Multicomponent training program with weight-bearing exercises elicits favorable bone density, muscle strength, and balance adaptations in older women

A comprehensive review and advanced biomolecule-based therapies for osteoporosis

BACKGROUND

The prevalence of osteoporosis (OP) on a global scale is significantly elevated that causes life threatening issues. The potential of groundbreaking biomolecular therapeutics in the field of OP is highly encouraging. The administration of biomolecular agents has the potential to mitigate the process of bone demineralization while concurrently augmenting the regenerative capacity of bone tissue, thereby facilitating a personalized therapeutic approach. Biomolecules-based therapies showed promising results in term of bone mass protection and restoration in OP.

AIM OF REVIEW

We summarized the recent biomolecular therapies with notable progress in clinical, demonstrating the potential to transform illness management. These treatments frequently utilize different biomolecule based strategies. Biomolecular therapeutics has a targeted character, which results in heightened specificity and less off-target effects, ultimately leading to increased patient outcomes. These aspects have the capacity to greatly enhance the management of OP, thus resulting in a major enhancement in the quality of life encountered by individuals affected by this condition.

Mechanism-Driven Strategies for Reducing Fall Risk in the Elderly: A Multidisciplinary Review of Exercise Interventions

Falls among older adults present a major public health challenge, causing significant physical, psychological, and economic consequences. Exercise interventions are a proven strategy to reduce fall risk by targeting biomechanical, physiological, and psychological factors. This review examines evidence from 155 studies published between 2004 and 2024, including systematic reviews, meta-analyses, randomized controlled trials, and cohort studies. Data were rigorously screened and extracted using predefined criteria, with studies sourced from PubMed, MEDLINE, EBSCO (EDS), and additional gray literature identified via Google Scholar. Key findings show that balance and strength training improves postural control, gait stability, and neuromuscular coordination, while resistance training mitigates sarcopenia and enhances joint mobility. Cognitive exercises enhance attention, spatial awareness, decision-making, and psychological benefits like reduced fear of falling and greater social engagement. Multidisciplinary approaches integrating physical, cognitive, and social components deliver the most significant impact. This review underscores the value of evidence-based exercise programs in promoting active aging and enhancing the quality of life for older adults.

Population-specific equations of age-related maximum handgrip force: a comprehensive review

Background

The measurement of handgrip force responses is important in many aspects, for example: to complement neurological assessments, to investigate the contribution of muscle mass in predicting functional outcomes, in setting realistic treatment goals, evaluating rehabilitation strategies. Normative data about handgrip force can assist the therapist in interpreting a patient's results compared with healthy individuals of the same age and gender and can serve as key decision criteria. In this context, establishing normative values of handgrip strength is crucial. Hence, the aim of the this study is to develop a tool that could be used both in rehabilitation and in the prevention of work-related musculoskeletal disorders. This tool takes the form of population-specific predictive equations, which express maximum handgrip force as a function of age.

Methodology

In order to collect data from studies measuring maximum handgrip force, three databases were searched. The search yielded 5,058 articles. Upon the removal of duplicates, the screening of abstracts and the full-text review of potentially relevant articles, 143 publications which focussed on experimental studies on various age groups were considered as fulfilling the eligibility criteria. A comprehensive literature review produced 1,276 mean values of maximum handgrip force.

Results

A meta-analysis resulted in gender- and world region-specific (general population, USA, Europe and Asia) equations expressing maximum force as a function of age. The equations showed quantitative differences and trends in maximum handgrip force among age, gender and national groups. They also showed that values of maximum handgrip force are about 40% higher for males than for females and that age-induced decrease in force differs between males and females, with a proved 35% difference between the ages of 35 and 75. The difference was lowest for the 60-64 year olds and highest for the 18-25 year-olds. The equations also showed that differences due to region are smaller than those due to age or gender.

Conclusions

The equations that were developed for this study can be beneficial in setting population-specific thresholds for rehabilitation programmes and workstation exposure. They can also contribute to the modification of commonly used methods for assessing musculoskeletal load and work-related risk of developing musculoskeletal disorders by scaling their limit values.

Effects of weight-bearing dance aerobics on lower limb muscle morphology, strength and functional fitness in older women

Objective

To investigate the effects of 12-week weight-bearing dance aerobics (WBDA) on muscle morphology, strength and functional fitness in older women.

Methods

This controlled study recruited 37 female participants (66.31y ± 3.83) and divided them into intervention and control groups according to willingness. The intervention group received 90-min WBDA thrice a week for 12 weeks, while the control group maintained normal activities. The groups were then compared by measuring muscle thickness, fiber length and pennation angle by ultrasound, muscle strength using an isokinetic multi-joint module and functional fitness, such as 2-min step test, 30-s chair stand, chair sit-and-reach, TUG and single-legged closed-eyed standing test. The morphology, strength, and functional fitness were compared using ANCOVA or Mann-Whitney U test to study the effects of 12 weeks WBDA.

Results

Among all recruited participants, 33 completed all tests. After 12 weeks, the thickness of the vastus intermedius (F = 17.85, P < 0.01) and quadriceps (F = 15.62, P < 0.01) was significantly increased in the intervention group compared to the control group, along with a significant increase in the torque/weight of the knee flexor muscles (F = 4.47, P = 0.04). Similarly, the intervention group revealed a significant improvement in the single-legged closed-eyed standing test (z = -2.16, P = 0.03) compared to the control group.

Conclusion

The study concluded that compared to the non-exercising control group, 12-week WBDA was shown to thicken vastus intermedius, increase muscle strength, and improve physical function in older women. In addition, this study provides a reference exercise program for older women.

Agility training to integratively promote neuromuscular, cardiorespiratory and cognitive function in healthy older adults: a one-year randomized-controlled trial

BACKGROUND

Exercise training recommendations for seniors include the targeted training of strength, balance, endurance and flexibility domains. Agility training (AT) is conceptualized as a multi-component and time-efficient training framework for older adults to improve physical, functional and cognitive health domains that are relevant for maintaining activities of daily living. The aim of this one-year trial was to comparatively evaluate the effects of agility training on physical and cognitive function.

