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Does exercise affect bone mineral density and content when added to a calorie-restricted diet? A systematic review and meta-analysis of controlled clinical trials

Abstract

The effects of exercise in conjunction with weight-loss diets on bone health are mixed. Our objective was to systematically review and meta-analyze controlled clinical trials in adults investigating the addition of exercise to a weight-loss diet compared with a calorie-matched weight-loss diet without exercise on bone measures. Online databases including PubMed/MEDLINE, EMBASE, ISI (Web of Science), Scopus, and Google Scholar were searched up to April 2021 with no restriction. A random effects model was used to calculate the overall estimates. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Fourteen eligible controlled clinical trials were included in the systematic review. The meta-analysis revealed that, compared to weight-loss diets alone, the addition of exercise did not improve total body bone mineral density (BMD) [weighted mean difference (WMD) = 0.002 g/cm2, P = 0.62, n = 8], lumbar BMD (WMD = 0.007 g/cm2, P = 0.44, n = 9), total hip BMD (WMD = 0.015 g/cm2, P = 0.14, n = 4) and total bone mineral content (BMC) (WMD =  − 11.97 g, P = 0.29, n = 7). Subgroup analysis revealed that resistance exercise in conjunction with hypocaloric diets positively affects total BMD compared to an energy restrictive diet alone (WMD = 0.01 g/cm2, P = 0.003, n = 3). Overall, it appears that only resistance exercise beneficially affects total BMD during a calorie-restricted diet in adults. Further well-controlled and long-term clinical trials are still needed to confirm these results. PROSPERO registration number: CRD42020173434.

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Fig. 1
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Data availability

All generated or analyzed data are included in this article, its supplementary file, and protocol [22].

Abbreviations

BMD:

Bone mineral density

BMC:

Bone mineral content

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PROSPERO:

Prospective Register of Systematic Reviews

MeSH:

Medical Subject Headings

WHO:

World Health Organization

BMI:

Body mass index

SD:

Standard deviation

GRADE:

Grading of Recommendations Assessment, Development and Evaluation

SE:

Standard error

WMD:

Weighted mean difference

CIs:

Confidence intervals

I2 :

I-squared

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Acknowledgements

The authors would like to thank the research council of Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences for scientific support of the present study.

Funding

The present systematic review was financially supported by Nutrition and Food Security research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

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Correspondence to Amin Salehi-Abargouei.

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Yazdanpanah, Z., Beigrezaei, S., Mohseni-Takalloo, S. et al. Does exercise affect bone mineral density and content when added to a calorie-restricted diet? A systematic review and meta-analysis of controlled clinical trials. Osteoporos Int (2021). https://doi.org/10.1007/s00198-021-06187-9

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Keywords

  • Bone mineral content
  • Bone mineral density
  • Diet
  • Exercise
  • Meta-analysis
  • Weight loss