Calcified Tissue International

, Volume 88, Issue 2, pp 117–129 | Cite as

Multicomponent Training Program with Weight-Bearing Exercises Elicits Favorable Bone Density, Muscle Strength, and Balance Adaptations in Older Women

  • Elisa A. MarquesEmail author
  • Jorge Mota
  • Leandro Machado
  • Filipa Sousa
  • Margarida Coelho
  • Pedro Moreira
  • Joana Carvalho


Physical exercise is advised as a preventive and therapeutic strategy against aging-induced bone weakness. In this study we examined the effects of 8-month multicomponent training with weight-bearing exercises on different risk factors of falling, including muscle strength, balance, agility, and bone mineral density (BMD) in older women. Participants were randomly assigned to either an exercise-training group (ET, n = 30) or a control group (CON, n = 30). Twenty-seven subjects in the ET group and 22 in the CON group completed the study. Training was performed twice a week and was designed to load bones with intermittent and multidirectional compressive forces and to improve physical function. Outcome measures included lumbar spine and proximal femoral BMD (by dual X-ray absorptiometry), muscle strength, balance, handgrip strength, walking performance, fat mass, and anthropometric data. Potential confounding variables included dietary intake, accelerometer-based physical activity, and molecularly defined lactase nonpersistence. After 8 months, the ET group decreased percent fat mass and improved handgrip strength, postural sway, strength on knee flexion at 180°/s, and BMD at the femoral neck (+2.8%). Both groups decreased waist circumference and improved dynamic balance, chair stand performance, strength on knee extension for the right leg at 180°/s, and knee flexion for both legs at 60°/s. No associations were found between lactase nonpersistence and BMD changes. Data suggest that 8 months of moderate-impact weight-bearing and multicomponent exercises reduces the potential risk factors for falls and related fractures in older women.


Bone density Weight-bearing exercise Age Dual-energy X-ray absorptiometry Mechanical loading 



The authors thank Joana Campos for her kind support in genotyping assays and Norton Oliveira for his kind help in isokinetic strength tests. This research was funded by the Portuguese Foundation of Science and Technology, grant FCOMP-01-0124-FEDER-009587—PTDC/DES/102094/2008. E. A. M. and J. M. are supported by grants from the Portuguese Foundation of Science and Technology (SFRH/BD/36319/2007 and SFRH/BSAB/1025/2010, respectively).