METHODS

Seventy-nine healthy older adults (AT: 61.5% female, 70.8 ± 4.8 years, 27.7 ± 4.2 kg/m2; CG: 60.5% female, 69.6 ± 4.7 years, 27.5 ± 4.4 kg/m2) took part in this one-year randomized controlled intervention and were either assigned to the agility training group (AT) with two weekly 60 min AT sessions or to the control group (CG), receiving no treatment. Participants were assessed pre, intermediate and post intervention for strength and power, balance, gait speed under multi-task conditions, aerobic capacity as well as cognitive performance. Linear mixed effects models were used to analyze the effect of treatment over time.

RESULTS

Fifty-four participants (AG: 25, CG: 29) were analyzed, most drop-outs attributed to COVID-19 (17/30 dropouts). Adherence was good (75%) of 90 offered sessions. Notable effects in favor of AT were found for gait parameters in single (d = 0.355, Δ = 4.3%), dual (d = 0.375, Δ = 6.1%) and triple (d = 0.376, Δ = 6.4%) task conditions, counter movement jump performance (strength and power) (d = 0.203, Δ = 6.9%), static one leg balance (d = 0.256, Δ = 12.33%) and n-back reaction time (cognitive performance) (d = 0.204, Δ = 3.8%). No effects were found for the remaining outcomes (d < 0.175).

CONCLUSION

AT might serve as an integrative training approach for older adults particularly improving gait and lower limb power parameters. It seems suitable to improve a broad range of seniors' health domains and should replace isolated training of these domains. However, individual variation and progression of exercises should be considered when programming agility training providing adequate challenges throughout a long-term intervention for all participants.

TRIAL REGISTRATION

DRKS, DRKS00017469 . Registered 19 June 2019-Retrospectively registered.

The association between muscle mass quantity and its quality in physically active older women

In this study, the authors aim to determine whether lower limb strength is related to lower limb lean mass and whether this relationship is affected by lower limb functionality in physically active older women. Twenty-six women underwent measures of knee muscles strength and lean mass of lower limbs. Bilateral strength of the knee flexors and extensors was measured by an isokinetic dynamometer. The concentric peak torque was measured at an angular velocity of 60°/s. Lean mass of the lower limbs was measured by bio-impedance analysis. Pearson's correlation analysis revealed significant association between the strength of the knee flexors and lean mass on non-dominant limb only (r = .427, p = .03). Researchers revealed that strategies aiming to prevent lean mass and muscle strength losses should be specifically targeted to individual muscles or muscle groups, even in physically active older women. To improve overall mobility, the strengthening of larger muscle such as hamstring is crucial.

Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators

The aim of this systematic review and meta-analysis was (1) to determine exercise effects on bone mineral density (BMD) in postmenopausal women and (2) to address the corresponding implication of bone and menopausal status or supervision in postmenopausal women. A comprehensive search of eight electronic databases according to the PRISMA statement up to August 9, 2022, included controlled exercise trials ≥ 6 months. BMD changes (standardized mean differences: SMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) were considered as outcomes. Study group comparisons were conducted for osteopenia/osteoporosis versus normal BMD, early versus late postmenopausal women, and predominantly supervised versus predominantly non-supervised study arms. We applied an inverse heterogeneity (IVhet) model. In summary, 80 studies involving 94 training and 80 control groups with a pooled number of 5581 participants were eligible. The IVhet model determined SMDs of 0.29 (95% CI: 0.16-0.42), 0.27 (95% CI: 0.16-0.39), and 0.41 (95% CI: 0.30-0.52) for LS, FN, and THBMD, respectively. Heterogeneity between the trial results varied from low (I2 = 20%, TH BMD) to substantial (I2 = 68%, LS-BMD). Evidence for publication bias/small study effects was negligibly low (FN-, TH-BMD) to high (LSBMD). We observed no significant differences (p > .09) for exercise effects on LS-, FN-, or TH-BMD-LS between studies/study arms with or without osteopenia/osteoporosis, early versus late postmenopausal women, or predominantly supervised versus non-supervised exercise programs. Using robust statistical methods, the present work provides further evidence for a positive effect of exercise on BMD in postmenopausal women. Differences in bone status (osteopenia/osteoporosis versus normal bone), menopausal status (early versus late postmenopausal), and supervision (yes versus no) did not significantly affect the exercise effects on BMD at LS or proximal femur.

Combined training prescriptions for improving cardiorespiratory fitness, physical fitness, body composition, and cardiometabolic risk factors in older adults: Systematic review and meta-analysis of controlled trials

Background

Improved physical fitness is important for preventing COVID-19-related mortality. So, combined training can effectively increase peak oxygen consumption, physical fitness, body composition, blood pressure, and the healthrelated characteristics of adults; however, its impact in the elderly remains unclear.

Methods

This systematic review and meta-analysis aimed to evaluate the effects of combined training on older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until April 2021) for randomized trials comparing the effect of combined training on cardiorespiratory fitness, physical fitness, body composition, blood pressure, and cardiometabolic risk factors in older adults.

Results

Combined training significantly improved peak oxygen consumption compared to no exercise (WMD = 3.10, 95% CI: 2.83 to 3.37). Combined resistance and aerobic training induced favorable changes in physical fitness (timed up-and-go = -1.06, 30-s chair stand = 3.85, sit and reach = 4.43, 6-minute walking test = 39.22, arm curl = 4.60, grip strength = 3.65, 10-m walk = -0.47, maximum walking speed = 0.15, one-leg balance = 2.71), body composition (fat mass = -2.91, body fat% = -2.31, body mass index = -0.87, waist circumference = -2.91), blood pressure (systolic blood pressure = -8.11, diastolic blood pressure = -4.55), and cardiometabolic risk factors (glucose = -0.53, HOMA-IR = -0.14, high-density lipoprotein = 2.32, total cholesterol = -5.32) in older individuals. Finally, the optimal exercise prescription was ≥ 30 min/session × 50-80% VO2peak, ≥ 3 times/week for ≥ 12 weeks and resistance intensity 70-75% one-repetition maximum, 8-12 repetitions × 3 sets.

Conclusions

Combined training improved VO2peak and some cardiometabolic risk factors in older populations. The dose-effect relationship varied between different parameters. Exercise prescriptions must be formulated considering individual needs during exercise.

The effect of dance on physical health and cognition in community dwelling older adults: a systematic review and meta-analysis

BACKGROUND

Dancing is an attractive form of exercise among older adults and may positively influence physical and psychosocial health. The aim of this systematic review was to synthesize the evidence examining the dance prescription and effectiveness of dance in community dwelling older adults.

