Skip to main content

Effects of Exercise on Bone Status in Female Subjects, from Young Girls to Postmenopausal Women: An Overview of Systematic Reviews and Meta-Analyses

Sports Medicine volume 46, pages 1165–1182 (2016)Cite this article

Abstract

Background

Osteoporosis and postmenopausal bone loss pose a huge social and economic burden worldwide. Regular exercise and physical activity are effective interventions for maximizing or maintaining peak bone mass and preventing bone loss in the elderly; however, most recommendations are addressed to the general public and lack specific indications for girls and women, the segment of the population most at risk for developing osteoporosis.

Objective

The aim of this overview of systematic reviews and meta-analyses was to summarize current evidence for the effects of exercise and physical activity interventions on bone status in girls and women, and to explore whether specific exercise programs exist for improving or maintaining bone mass or bone strength in females.

Methods

The PubMed, EMBASE, PEDro, and Cochrane Library databases were searched from January 2009, updated to 22 June 2015, using the following groups of search terms: (i) ‘physical activity’ and ‘exercise’; and (ii) ‘bone’, ‘bone health’, ‘bone strength’, ‘bone structure’, ‘bone metabolism’, ‘bone turnover’, and ‘bone biomarkers’. Searches and screening were limited to systematic reviews or meta-analyses of studies in females and published in English. Our final analysis included 12 articles that met the inclusion criteria.

Results

Combined-impact exercise protocols (impact exercise with resistance training) are the best choice to preserve/improve bone mineral density in pre- and postmenopausal women. Peak bone mass in young girls can be improved with short bouts of school-based high-impact plyometric exercise programs. Whole-body vibration exercises have no beneficial effects on bone in postmenopausal or elderly women.

Conclusions and Implications

Lifelong exercise, specific for age, is an effective way to sustain bone health in girls and women.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 49.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. World Health Organization. Physical inactivity: a global public health problem. 2014. Available at: http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/. Accessed July 2014.

  2. US Department of Health and Human Services. 2008 physical activity guidelines for Americans. Washington, DC: US Department of Health and Human Services; 2008.

    Google Scholar 

  3. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402–7.

    CAS  Article  PubMed  Google Scholar 

  4. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–30.

    Article  PubMed  Google Scholar 

  6. US Department of Health and Human Services. Bone health and osteoporosis: a report of the Surgeon General. Rockville (MD): US Department of Health and Human Services, Office of the Surgeon General; 2004.

  7. Karsenty G, Ferron M. The contribution of bone to whole-organism physiology. Nature. 2012;481(7381):314–20.

    CAS  Article  PubMed  Google Scholar 

  8. Banfi G, Lombardi G, Colombini A, et al. Bone metabolism markers in sports medicine. Sports Med. 2010;40(8):697–714.

    Article  PubMed  Google Scholar 

  9. Lombardi G, Perego S, Luzi L, et al. A four-season molecule: osteocalcin. Updates in its physiological roles. Endocrine. 2015;48(2):394–404.

    CAS  Article  PubMed  Google Scholar 

  10. National Osteoporosis Foundation. Clinician’s gudie to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014.

    Google Scholar 

  11. Ishikawa S, Kim Y, Kang M, et al. Effects of weight-bearing exercise on bone health in girls: a meta-analysis. Sports Med. 2013;43(9):875–92.

    Article  PubMed  Google Scholar 

  12. Babatunde OO, Forsyth JJ, Gidlow CJ. A meta-analysis of brief high-impact exercises for enhancing bone health in premenopausal women. Osteoporos Int. 2012;23(1):109–19.

    CAS  Article  PubMed  Google Scholar 

  13. Martyn-St James M, Carroll S. Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. J Bone Miner Metab. 2010;28(3):251–67.

  14. Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2011;(7):CD000333.

  15. World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.

    Google Scholar 

  16. Kohrt WM, Bloomfield SA, Little KD, et al. American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc. 2004;36(11):1985–96.