  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 the evidence. Sports Med 31:427–438CrossRefPubMedGoogle Scholar
  2. 2.
    Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893CrossRefPubMedGoogle Scholar
  3. 3.
    Peeters G, van Schoor NM, Lips P (2009) Fall risk: the clinical relevance of falls and how to integrate fall risk with fracture risk. Best Pract Res Clin Rheumatol 23:797–804CrossRefPubMedGoogle Scholar
  4. 4.
    Howe TE, Rochester L, Jackson A, Banks PM, Blair VA (2007) Exercise for improving balance in older people. Cochrane Database Syst Rev:CD004963Google Scholar
  5. 5.
    Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2009) WITHDRAWN: interventions for preventing falls in elderly people. Cochrane Database Syst Rev:CD000340Google Scholar
  6. 6.
    Karinkanta S, Heinonen A, Sievanen H, Uusi-Rasi K, Pasanen M, Ojala K, Fogelholm M, Kannus P (2007) A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 18:453–462CrossRefPubMedGoogle Scholar
  7. 7.
    Niu K, Ahola R, Guo H, Korpelainen R, Uchimaru J, Vainionpaa A, Sato K, Sakai A, Salo S, Kishimoto K, Itoi E, Komatsu S, Jamsa T, Nagatomi R (2010) Effect of office-based brief high-impact exercise on bone mineral density in healthy premenopausal women: the Sendai Bone Health Concept Study. J Bone Miner Metab 28:568–577CrossRefPubMedGoogle Scholar
  8. 8.
    Vainionpaa A, Korpelainen R, Vihriala E, Rinta-Paavola A, Leppaluoto J, Jamsa T (2006) Intensity of exercise is associated with bone density change in premenopausal women. Osteoporos Int 17:455–463CrossRefPubMedGoogle Scholar
  9. 9.
    Kung AW, Huang QY (2007) Genetic and environmental determinants of osteoporosis. J Musculoskelet Neuronal Interact 7:26–32PubMedGoogle Scholar
  10. 10.
    Daly RM, Ahlborg HG, Ringsberg K, Gardsell P, Sernbo I, Karlsson MK (2008) Association between changes in habitual physical activity and changes in bone density, muscle strength, and functional performance in elderly men and women. J Am Geriatr Soc 56:2252–2260CrossRefPubMedGoogle Scholar
  11. 11.
    Harris TJ, Owen CG, Victor CR, Adams R, Ekelund U, Cook DG (2009) A comparison of questionnaire, accelerometer, and pedometer: measures in older people. Med Sci Sports Exerc 41:1392–1402CrossRefPubMedGoogle Scholar
  12. 12.
    Englund U, Littbrand H, Sondell A, Pettersson U, Bucht G (2005) A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women. Osteoporos Int 16:1117–1123CrossRefPubMedGoogle Scholar
  13. 13.
    Ebrahim S, Thompson PW, Baskaran V, Evans K (1997) Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Age Ageing 26:253–260CrossRefPubMedGoogle Scholar
  14. 14.
    Obermayer-Pietsch BM, Bonelli CM, Walter DE, Kuhn RJ, Fahrleitner-Pammer A, Berghold A, Goessler W, Stepan V, Dobnig H, Leb G, Renner W (2004) Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res 19:42–47CrossRefPubMedGoogle Scholar
  15. 15.
    Enattah N, Pekkarinen T, Valimaki MJ, Loyttyniemi E, Jarvela I (2005) Genetically defined adult-type hypolactasia and self-reported lactose intolerance as risk factors of osteoporosis in Finnish postmenopausal women. Eur J Clin Nutr 59:1105–1111CrossRefPubMedGoogle Scholar
  16. 16.
    Enattah NS, Sulkava R, Halonen P, Kontula K, Jarvela I (2005) Genetic variant of lactase-persistent C/T-13910 is associated with bone fractures in very old age. J Am Geriatr Soc 53:79–82CrossRefPubMedGoogle Scholar
  17. 17.
    Rikli RE, Jones CJ (1999) Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Activ 7:129–161Google Scholar
  18. 18.
    Bohannon RW (1994) One-legged balance test times. Percept Mot Skills 78:801–802PubMedGoogle Scholar
  19. 19.
    Copeland JL, Esliger DW (2009) Accelerometer assessment of physical activity in active, healthy older adults. J Aging Phys Act 17:17–30PubMedGoogle Scholar
  20. 20.
    Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 41:1510–1530CrossRefPubMedGoogle Scholar
  21. 21.
    Tamura K, Dudley J, Nei M, Kumar S (2007) MEGA4: Molecular Evolutionary Genetics Analysis (MEGA) software version 4.0. Mol Biol Evol 24:1596–1599CrossRefPubMedGoogle Scholar
  22. 22.
    Mazumdar S, Liu KS, Houck PR, Reynolds CF 3rd (1999) Intent-to-treat analysis for longitudinal clinical trials: coping with the challenge of missing values. J Psychiatr Res 33:87–95CrossRefPubMedGoogle Scholar
  23. 23.
    Hourigan SR, Nitz JC, Brauer SG, O’Neill S, Wong J, Richardson CA (2008) Positive effects of exercise on falls and fracture risk in osteopenic women. Osteoporos Int 19:1077–1086CrossRefPubMedGoogle Scholar
  24. 24.
    Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56:2234–2243CrossRefPubMedGoogle Scholar
  25. 25.
    Carvalho MJ, Marques E, Mota J (2008) Training and detraining effects on functional fitness after a multicomponent training in older women. Gerontology 55:41–48CrossRefPubMedGoogle Scholar