METHODS

Eight databases were searched to identify randomized controlled trials that evaluated the effectiveness of dance programs on community-dwelling older adults from 2007 to December 2020. Data regarding participants, dance programs and outcomes of interest were extracted and narratively synthesized. A meta-analysis was performed on the outcome data where possible.

RESULTS

Twenty-two studies met the inclusion criteria, of those 15 were deemed to be fair quality and 7 high quality using the PEDro scale. Nineteen studies included in the meta-analysis found that dancing can improve mobility and endurance compared to no intervention and afforded equivalent outcomes compared to other exercise programs.

CONCLUSION

The findings suggest that dance is an effective, safe and viable activity for community-dwelling older adults..

Progressive Resistance Training for Concomitant Increases in Muscle Strength and Bone Mineral Density in Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Older adults experience considerable muscle and bone loss that are closely interconnected. The efficacy of progressive resistance training programs to concurrently reverse/slow the age-related decline in muscle strength and bone mineral density (BMD) in older adults remains unclear.

OBJECTIVES

We aimed to quantify concomitant changes in lower-body muscle strength and BMD in older adults following a progressive resistance training program and to determine how these changes are influenced by mode (resistance only vs. combined resistance and weight-bearing exercises), frequency, volume, load, and program length.

METHODS

MEDLINE/PubMed and Embase databases were searched for articles published in English before 1 June, 2021. Randomized controlled trials reporting changes in leg press or knee extension one repetition maximum and femur/hip or lumbar spine BMD following progressive resistance training in men and/or women ≥ 65 years of age were included. A random-effects meta-analysis and meta-regression determined the effects of resistance training and the individual training characteristics on the percent change (∆%) in muscle strength (standardized mean difference) and BMD (mean difference). The quality of the evidence was assessed using the Cochrane risk-of-bias tool (version 2.0) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Seven hundred and eighty studies were identified and 14 were included. Progressive resistance training increased muscle strength (∆ standardized mean difference = 1.1%; 95% confidence interval 0.73, 1.47; p ≤ 0.001) and femur/hip BMD (∆ mean difference = 2.77%; 95% confidence interval 0.44, 5.10; p = 0.02), but not BMD of the lumbar spine (∆ mean difference = 1.60%; 95% confidence interval - 1.44, 4.63; p = 0.30). The certainty for improvement was greater for muscle strength compared with BMD, evidenced by less heterogeneity (I2 = 78.1% vs 98.6%) and a higher overall quality of evidence. No training characteristic significantly affected both outcomes (p > 0.05), although concomitant increases in strength and BMD were favored by higher training frequencies, increases in strength were favored by resistance only and higher volumes, and increases in BMD were favored by combined resistance plus weight-bearing exercises, lower volumes, and higher loads.

CONCLUSIONS

Progressive resistance training programs concomitantly increase lower-limb muscle strength and femur/hip bone mineral density in older adults, with greater certainty for strength improvement. Thus, to maximize the efficacy of progressive resistance training programs to concurrently prevent muscle and bone loss in older adults, it is recommended to incorporate training characteristics more likely to improve BMD.

Effects of physical exercise on bone mineral density in older postmenopausal women: a systematic review and meta-analysis of randomized controlled trials

Osteoporosis or decreased bone mineral density (BMD) is the most important risk factor for fractures, especially in older postmenopausal women (PMW). However, the interactions between exercise training and bone mineral density are not completely understood. We evaluated the effects of physical exercise on BMD in women aged ≥ 60 years postmenopausal.

PURPOSE

This systematic review and meta-analysis sets out to determine the effects of physical exercise on BMD in older postmenopausal women.

METHODS

A systematic search was conducted in Medline, Science Direct, Cochrane, PubMed, CINAHL, Google Scholar, Scopus, and ProQuest up to December 25, 2021. Fifty-three studies, which assessed a total of 2896 participants (mean age: between 60 and 82 years), were included and analyzed using a random-effects model to estimate weighted mean differences (WMD) with 95% confidence intervals (CI).

RESULTS

The meta-analysis found that exercise training significantly (p < 0.05) increased femoral neck (WMD: 0.01 g/cm²; 95% CI, 0.00 to 0.01], p = 0.0005; I² = 57%; p < 0.0001), lumbar spine (WMD: 0.01 g/cm², 95% CI, 0.01 to 0.02], I² = 81%; p = 0.0001), and trochanter (WMD: 0.01 g/cm², 95% CI 0.00, 0.02]; p = 0.009; I² = 17%; p = 0.23). There were no significant differences between the intervention and control groups for total body and total hip BMD.

CONCLUSION

Our findings suggest that exercise training may improve bone mineral density in older PMW. This improvement is mediated by increases in the femoral neck, lumbar spine, and trochanter BMD. Further long-term studies are required to confirm these findings.

Cognitive determinants of weight control by dietary patterns among postmenopausal women with osteoporosis: An application of theory of planned behavior

Background: In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis.

Methods: This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used.

Results: The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained=24.44%); healthy (n=71), mixed (n=78), and western (n=91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude (β: 0.140, P <0.001) and subjective norms (SNs) (β: 0.498, P <0.01) were the only predictors of weight control behavior, respectively. In the women with healthy and western patterns, the TPB-based variables altogether explained 11% and 16% of variations in the behavior, respectively. Among all patients, the TPB-based variables explained 12.2% of variations in weight control behavior, within which SNs were the only significant predictor of the behavior (β=-0.199, P <0.01).

Conclusion: Our findings highlighted the remarkable role of dietary patterns in the associations between weight control and its cognitive determinants. Dietary patterns should be considered while designing weight control educational interventions among women with osteoporosis. In such interventions, promoting SNs and perceived behavioral control (PBC) should be considered as the core strategies to promote the behaviors among the patients who follow an unhealthy diet.

The effect of exercise intensity on bone in postmenopausal women (part 2): A meta-analysis

BACKGROUND

Previous reviews have concluded that exercise has only modest effects on bone mineral density (BMD) in postmenopausal women. Despite the well-recognized strong positive relationship between load magnitude and bone response observed from animal research, the majority of human trials have examined the effects of only low to moderate intensity exercise on bone. We speculated that meta-analysing according to intensity may reveal a more potent exercise effect at higher intensity.

OBJECTIVES

To determine the effects of low, moderate and high intensity exercise on BMD at the spine and hip in postmenopausal women.

