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The Impact of Different Modes of Exercise Training on Bone Mineral Density in Older Postmenopausal Women: A Systematic Review and Meta-analysis Research


Effectiveness of exercise on bone mass is closely related to the mode of exercise training regimen, as well as the study design. This study aimed to determine the effect of different modes of exercise training on lumbar spine and femoral neck bone mineral density (BMD) in older postmenopausal women (PMW). PubMed, CINAHL, Medline, Google Scholar, and Scopus databases and reference lists of included studies were searched up until March 25, 2019 for randomized controlled trials (RCTs) that evaluated the effectiveness of various modes of exercise training in PMW. Sixteen RCTs with 1624 subjects were included. Our study found no significant change in both lumbar spine and femoral neck BMD following exercise training (MD: 0.01 g/cm2; 95% confidence interval (CI) [− 0.01, 0.02] and MD: 0.00 g/cm2; 95% CI [− 0.01, 0.01], respectively). However, subgroup analysis by type of exercise training revealed that lumbar spine BMD (MD: 0.01; 95% CI [0.00, 0.02]) raised significantly when whole-body vibration (WBV) was employed as intervention compared with RCTs that utilized aerobic (MD: − 0.01; 95% CI [− 0.02, − 0.01]), resistance (MD: 0.01; 95% CI [− 0.04, 0.06]), and combined training (MD: 0.03; 95% CI [− 0.01, 0.08]). On the other hand, lumbar spine BMD (MD: − 0.01; 95% CI [− 0.02, − 0.01]) reduced significantly when aerobic exercise training was used as intervention compared with RCTs that utilized resistance training, combined training, and WBV. By contrast, these analyses did not have significant effect on change in femoral neck BMD. WBV is an effective method to improve lumbar spine BMD in older PMW.

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  1. 1.

    Christenson E, Jiang X, Kagan R, Schnatz P (2012) Osteoporosis management in post-menopausal women. Minerva Ginecol 64(3):181–194

  2. 2.

    Lane NE (2006) Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 194(2):S3–S11

  3. 3.

    Holroyd C, Cooper C, Dennison E (2008) Epidemiology of osteoporosis. Best Pract Res Clin Endocrinol Metab 22(5):671–685

  4. 4.

    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733

  5. 5.

    Wolff I, Van Croonenborg J, Kemper H, Kostense P, Twisk J (1999) The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre-and postmenopausal women. Osteoporos Int 9(1):1–12

  6. 6.

    Gordon JL, Eisenlohr-Moul TA, Rubinow DR, Schrubbe L, Girdler SS (2016) Naturally occurring changes in estradiol concentrations in the menopause transition predict morning cortisol and negative mood in perimenopausal depression. Clin Psychol Sci 4(5):919–935

  7. 7.

    Stathopoulos KD, Katsimbri P, Atsali E, Metania E, Zoubos AB et al (2011) Age-related differences of bone mass, geometry, and strength in treatment-naive postmenopausal women. A tibia pQCT study. J Clin Densitom 14(1):33–40

  8. 8.

    Robling AG, Hinant FM, Burr DB, Turner CH (2002) Improved bone structure and strength after long-term mechanical loading is greatest if loading is separated into short bouts. J Bone Min Res 17(8):1545–1554

  9. 9.

    Rochefort G, Pallu S, Benhamou C-L (2010) Osteocyte: the unrecognized side of bone tissue. Osteoporos Int 21(9):1457–1469

  10. 10.

    Kanis J, Johnell O, Oden A, Dawson A, De Laet C et al (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12(12):989–995

  11. 11.

    Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM et al (2005) Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 90(5):2787–2793

  12. 12.

    Sazy JA, Horstmann HM (1991) Exercise participation after menopause. Clin Sports Med 10(2):359–369

  13. 13.

    Sinaki M (1989) Exercise and osteoporosis. Arch Phys Med Rehabil 70(3):220–229

  14. 14.

    Basat H, Esmaeilzadeh S, Eskiyurt N (2013) The effects of strengthening and high-impact exercises on bone metabolism and quality of life in postmenopausal women: a randomized controlled trial. J Back Musculoskelet Rehabil 26(4):427–435

  15. 15.