  26. 26.
    Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, Robbins AS (2000) Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. J Gerontol A Biol Sci Med Sci 55:M317–M321PubMedGoogle Scholar
  27. 27.
    Pluijm SMF, Smit JH, Tromp EAM, Stel VS, Deeg DJH, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17:417–425CrossRefPubMedGoogle Scholar
  28. 28.
    Robbins JA, Schott AM, Garnero P, Delmas PD, Hans D, Meunier PJ (2005) Risk factors for hip fracture in women with high BMD: EPIDOS study. Osteoporos Int 16:149–154CrossRefPubMedGoogle Scholar
  29. 29.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev:CD007146Google Scholar
  30. 30.
    Park H, Kim KJ, Komatsu T, Park SK, Mutoh Y (2008) Effect of combined exercise training on bone, body balance, and gait ability: a randomized controlled study in community-dwelling elderly women. J Bone Miner Metab 26:254–259CrossRefPubMedGoogle Scholar
  31. 31.
    Marques E, Carvalho J, Soares JM, Marques F, Mota J (2009) Effects of resistance and multicomponent exercise on lipid profiles of older women. Maturitas 63:84–88CrossRefPubMedGoogle Scholar
  32. 32.
    Burr DB, Robling AG, Turner CH (2002) Effects of biomechanical stress on bones in animals. Bone 30:781–786CrossRefPubMedGoogle Scholar
  33. 33.
    Hsieh YF, Wang T, Turner CH (1999) Viscoelastic response of the rat loading model: implications for studies of strain-adaptive bone formation. Bone 25:379–382CrossRefPubMedGoogle Scholar
  34. 34.
    Lanyon L, Skerry T (2001) Postmenopausal osteoporosis as a failure of bone’s adaptation to functional loading: a hypothesis. J Bone Miner Res 16:1937–1947CrossRefPubMedGoogle Scholar
  35. 35.
    Priemel M, Schilling AF, Haberland M, Pogoda P, Rueger JM, Amling M (2002) Osteopenic mice: animal models of the aging skeleton. J Musculoskelet Neuronal Interact 2:212–218PubMedGoogle Scholar
  36. 36.
    Cheng S, Sipila S, Taaffe DR, Puolakka J, Suominen H (2002) Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women. Bone 31:126–135CrossRefPubMedGoogle Scholar
  37. 37.
    Kemmler W, Lauber D, Weineck J, Hensen J, Kalender W, Engelke K (2004) Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS). Arch Intern Med 164:1084–1091CrossRefPubMedGoogle Scholar
  38. 38.
    Vainionpaa A, Korpelainen R, Leppaluoto J, Jamsa T (2005) Effects of high-impact exercise on bone mineral density: a randomized controlled trial in premenopausal women. Osteoporos Int 16:191–197CrossRefPubMedGoogle Scholar
  39. 39.
    Sugiyama T, Yamaguchi A, Kawai S (2002) Effects of skeletal loading on bone mass and compensation mechanism in bone: a new insight into the “mechanostat” theory. J Bone Miner Metab 20:196–200CrossRefPubMedGoogle Scholar
  40. 40.
    Jessup JV, Horne C, Vishen RK, Wheeler D (2003) Effects of exercise on bone density, balance, and self-efficacy in older women. Biol Res Nurs 4:171–180CrossRefPubMedGoogle Scholar
  41. 41.
    Stewart KJ, Bacher AC, Hees PS, Tayback M, Ouyang P, Jan de Beur S (2005) Exercise effects on bone mineral density relationships to changes in fitness and fatness. Am J Prev Med 28:453–460CrossRefPubMedGoogle Scholar
  42. 42.
    Frost HM (1986) Intermediary organization of the skeleton. CRC Press, Boca Raton, FLGoogle Scholar
  43. 43.
    Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993) Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 341:72–75CrossRefPubMedGoogle Scholar
  44. 44.
    Bass SL, Eser P, Daly R (2005) The effect of exercise and nutrition on the mechanostat. J Musculoskelet Neuronal Interact 5:239–254PubMedGoogle Scholar
  45. 45.
    Bacsi K, Kosa JP, Lazary A, Balla B, Horvath H, Kis A, Nagy Z, Takacs I, Lakatos P, Speer G (2009) LCT 13910 C/T polymorphism, serum calcium, and bone mineral density in postmenopausal women. Osteoporos Int 20:639–645CrossRefPubMedGoogle Scholar
  46. 46.
    Watts NB (2004) Fundamentals and pitfalls of bone densitometry using dual-energy X-ray absorptiometry (DXA). Osteoporos Int 15:847–854CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Elisa A. Marques
    • 1
    Email author
  • Jorge Mota
    • 1
  • Leandro Machado
    • 2
  • Filipa Sousa
    • 2
  • Margarida Coelho
    • 3
  • Pedro Moreira
    • 1
    • 4
  • Joana Carvalho
    • 1
  1. 1.Research Centre in Physical Activity, Health and Leisure, Faculty of SportUniversity of PortoPortoPortugal
  2. 2.Centre of Research, Education, Innovation and Intervention in SportUniversity of PortoPortoPortugal
  3. 3.Institute of Molecular Pathology and ImmunologyUniversity of PortoPortoPortugal
  4. 4.Faculty of Nutrition and Food SciencesUniversity of PortoPortoPortugal

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