METHODS

Electronic databases and reference lists were searched for RCTs that examined the effect of exercise compared to control on DXA-derived lumbar spine, femoral neck or total hip BMD in healthy postmenopausal women. Interventions were classified as low, moderate or high intensity and pooled based on classification. Mean differences (MD) were calculated using random effects models and a risk of bias analysis was undertaken. To determine the effect of different exercise types (resistance and impact training) on BMD outcomes, subgroup analyses for all intensity categories and outcomes were conducted. Separate meta-analyses were undertaken to examine the influence of adding exercise to a bone medication intervention and to examine exercise effects on fracture risk.

RESULTS

Fifty-three trials, testing 63 interventions (19 low, 40 moderate, 4 high intensity) were included. At the lumbar spine, high intensity exercise yielded greater BMD effects (MD = 0.031 g/cm² 95% CI [0.012, 0.049], p = 0.002) than moderate (MD = 0.012 g/cm² 95% CI [0.008, 0.017], p < 0.001) and low intensity (MD = 0.010 g/cm² 95% CI [0.005, 0.015], p < 0.001). Low and moderate intensity exercise was equally effective at the femoral neck (low: 0.011 g/cm² 95% CI [0.006, 0.016], p < 0.001; moderate: 0.011 g/cm² 95% CI [0.007, 0.015], p < 0.001), but no effect of high-intensity exercise was observed. Moderate intensity exercise increased total hip BMD (0.008 g/cm² 95% CI [0.004, 0.012], p < 0.001), but low intensity did not. There were insufficient data to meta-analyse the effect of high intensity exercise at the total hip. Resistance training, potentially in combination with impact training, appears to be the most effective osteogenic stimulus at the spine and hip. Findings from meta-regression analyses were not informative and no influence of exercise on medication efficacy was observed. Risk of bias was mainly low or unclear due to insufficient information reported.

CONCLUSION

High intensity exercise is a more effective stimulus for lumbar spine BMD than low or moderate intensity, but not femoral neck BMD, however, the latter finding may be due to lack of power. While data from high-intensity exercise interventions are limited, the current comprehensive meta-analysis demonstrates the same positive relationship between load magnitude and bone response in humans that is observed in animal research. Findings have implications for optimal exercise prescription for osteoporosis in postmenopausal women.

STUDY REGISTRATION

Registered on PROSPERO (CRD42018117254).

The effect of exercise intensity on bone in postmenopausal women (part 1): A systematic review

BACKGROUND

Previous systematic reviews and meta-analyses of exercise effects on bone have reported null or modest effect sizes. While animal research has determined that a strong positive relationship exists between load magnitude/intensity and bone adaptation, nevertheless many human exercise interventions have been applied at low intensity. Meta-analytic pooling of exercise interventions irrespective of intensity dilutes the ability to detect efficacy of any one training regimen. Parsing out efficacy of low, moderate and high intensity exercise interventions will assist the determination of optimal exercise prescription for bone.

OBJECTIVES

First, to summarise and critically evaluate existing evidence of exercise effect on bone mass, bone structure and bone turnover markers (BTMs) in healthy postmenopausal women. Second, to examine the influence of intensity on bone response to exercise.

METHODS

Electronic databases (Embase, Scopus, CINAHL Plus, SPORTDiscus), database platforms (PubMed, Cochrane CENTRAL, ProQuest Central, Web of Science) and reference lists of included studies were searched for controlled trials and randomised controlled trials that described the effect of any exercise intervention compared to control on bone mass, bone structure or BTMs in healthy postmenopausal women. Fracture incidence was included as an exploratory endpoint. Data was extracted and weighed against the results of a comprehensive risk of bias analysis.

RESULTS

One hundred trials were included, investigating a total of 120 exercise interventions. Of those, 57 interventions were low intensity, 57 were moderate, and six were high intensity. On balance, low intensity exercise was not an effective stimulus to increase bone mass. Higher quality evidence suggests moderate to high intensity interventions, particularly those that combined high intensity resistance and impact training, were most beneficial for bone mass. Only high intensity exercise appears to improve structural parameters of bone strength, however, data are limited. Only low and moderate intensity interventions have measured BTMs and no notable benefits have been observed. The quality of trials varied greatly, and risk of bias determinations were frequently limited by insufficiently reported detail.

CONCLUSION

Heterogeneity in both study quality and outcomes limits the ability to draw strong conclusions from this comprehensive systematic review of RCT and CT reports. Nevertheless, there is a tendency in the higher quality data to indicate exercise intensity is positively related to the adaptive bone response. Part 2 of this review series reports a meta-analysis of the RCT data in order to draw quantitative conclusions from the higher quality trials.

STUDY REGISTRATION

Registered on PROSPERO (CRD42018117254).

High-Speed Bodyweight Resistance Training Improves Functional Performance Through Maximal Velocity in Older Females

The authors compared the effects of bodyweight resistance training at moderate- or high-speed conditions on muscle power, velocity of movement, and functional performance in older females. In a randomized, single-blinded noncontrolled trial, participants completed 12 weeks (three sessions/week) of bodyweight resistance training at high (n = 14; age = 70.6 ± 4.3 years) or moderate (n = 12; age = 72.8 ± 4.2 years) speeds. Data were analyzed with an analysis of variance (Group × Time) with α level set at <.05. After the intervention, timed up and go test performance (p < .05) and the rising from a chair test mean (22.4%) and maximal velocity (28.5%), mean (24.4%) and maximal power (27.7%), normalized mean (25.1%), and normalized maximal power (28.5%) increased in the high-speed group (p < .05). However, the moderate-speed group achieved no improvements (Δ6.7-14.4%; p > .2). The authors conclude that high-speed bodyweight resistance training is an effective and economically practical strategy to improve the functional capacity of older women relevant to daily life activities.

Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour

BACKGROUND

Various physical activity interventions for prevention and treatment of osteoporosis have been designed and evaluated, but the effect of such interventions on the prevention of osteoporosis in older people is unclear. The aim of this review was to investigate the association between physical activity and osteoporosis prevention in people aged 65 years and above.

METHODS

A systematic review was conducted and searches for individual studies were conducted in PubMed (January 2010 to March 2020) and for systematic reviews were conducted in PubMed, Embase, CINAHL and SPORTDiscus (January 2008 to July 2020). Records were screened according to the following eligibility criteria: i) population: adults aged 65 years and older; ii) exposure: greater volume, duration, frequency, or intensity of physical activity; iii) comparison: no physical activity or lesser volume, duration, frequency, or intensity of physical activity; iv) outcome: osteoporosis related measures (e.g., bone mineral density). The methodological quality of included studies was assessed and meta-analysis summarised study effects. The GRADE approach was used to rate certainty of evidence.