    Article  PubMed  Google Scholar 

  17. National Institute of Health. Osteoporosis prevention, diagnosis, and therapy. NIH Consens Statement. 2000;17(1):1–36.

    Google Scholar 

  18. OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. 2011. Available at: http://www.cebm.net/index.aspx?o=5653. Accessed May 2014.

  19. Hagen KB, Dagfinrud H, Moe RH, et al. Exercise therapy for bone and muscle health: an overview of systematic reviews. BMC Med. 2012;10:167.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Smith V, Devane D, Begley CM, et al. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shea BJ, Hamel C, Wells GA, et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62(10):1013–20.

    Article  PubMed  Google Scholar 

  24. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7:10.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Seo HJ, Kim KU. Quality assessment of systematic reviews or meta-analyses of nursing interventions conducted by Korean reviewers. BMC Med Res Methodol. 2012;12:129.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ. 2009;87(5):353–61.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bielemann RM, Martinez-Mesa J, Gigante DP. Physical activity during life course and bone mass: a systematic review of methods and findings from cohort studies with young adults. BMC Musculoskelet Disord. 2013;14:77.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Polidoulis I, Beyene J, Cheung AM. The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int. 2012;23(1):39–51.

    CAS  Article  PubMed  Google Scholar 

  29. Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age. 2012;34(6):1493–515.

    Article  PubMed  Google Scholar 

  30. Kelley GA, Kelley KS, Kohrt WM. 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. 2012;13:177.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lau RW, Liao LR, Yu F, et al. The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis. Clin Rehabil. 2011;25(11):975–88.

    Article  PubMed  Google Scholar 

  32. Martyn-St James M, Carroll S. A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med. 2009;43(12):898–908.

  33. Zhao R, Zhao M, Zhang L. Efficiency of jumping exercise in improving bone mineral density among premenopausal women: a meta-analysis. Sports Med. 2014;44(10):1393–402.

    Article  PubMed  Google Scholar 

  34. Nikander R, Sievanen H, Heinonen A, et al. Targeted exercise against osteoporosis: a systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010;8:47.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Turner CH, Robling AG. Designing exercise regimens to increase bone strength. Exerc Sport Sci Rev. 2003;31(1):45–50.

    Article  PubMed  Google Scholar 

  36. Fonseca H, Moreira-Goncalves D, Coriolano HJ, et al. Bone quality: the determinants of bone strength and fragility. Sports Med. 2014;44(1):37–53.

    Article  PubMed  Google Scholar 

  37. Maimoun L, Sultan C. Effects of physical activity on bone remodeling. Metabolism. 2011;60(3):373–88.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are indebted to Mr. Kenneth Britsch for language editing.

Author information

Authors and Affiliations

  1. Sport Biological Centre, China Institute of Sport Science, Beijing, China

    Jincheng Xu

  2. Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161, Milan, Italy

    Giovanni Lombardi & Giuseppe Banfi

  3. Department of Sport Rehabilitation, Beijing Sport University, Beijing, China

    Wei Jiao

  4. Vita-Salute San Raffaele University, Milan, Italy

    Giuseppe Banfi

Authors
  1. Jincheng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Lombardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Banfi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Lombardi.

Ethics declarations

Funding

This work was supported independently by the China Scholarship Council (Grant No. 201306520008) and the Italian Ministry of Health.

Conflict of interest

Jincheng Xu, Giovanni Lombardi, Wei Jiao, and Giuseppe Banfi declare that they have no conflicts of interest relevant to the content of this review.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Xu, J., Lombardi, G., Jiao, W. et al. Effects of Exercise on Bone Status in Female Subjects, from Young Girls to Postmenopausal Women: An Overview of Systematic Reviews and Meta-Analyses. Sports Med 46, 1165–1182 (2016). https://doi.org/10.1007/s40279-016-0494-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-016-0494-0

Keywords

  • Resistance Training
  • Exercise Program
  • Bone Mineral Content
  • Standardize Mean Difference
  • Weighted Mean Difference