    Vélez-Toral M, Godoy-Izquierdo D, de Guevara NML, de Teresa Galván C, Ballesteros AS et al (2017) Improvements in health-related quality of life, cardio-metabolic health, and fitness in postmenopausal women after an exercise plus health promotion intervention: a randomized controlled trial. J Phys Act Health 14(5):336–343

  16. 16.

    Wen H, Huang T, Li T, Chong P, Ang B (2017) Effects of short-term step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass. Osteoporos Int 28(2):539–547

  17. 17.

    Marín-Cascales E, Alcaraz PE, Ramos-Campo DJ, Martinez-Rodriguez A, Chung LH et al (2018) Whole-body vibration training and bone health in postmenopausal women: a systematic review and meta-analysis. Medicine 97(34):e11918

  18. 18.

    Zhao R, Zhao M, Xu Z (2015) The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int 26(5):1605–1618

  19. 19.

    Moreira LDF, Fronza FCA, dos Santos RN, Zach PL, Kunii IS et al (2014) The benefits of a high-intensity aquatic exercise program (HydrOS) for bone metabolism and bone mass of postmenopausal women. J Bone Min Metab 32(4):411–419

  20. 20.

    Qin J, Rong X, Zhu G, Jiang Y (2018) The effects of square dancing on bone mineral density and bone turnover markers in patients with postmenopausal osteoporosis. J Mech Med Biol 18(08):1840027

  21. 21.

    Tantiwiboonchai N, Kritpet T, Yuktanandana P (2017) Effects of Muay Thai aerobic dance on biochemical bone markers and physical fitness in elderly women. J Exerc Physiol Online 20(1):188–199

  22. 22.

    Zhao R, Zhang M, Zhang Q (2017) The effectiveness of combined exercise interventions for preventing postmenopausal bone loss: a systematic review and meta-analysis. J Orthop Sports Phys Ther 47(4):241–251

  23. 23.

    Oliveira L, Oliveira R, Pires-Oliveira D (2016) Effects of whole body vibration on bone mineral density in postmenopausal women: a systematic review and meta-analysis. Osteoporos Int 27(10):2913–2933

  24. 24.

    Martyn-St James M, Carroll S (2006) High-intensity resistance training and postmenopausal bone loss: a meta-analysis. Osteoporos Int 17(8):1225–1240

  25. 25.

    Kelley GA, Kelley KS, Kohrt WM (2012) Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 13(1):177

  26. 26.

    Fratini A, Bonci T, Bull AM (2016) Whole body vibration treatments in postmenopausal women can improve bone mineral density: results of a stimulus focussed meta-analysis. PLoS ONE 11(12):e0166774

  27. 27.

    Martyn-St James M, Carroll S (2010) Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. J Bone Min Metab 28(3):251–267

  28. 28.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

  29. 29.

    Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

  30. 30.

    Smart NA, Waldron M, Ismail H, Giallauria F, Vigorito C et al (2015) Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc 13(1):9–18

  31. 31.

    Marques EA, Wanderley F, Machado L, Sousa F, Viana JL et al (2011) Effects of resistance and aerobic exercise on physical function, bone mineral density, OPG and RANKL in older women. Exp Gerontol 46(7):524–532

  32. 32.

    Pruitt LA, Taaffe DR, Marcus R (1995) Effects of a one-year high-intensity versus low-intensity resistance training program on bone mineral density in older women. J Bone Min Res 10(11):1788–1795

  33. 33.

    Rhodes E, Martin A, Taunton J, Donnelly M, Warren J et al (2000) Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. Brit J Sports Med 34(1):18–22

  34. 34.

    Verschueren SM, Roelants M, Delecluse C, Swinnen S, Vanderschueren D et al (2004) Effect of 6-month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Min Res 19(3):352–359

  35. 35.

    Chuin A, Labonté M, Tessier D, Khalil A, Bobeuf F et al (2009) Effect of antioxidants combined to resistance training on BMD in elderly women: a pilot study. Osteoporos Int 20(7):1253–1258

  36. 36.