RESULTS

We included a total of 59 studies, including 12 observational studies and 47 trials. Within the included trials, 40 compared physical activity with no intervention controls, 11 compared two physical activity programs, and six investigated different doses of physical activity. Included studies suggest that physical activity interventions probably improve bone health among older adults and thus prevent osteoporosis (standardised effect size 0.15, 95% CI 0.05 to 0.25, 20 trials, moderate-certainty evidence, main or most relevant outcome selected for each of the included studies). Physical activity interventions probably improve lumbar spine bone mineral density (standardised effect size 0.17, 95% CI 0.04 to 0.30, 11 trials, moderate-certainty evidence) and may improve hip (femoral neck) bone mineral density (standardised effect size 0.09, 95% CI - 0.03 to 0.21, 14 trials, low-certainty evidence). Higher doses of physical activity and programs involving multiple exercise types or resistance exercise appear to be most effective. Typical programs for which significant intervention impacts were detected in trials were undertaken for 60+ mins, 2-3 times/week for 7+ months. Observational studies suggested a positive association between long-term total and planned physical activity on bone health.

CONCLUSIONS

Physical activity probably plays a role in the prevention of osteoporosis. The level of evidence is higher for effects of physical activity on lumbar spine bone mineral density than for hip. Higher dose programs and those involving multiple exercises and resistance exercises appear to be more effective.

Effects of Different Types of Exercise on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-analysis

In this sub-analysis of a comprehensive meta-analysis, we aimed to determine the effect of different types of exercise on (areal) bone mineral density (BMD) in postmenopausal women. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) with at least one exercise and one control group, (c) intervention ≥ 6 months, (d) BMD assessments at lumbar spine (LS), femoral neck (FN) or total hip (TH), (e) in postmenopausal women. Eight electronic databases were scanned without language restrictions up to March 2019. The present subgroup analysis was conducted as a mixed-effect meta-analysis with "type of exercise" as the moderator. The 84 eligible exercise groups were classified into (a) weight bearing (WB, n = 30) exercise, (b) (dynamic) resistance exercise (DRT, n = 18), (c) mixed WB&DRT interventions (n = 36). Outcome measures were standardized mean differences (SMD) for BMD-changes at LS, FN and TH. All types of exercise significantly affect BMD at LS, FN and TH. SMD for LS average 0.40 (95% CI 0.15-0.65) for DRT, SMD 0.26 (0.03-0.49) for WB and SMD 0.42 (0.23-0.61) for WB&DRT. SMD for FN were 0.27 (0.09-0.45) for DRT, 0.37 (0.12-0.62) for WB and 0.35 (0.19-0.51) for WB&DRT. Lastly, SMD for TH changes were 0.51 (0.28-0.74) for DRT, 0.40 (0.21-0.58) for WB and 0.34 (0.14-0.53) for WB&DRT. In summary, we provided further evidence for the favorable effect of exercise on BMD largely independent of the type of exercise. However, in order to generate dedicated exercise recommendations or exercise guideline, meta-analyses might be a too rough tool.

Effect of Exercise Training on Bone Mineral Density in Post-menopausal Women: A Systematic Review and Meta-Analysis of Intervention Studies

Osteoporosis is a major health problem in post-menopausal women (PMW). Exercise training is considered a cost-effective strategy to prevent osteoporosis in middle aged-older people. The purpose of this study is to summarize the effect of exercise on BMD among PMW. A comprehensive search of electronic databases was conducted through PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest, and Primo. BMD changes (standardized mean differences: SMD) of the lumbar spine (LS) femoral neck (FN) and/or total hip were considered as outcome measures. After subgroup categorization, statistical methods were used to combine data and compare subgroups. Seventy-five studies were included. The pooled number of participants was 5,300 (intervention group: n = 2,901, control group: n = 2,399). The pooled estimate of random effect analysis was SMD = 0.37, 95%-CI: 0.25–0.50, SMD = 0.33, 95%-CI: 0.23–0.43, and SMD = 0.40, 95%-CI: 0.28–0.51 for LS, FN, and total Hip-BMD, respectively. In the present meta-analysis, there was a significant (p < 0.001), but rather low effect (SMD = 0.33–0.40) of exercise on BMD at LS and proximal femur. A large variation among the single study findings was observed, with highly effective studies but also studies that trigger significant negative results. These findings can be largely attributed to differences among the exercise protocols of the studies. Findings suggest that the true effect of exercise on BMD is diluted by a considerable amount of studies with inadequate exercise protocols.

Agility Training to Integratively Promote Neuromuscular, Cognitive, Cardiovascular and Psychosocial Function in Healthy Older Adults: A Study Protocol of a One-Year Randomized-Controlled Trial

Exercise training effectively mitigates aging-induced health and fitness impairments. Traditional training recommendations for the elderly focus separately on relevant physiological fitness domains, such as balance, flexibility, strength and endurance. Thus, a more holistic and functional training framework is needed. The proposed agility training concept integratively tackles spatial orientation, stop and go, balance and strength. The presented protocol aims at introducing a two-armed, one-year randomized controlled trial, evaluating the effects of this concept on neuromuscular, cardiovascular, cognitive and psychosocial health outcomes in healthy older adults. Eighty-five participants were enrolled in this ongoing trial. Seventy-nine participants completed baseline testing and were block-randomized to the agility training group or the inactive control group. All participants undergo pre- and post-testing with interim assessment after six months. The intervention group currently receives supervised, group-based agility training twice a week over one year, with progressively demanding perceptual, cognitive and physical exercises. Knee extension strength, reactive balance, dual task gait speed and the Agility Challenge for the Elderly (ACE) serve as primary endpoints and neuromuscular, cognitive, cardiovascular, and psychosocial meassures serve as surrogate secondary outcomes. Our protocol promotes a comprehensive exercise training concept for older adults, that might facilitate stakeholders in health and exercise to stimulate relevant health outcomes without relying on excessively time-consuming physical activity recommendations.

