogle Scholar
  25. 25.
    Nikander R, Sievänen H, Heinonen A et al (2005) Femoral neck structure in adult female athletes subjected to different loading modalities. J Bone Miner Res 20:520–528PubMedCrossRefGoogle Scholar
  26. 26.
    Sievänen H, Koskue V, Rauhio A et al (1998) Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res 13:871–882PubMedCrossRefGoogle Scholar
  27. 27.
    Wolfson L, Whipple R, Derby C et al (1996) Balance and strength training in older adults: Intervention gains and Tai Chi maintenance. J Am Geriatr Soc 44:498–506PubMedGoogle Scholar
  28. 28.
    Helbostad JL, Sletvold O, Moe-Nilssen R (2004) Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A randomized study. Aging Clin Exp Res 16:113–121PubMedGoogle Scholar
  29. 29.
    Toraman NF, Ayceman N (2005) Effects of six weeks of detraining on retention of functional fitness of old people after nine weeks of multicomponent training. Br J Sports Med 39:565–568PubMedCrossRefGoogle Scholar
  30. 30.
    Toulette C, Thevenon A, Fabre C (2006) Effects of training and detraining on the static and dynamic balance in elderly fallers and non-fallers: A pilot study. Disabil Rehabil 28(2):125–133CrossRefGoogle Scholar
  31. 31.
    Lexell J, Downham DY, Larsson Y et al (1995) Heavy-resistance training in older Scandinavian men and women: short- and long-term effects on arm and leg muscles. Scand J Med Sci Sports 5:329–341PubMedGoogle Scholar
  32. 32.
    Sforzo GA, McManis BG, Black D et al (1995) Resilience to exercise detraining in healthy older adults. J Am Geriatr Soc 43:209–215PubMedGoogle Scholar
  33. 33.
    Taaffe DR, Marcus R (1997) Dynamic muscle strength alterations to detraining and retraining in elderly men. Clin Physiol 17:311–324PubMedGoogle Scholar
  34. 34.
    Porter MM, Nelson ME, Fiatarone Singh MA et al (2002) Effects of long-term resistance training and detraining on strength and physical activity in older women. J Aging Phys Act 10:260–720Google Scholar
  35. 35.
    Trappe S, Williamson D, Godard M (2002) Maintenance of whole muscle strength and size following resistance training in older men. J Gerontol Biol Sci Med Sci 57A:B138–B143Google Scholar
  36. 36.
    Karlsson MK (2003) The skeleton in long-term perspective - Are exercise induced benefits eroded by time? J Musculoskel Neuron Interact 3:348–351Google Scholar
  37. 37.
    Dalsky GP, Stocke KS, Ehsani AA et al (1988) Weight-bearing exercise training andlumbar bone mineral content in postmenopausal women. Ann Intern Med 108:824–828PubMedGoogle Scholar
  38. 38.
    Iwamoto J, Takeda T, Ichimura S (2001) Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis. J Orthop Sci 6:128–132PubMedCrossRefGoogle Scholar
  39. 39.
    Sievänen H (2000) A physical model for dual-energy X-ray absorptiometry—derived bone mineral density. Invest Radiol 35:325–330PubMedCrossRefGoogle Scholar
  40. 40.
    Currey JD (2001) Bone strength: what are we trying to measure? Calsif Tissue Int 68:205–210CrossRefGoogle Scholar
  41. 41.
    Järvinen TLN, Kannus P, Sievänen H et al (1998) Randomized controlled study of effects of sudden impact loading on rat femur. J Bone Miner Res 13:1475–1482PubMedCrossRefGoogle Scholar
  42. 42.
    Adami S, Gatti D, Braga V et al (1999) Site-specific effects of strength training on bone structure and geometry of ultradistal radius in postmenopausal women. J Bone Miner Res 14:120–124PubMedCrossRefGoogle Scholar
  43. 43.
    Warden SJ, Fuchs RK, Castillo AB et al (2007) Exercise when young provides lifelong benefits to bone structure and strength. J Bone Miner Res 22:251–259PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • S. Karinkanta
    • 1
    • 5
  • A. Heinonen
    • 1
    • 2
  • H. Sievänen
    • 1
  • K. Uusi-Rasi
    • 1
  • M. Fogelholm
    • 1
    • 6
  • P. Kannus
    • 1
    • 3
    • 4
  1. 1.The UKK Institute for Health Promotion ResearchTampereFinland
  2. 2.Department of Health SciencesUniversity of JyväskyläJyväskyläFinland
  3. 3.Medical School, University TampereTampereFinland
  4. 4.Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and RehabilitationTampere University HospitalTampereFinland
  5. 5.Research UnitPirkanmaa Hospital DistrictTampereFinland
  6. 6.Academy of FinlandHelsinkiFinland

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