    Santin-Medeiros F, Santos-Lozano A, Rey-Lopez JP, Vallejo NG (2015) Effects of eight months of whole body vibration training on hip bone mass in older women. Nutr Hosp 31(4):1654–1659

  37. 37.

    Brentano MA, Cadore EL, Da Silva EM, Ambrosini AB, Coertjens M et al (2008) Physiological adaptations to strength and circuit training in postmenopausal women with bone loss. J Strength Cond Res 22(6):1816–1825

  38. 38.

    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(9):1117–1123

  39. 39.

    Beck BR, Norling TL (2010) The effect of 8 mos of twice-weekly low-or higher intensity whole body vibration on risk factors for postmenopausal hip fracture. Am J Phys Med Rehabil 89(12):997–1009

  40. 40.

    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 Min Metab 26(3):254–259

  41. 41.

    Korpelainen R, Keinänen-Kiukaanniemi S, Heikkinen J, Väänänen K, Korpelainen J (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(1):109–118

  42. 42.

    Von Stengel S, Kemmler W, Engelke K, Kalender W (2011) Effects of whole body vibration on bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women. Osteoporos Int 22(1):317–325

  43. 43.

    Brooke-Wavell K, Jones P, Hardman A, Tsuritani I, Yamada Y (2001) Commencing, continuing and stopping brisk walking: effects on bone mineral density, quantitative ultrasound of bone and markers of bone metabolism in postmenopausal women. Osteoporos Int 12(7):581–587

  44. 44.

    Leung K, Li C, Tse Y, Choy T, Leung P et al (2014) Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly—a cluster-randomized controlled trial. Osteoporos Int 25(6):1785–1795

  45. 45.

    Lau E, Woo J, Leung P, Swaminathan R, Leung D (1992) The effects of calcium supplementation and exercise on bone density in elderly Chinese women. Osteoporos Int 2(4):168–173

  46. 46.

    Lord SR, Ward J, Williams P, Zivanovic E (1996) The effects of a community exercise program on fracture risk factors in older women. Osteoporos Int 6(5):361–367

  47. 47.

    Marques EA, Mota J, Carvalho J (2012) Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age 34(6):1493–1515

  48. 48.

    Nelson ME, Fisher EC, Dilmanian FA, Dallal G, Evans W (1991) A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Clin Nutr 53(5):1304–1311

  49. 49.

    Wagner H, Melhus H, Pedersen NL, Michaëlsson K (2013) Genetic influence on bone phenotypes and body composition: a Swedish twin study. J Bone Min Metab 31(6):681–689

  50. 50.

    Vainionpää A, Korpelainen R, Sievänen H, Vihriälä E, Leppäluoto J et al (2007) Effect of impact exercise and its intensity on bone geometry at weight-bearing tibia and femur. Bone 40(3):604–611

  51. 51.

    Yang P, Bruggemann G, Rittweger J (2011) What do we currently know from in vivo bone strain measurements in humans. J Musculoskelet Neuronal Interact 11(1):8–20

  52. 52.

    Al Nazer R, Lanovaz J, Kawalilak C, Johnston JD, Kontulainen S (2012) Direct in vivo strain measurements in human bone—A systematic literature review. J Biomech 45(1):27–40

  53. 53.

    Weaver CM, Teegarden D, Lyle RM, McCabe GP, McCabe LD et al (2001) Impact of exercise on bone health and contraindication of oral contraceptive use in young women. Med Sci Sports Exerc 33(6):873–880

  54. 54.

    Ryan A, Treuth M, Hunter G, Elahi D (1998) Resistive training maintains bone mineral density in postmenopausal women. Calcif Tissue Int 62(4):295–299

  55. 55.

    Liang M, Braun W, Bassin S, Dutto D, Pontello A et al (2011) Effect of high-impact aerobics and strength training on BMD in young women aged 20–35 years. Int J Sports Med 32(02):100–108

  56. 56.