Impact of calcium, vitamin D, vitamin K, oestrogen, isoflavone and exercise on bone mineral density for osteoporosis prevention in postmenopausal women: a network meta-analysis

The aim of this network meta-analysis is to compare bone mineral density (BMD) changes among different osteoporosis prevention interventions in postmenopausal women. We searched MEDLINE, Embase and Cochrane Library from inception to 24 February 2019. Included studies were randomised controlled trials (RCT) comparing the effects of different treatments on BMD in postmenopausal women. Studies were independently screened by six authors in three pairs. Data were extracted independently by two authors and synthesised using Bayesian random-effects network meta-analysis. The results were summarised as mean difference in BMD and surface under the cumulative ranking (SUCRA) of different interventions. A total of ninety RCT (10 777 participants) were included. Ca, vitamin D, vitamin K, oestrogen, exercise, Ca + vitamin D, vitamin D + vitamin K and vitamin D + oestrogen were associated with significantly beneficial effects relative to no treatment or placebo for lumbar spine (LS). For femoral neck (FN), Ca, exercise and vitamin D + oestrogen were associated with significantly beneficial intervention effects relative to no treatment. Ranking probabilities indicated that oestrogen + vitamin D is the best strategy in LS, with a SUCRA of 97·29 % (mean difference: +0·072 g/cm2 compared with no treatment, 95 % credible interval (CrI) 0·045, 0·100 g/cm2), and Ca + exercise is the best strategy in FN, with a SUCRA of 79·71 % (mean difference: +0·029 g/cm2 compared with placebo, 95 % CrI –0·00093, 0·060 g/cm2). In conclusion, in postmenopausal women, many interventions are valuable for improving BMD in LS and FN. Different intervention combinations can affect BMD at different sites diversely.

The effects of same-session combined exercise training on cardiorespiratory and functional fitness in older adults: a systematic review and meta-analysis

Endurance and strength training are effective strategies for counteracting age-associated reductions in physical performance in older adults, with a combination of both exercise modes recommended to maximise potential fitness benefits. This meta-analysis sought to quantify the effects of same-session combined endurance and strength training on fitness in adults aged over 50 years. Five electronic databases were searched with studies required to include one of the following outcome measures: VO_2peak, 6-min walk test (6MWT), 8-ft timed up-and-go (TUG), and 30-s chair stand. Separate random-effects meta-analyses compared combined training with (1) no-exercise control, (2) endurance training, and (3) strength training with probabilistic magnitude-based inferences subsequently applied. Twenty-seven studies involving 1346 subjects with a mean age of 68.8 years (range 54–85 years) were included in the analysis. The meta-analysed effect on VO_2peak was a moderately beneficial effect for the combined training compared to no-exercise controls (3.6 mL kg⁻¹ min⁻¹; ± 95% confidence limits 0.8 mL kg⁻¹ min⁻¹) with additional increases for studies with greater proportions of female participants and shorter training interventions. Combined training also had small-to-moderately beneficial effects on VO_2peak when compared to endurance training (0.8 mL kg⁻¹ min⁻¹; ± 1.0 mL kg⁻¹ min⁻¹), 30-s chair stand when compared with strength training (1.1 repetitions; ± 0.5 repetitions) and on TUG (0.8 s; ± 0.7 s), 30-s chair stand (2.8 repetitions; ± 1.7 repetitions), and 6MWT (31.5 m; ± 22.4 m) when compared to no-exercise controls. All other comparisons were unclear. Same-session combined training can induce clinically relevant fitness improvements in older adults.

Pilates versus resistance training on trunk strength and balance adaptations in older women: a randomized controlled trial

Background

The neuromuscular decline impact in the functional independence of older women is determining the necessity of implementing new strategies focused on core strength training and postural stability maintenance to promote healthy aging.

Objectives

To define whether Pilates or resistance training is better at improving (a) core isometric and isokinetic muscular strength, and (b) static and dynamic balance, in older women.

Methods

This was a cluster randomized controlled trial. Physically independent older women (60–80 years) from day centers were randomly allocated to Pilates, Muscular and Control Groups (PG, MG and CG) using a block randomization method. Only the research staff performing the assessment and statistical analysis were blinded. Exercise groups trained twice a week (1 h per session) for 18 weeks in a moderate-to-vigorous intensity. Core strength (primary outcome): trunk and hip isometric and hip isokinetic muscular strength (Biodex System III Pro Isokinetic Dynamometer), alongside one leg static balance (portable force platform Kistler 9286AA) and dynamic balance (timed up and go (TUG)) were assessed.

Results

A total of 60 participants were randomized (PG, n = 20; MG, n = 20; CG, n = 20) and 49 completed the trial (PG, n = 16; MG, n = 19; CG, n = 14). Regarding hip isometric extension strength, PG was statistically better than CG (P = 0.004). There were no differences between groups regarding isokinetic strength or balance. Intra-group comparisons showed significant improvements (P < 0.05) in the dynamic balance and trunk and hip isometric extension strength for PG and MG, whereas every hip isokinetic measurement was improved in MG. Exercise programs did not produce any adverse event.

Conclusions

The Pilates training program was more effective for improving isometric hip and trunk extension strength, while the Muscular training program generated greater benefits on trunk and hip isokinetic strength. Moreover, both training programs showed moderate effects for the TUG.

Clinical Trial Registration

The trial was registered at ClinicalTrials.gov (identifier: NCT02506491).

Effects of Two Different Neuromuscular Training Protocols on Regional Bone Mass in Postmenopausal Women: A Randomized Controlled Trial

Background: Osteoporosis is a condition associated with a greater incidence of fractures, and one of the main health-related concerns in postmenopausal women. To counteract possible reductions in bone properties, physical exercise has been proposed as an effective strategy. Particularly, training interventions with a high osteogenic potential are recommended. Purpose: To analyze the effect of 24 weeks of whole-body vibration and multi-component training on lumbar spine and femoral neck bone mass, and to determine what type of training produces greater adaptations in postmenopausal women. Methods: A total of 38 women completed the study (Clinical Gov database ID: NCT01966562). Participants were randomly assigned to one of the study groups: whole-body vibration group (WBVG), multi-component training group (MTG), or control group (CG). The experimental groups performed a progressive 24-week training (3 sessions/week) program. Bone mineral density (BMD) and bone mineral content (BMC) at the lumbar spine and femoral neck were assessed by Dual-energy X-ray absorptiometry. Results: Significantly and clinically relevant increases in lumbar spine bone mass (BMD: F = 3.29; p = 0.03; +5.15%; BMC: F = 2.90; p = 0.05; +10.58%) were observed in WBVG. MTG showed clinically important pre-post-changes on lumbar spine BMC (+7.78%), although there was no statistical significance (F = 1.97; p = 0.14). At the femoral neck, no statistically significant increases on bone mass were obtained in either training group. No changes were obtained in any variable in the CG. Additionally, no statistically significant differences were found between groups. Conclusion: The results indicated that 24 weeks of supervised WBV and MT may counteract the rapid loss of bone mass after the cessation of menstruation, thus improving postmenopausal women bone health. However, in the absence of statistically significant differences between groups, it is not possible to determine which training protocol produces greater adaptations. Clinical Trial Registration: www.ClinicalTrialsgov, identifier: NCT01966562.