    Chien M-Y, Wu Y, Hsu A-T, Yang R, Lai J (2000) Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women. Calcif Tissue Int 67(6):443–448

  57. 57.

    Yamazaki S, Ichimura S, Iwamoto J, Takeda T, Toyama Y (2004) Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis. J Bone Min Metab 22(5):500–508

  58. 58.

    Hamaguchi K, Kurihara T, Fujimoto M, Iemitsu M, Sato K et al (2017) The effects of low-repetition and light-load power training on bone mineral density in postmenopausal women with sarcopenia: a pilot study. BMC Geriatr 17(1):102

  59. 59.

    Wilhelm M, Roskovensky G, Emery K, Manno C, Valek K et al (2012) Effect of resistance exercises on function in older adults with osteoporosis or osteopenia: a systematic review. Physiother Can 64(4):386–394

  60. 60.

    Torvinen S, Kannus P, SievaÈnen H, JaÈrvinen TA, Pasanen M et al (2002) Effect of a vibration exposure on muscular performance and body balance. Randomized cross-over study. Clin Physiol Funct Imaging 22(2):145–152

  61. 61.

    Bemben DA, Palmer IJ, Bemben MG, Knehans AW (2010) Effects of combined whole-body vibration and resistance training on muscular strength and bone metabolism in postmenopausal women. Bone 47(3):650–656

  62. 62.

    Judex S, Rubin CT (2010) Is bone formation induced by high-frequency mechanical signals modulated by muscle activity? J Musculoskelet Neuronal Interact 10(1):3

  63. 63.

    Rubin C, Recker R, Cullen D, Ryaby J, McCabe J et al (2004) Prevention of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety. J Bone Min Res 19(3):343–351

  64. 64.

    Palombaro KM, Black JD, Buchbinder R, Jette DU (2013) Effectiveness of exercise for managing osteoporosis in women postmenopause. Phys Ther 93(8):1021–1025

  65. 65.

    Liu-Ambrose TY, Khan KM, Eng JJ, Heinonen A, McKay HA (2004) Both resistance and agility training increase cortical bone density in 75-to 85-year-old women with low bone mass: a 6-month randomized controlled trial. J Clin Densitom 7(4):390–398

  66. 66.

    Wang Q, Nicholson PH, Suuriniemi M, Lyytikäinen A, Helkala E et al (2004) Relationship of sex hormones to bone geometric properties and mineral density in early pubertal girls. J Clin Endocrinol Metab 89(4):1698–1703

  67. 67.

    Karinkanta S, Heinonen A, Sievänen H, Uusi-Rasi K, Pasanen M 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(4):453–462

  68. 68.

    Ammann PR, Rizzoli R (2003) Bone strength and its determinants. Osteoporos Int 14:13–18

  69. 69.

    Moayyeri A (2008) The association between physical activity and osteoporotic fractures: a review of the evidence and implications for future research. Ann Epidemiol 18(11):827–835

  70. 70.

    Kemmler W, Häberle L, Von Stengel S (2013) Effects of exercise on fracture reduction in older adults. Osteoporos Int 24(7):1937–1950

  71. 71.

    Howe TE, Shea B, Dawson LJ, Downie F, Murray A et al (2011) Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000333

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This study was not funded by any financial support.

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Correspondence to Nahid Bijeh.

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Gholam Rasul Mohammad Rahimi, Neil A. Smart, Michael T.C. Liang, Nahid Bijeh, Alsaeedi L. Albanaqi, Mehrdad Fathi, Arghavan Niyazi, Nasser Mohammad Rahimi declares that they have no conflict of interest.

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Mohammad Rahimi, G.R., Smart, N.A., Liang, M.T.C. et al. The Impact of Different Modes of Exercise Training on Bone Mineral Density in Older Postmenopausal Women: A Systematic Review and Meta-analysis Research. Calcif Tissue Int (2020). https://doi.org/10.1007/s00223-020-00671-w

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  • Postmenopausal women
  • Exercise training
  • Bone mineral density
  • Meta-analysis
  • Randomized controlled trials