The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients

Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.

Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies

OBJECTIVES

We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews.

METHODS

We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates.

RESULTS

For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention.

CONCLUSION

Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551.

Pretiree lifestyles in relation to musculoskeletal health: cross-sectional data from the Geelong Osteoporosis Study

Background: What happens in the early-elderly ‘pretiree’ period potentially influences the divergent paths of healthy or unhealthy ageing. In this cross-sectional study, we aimed to profile musculoskeletal health and lifestyle behaviours for men and women in their late-fifties and sixties.Methods: For 482 participants from the Geelong Osteoporosis Study, we measured DXA-derived appendicular lean mass (rALM), bone mineral density (BMD) at the femoral neck and percentage body fat mass (%BF). Low-rALM and low-BMD referred to sex-specific T-scores<-1.0. Associations between exposures and low-rALM and/or low-BMD were explored using multivariable logistic regression.Results: Three-quarters of participants had high %BF, 98(20.3%) had low-rALM, 202(41.9%) had low-BMD and 63(13.1%) had both low-rALM and low-BMD. Eight-two (17.0%) were very active and one-third participated in sports/recreational activities. Most [n=416(87.8%)] met the recommended daily intake (RDI) for protein; only 119(25.1%) met the RDI for calcium. Less than 10% smoked and one-third exceeded recommended alcohol intakes. Independent of age, weight and sex, greater %BF and sedentary behaviour increased the likelihood of low-rALM; high-alcohol consumption increased the likelihood of low-BMD; and greater %BF increased the likelihood of low-rALM and low-BMD combined.Conclusions: One-half of participants had rALM and BMD in the normal range. Only a few were involved in resistance-training or weight-bearing exercise, despite having the capacity to be physically active. As sedentary lifestyles, excessive adiposity and high alcohol use were associated with low-rALM and/or low-BMD, we propose that these adverse factors be potential targets among pretirees to minimise their risk of entering old age with poor musculoskeletal health. 

Whole-body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis

BACKGROUND

The aims of the present systematic review and meta-analysis were to evaluate published, randomized controlled trials that investigate the effects on whole-body vibration (WBV) training on total, femoral neck, and lumbar spine bone mineral density (BMD) in postmenopausal women, and identify the potential moderating factors explaining the adaptations to such training.

METHODS

From a search of electronic databases (PubMed, Web of Science, and Cochrane) up until September 2017, a total 10 studies with 14 WBV groups met the inclusion criteria. Three different authors tabulated, independently, the selected indices in identical predetermined forms. The methodological quality of all studies was evaluated according to the modified PEDro scale. For each trial, differences within arms were calculated as mean differences (MDs) and their 95% confidence intervals between pre- and postintervention values. The effects on bone mass between exercise and control groups were also expressed as MDs. Both analyses were performed in the total sample and in a specific class of postmenopausal women younger than 65 years of age (excluding older women).

RESULTS

The BMD of 462 postmenopausal women who performed WBV or control protocol was evaluated. Significant pre-post improvements in BMD of the lumbar spine were identified following WBV protocols (P = .03). Significant differences in femoral neck BMD (P = .03) were also found between intervention and control groups when analyzing studies that included postmenopausal women younger than 65 years.

CONCLUSIONS

WBV is an effective method to improve lumbar spine BMD in postmenopausal and older women and to enhance femoral neck BMD in postmenopausal women younger than 65 years.

Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology

BACKGROUND

The Italian Society for Orthopaedics and Traumatology conceived this guidance-which is primarily addressed to Italian orthopedic surgeons, but should also prove useful to other bone specialists and to general practitioners-in order to improve the diagnosis, prevention, and treatment of osteoporosis and its consequences.

MATERIALS AND METHODS

Literature reviews by a multidisciplinary team.

RESULTS

The following topics are covered: the role of instrumental, metabolic, and genetic evaluations in the diagnosis of osteoporosis; appraisal of the risk of fracture and thresholds for intervention; general strategies for the prevention and treatment of osteoporosis (primary and secondary prevention); the pharmacologic treatment of osteoporosis; the setting and implementation of fracture liaison services for tertiary prevention. Grade A, B, and C recommendations are provided based on the main levels of evidence (1-3). Toolboxes for everyday clinical practice are provided.

CONCLUSIONS

The first up-to-date Italian guidelines for the primary, secondary, and tertiary prevention of osteoporosis and osteoporotic fractures are presented.

Effects of exercise improves muscle strength and fat mass in patients with high fracture risk: A randomized control trial

BACKGROUND

The deterioration of the musculoskeletal system imposes significant impact on physical activity. Exercise is an important strategy which minimizes these changes. It is not clear which type of exercise provides better improvement on low physical performance, low muscle mass and low strength of sarcopenia. We aim to develop an integrated care (IC) model and compare its relative efficacy in limb fat free mass, muscle strength, and physical performance with low extremities exercise (LEE) in community dwelling older adults with high risk of fractures (Fracture Risk Assessment Tool (FRAX^®)) ≧3% for hip fracture, ≧20% for major osteoporotic fracture or 1-min osteoporosis risk test (≧1 point) or fall (≧2 falls in previous year).

METHODS

Patients were assigned randomized to participate in either IC or LEE group (n = 55 each) for 3 months. All participants received education including home-based exercise. The IC group consisted of different modalities of exercise while the LEE group performed machine-based low extremities exercise. Fat free mass, muscle strength, and physical performance were measured at their baseline and 3-months follow-up.

RESULTS

Mean age was 73.8 ± 7 years with 69.1% women. Entire cohort demonstrated significant increment in fat free mass, muscle strength (4 indicators) and physical performance (3 indicators). However, between group differences were not significant.

CONCLUSION

With regular supervise exercise; both groups are equally effective in decreasing fat mass and increasing physical performance, muscle mass and strength. However, the IC group required fewer resources and thus more financially feasible in a community setting.

Physical exercise programs at Basic Healthcare Units decrease body fat and improve the functional capacity of women over 50 years old

This study verified the effects of a physical exercise program performed at Basic Healthcare Units on the body composition and functional capacity of women over 50 years old and to compare these variables according to age. Forty-eight women (age, 65.4±7.3 years) were assessed. The program lasted 20 weeks, and was conducted 2 times per week, 60 min/day. Body mass and height were collected and body mass index (BMI) was calculated. Bioelectrical impedance was used to estimate fat mass and fat free mass. Functional capacities: handgrip test, Timed Up and Go (TUG) test, and Guralnick test were assessment. Weight (68.7±12.5 [pre]×66.8±12.5 [post], P<0.001), BMI (28.5±4.1 kg/m² [pre]×27.6±4.0 kg/m² [post], P<0.001), and fat mass (28.4±7.8 kg [pre]×26.4±7.3 kg [post], P<0.001) were decreased. For functional capacity, handgrip (21.2±5.8 kg [pre]×22.9±6.9 kg [post], P=0.014), lower limb strength (12.0±3.0 sec [pre]×8.5±2.2 sec [post], P<0.001), TUG (8.4±1.5 sec [pre]×7.6±1.1 se [post], P<0.001) and Guralnik tests (10.6±1.6 [pre]×11.8±0.5 [post], P<0.001) were improved. 20 weeks of exercise program performed at Basic Healthcare Units decreased body fat and improvement of functional capacity of women over 50 years old and there was difference according to age only on the body composition variables.

Physical activity and exercise as countermeasures to physical frailty and sarcopenia

The identification of cost-effective interventions that improve the health status and prevent disability in old age is one of the most important public health challenges. Regular physical activity is the only intervention that has consistently been shown to improve functional health and energy balance and to reduce the risk of cardiovascular disease, stroke, diabetes, several cancers, depression and falls. In advanced age, physical activity is also effective at mitigating sarcopenia, restoring robustness, and preventing/delaying the development of disability. On the other hand, physical inactivity is recognized as one of the leading causes of several chronic degenerative diseases and is also a major contributing factor to sarcopenia and functional disability. This compelling evidence has prompted the World Health Organization to recommend engaging in regular physical activity throughout one's life course. The present review summarizes the available evidence in support of physical activity as a remedy against physical frailty and sarcopenia. The relevant pathways through which the benefits of physical activity are conveyed are also discussed.

Implications of exercise-induced adipo-myokines in bone metabolism

Physical inactivity has been recognized, by the World Health Organization as the fourth cause of death (5.5 % worldwide). On the contrary, physical activity (PA) has been associated with improved quality of life and decreased risk of several diseases (i.e., stroke, hypertension, myocardial infarction, obesity, malignancies). Bone turnover is profoundly affected from PA both directly (load degree is the key determinant for BMD) and indirectly through the activation of several endocrine axes. Several molecules, secreted by muscle (myokines) and adipose tissues (adipokines) in response to exercise, are involved in the fine regulation of bone metabolism in response to the energy availability. Furthermore, bone regulates energy metabolism by communicating its energetic needs thanks to osteocalcin which acts on pancreatic β-cells and adipocytes. The beneficial effects of exercise on bone metabolism depends on the intermittent exposure to myokines (i.e., irisin, IL-6, LIF, IGF-I) which, instead, act as inflammatory/pro-resorptive mediators when chronically elevated; on the other hand, the reduction in the circulating levels of adipokines (i.e., leptin, visfatin, adiponectin, resistin) sustains these effects as well as improves the whole-body metabolic status. The aim of this review is to highlight the newest findings about the exercise-dependent regulation of these molecules and their role in the fine regulation of bone metabolism.

The effect of a long-term, community-based exercise program on bone mineral density in postmenopausal women with pre-diabetes and type 2 diabetes

The aim of this study was to evaluate the impact of a community-based exercise program on bone mineral density and body composition in postmenopausal women with pre-diabetes and type 2 diabetes. Twenty postmenopausal women (aged 61.3 ± 6.0 years) with pre-diabetes and type 2 diabetes were randomly assigned to a community-based exercise program group (n=10) or a control group (n=10). The community-based exercise program was multicomponent, three days per week for 32 weeks, and included walking, resistance and aquatic exercises. Body composition and bone mineral density were measured pre and post-training by dual X-ray absorptiometry. In the exercise group significant increases were found in the ward's triangle bone mineral density (+7.8%, p=0.043), and in fat-free mass (+2.4%, p=0.018). The findings suggest that regular multicomponent training is effective in preventing osteoporosis and sarcopenia among postmenopausal women with pre-diabetes and type 2 diabetes.

Impact of whole-body electromyostimulation on body composition in elderly women at risk for sarcopenia: the Training and ElectroStimulation Trial (TEST-III)

Most studies have confirmed the positive impact of resistance training on muscle mass and functional capacity in aging adults. However, due to physical limitation or a simple aversion against regular exercise, the majority of elderly subjects do not reach the exercise doses recommended for impacting strength or muscle mass. This led us to evaluate the effect of whole-body electromyostimulation (WB-EMS), a novel, time-efficient and smooth training technology, on body composition with special regard to sarcopenia. Seventy-six lean, non-sportive women (75 ± 4 years) were randomly assigned to either a WB-EMS group (WB-EMS, n = 38) that performed 18 min of WB-EMS (bipolar, 85 Hz) 3 sessions in 14 days (1.5 sessions/week) or a semi-active control group (aCG, n = 38). Body composition was assessed by dual-energy X-ray absorptiometry and maximum strength was evaluated using isometric techniques for trunk and legs. After 54 weeks of intervention, significant inter-group differences were determined for appendicular skeletal muscle mass (WB-EMS, 0.4 ± 2.2 % vs. aCG, -1.5 ± 3.1 %; p = 0.009), lean body mass (WB-EMS, 0.8 ± 1.8 % vs. aCG, -0.8 ± 2.7 %; p = 0.008) and maximum isometric strength (leg extensors, 9.8 ± 12.9 % vs. 0.2 ± 10.4 %; p = 0.003; trunk extensors, 10.1 ± 12.7 vs. -1.6 ± 8.6 %; p = 0.001). Although borderline significant for abdominal fat mass (WB-EMS, -2.9 ± 8.3 vs. aCG, 1.5 ± 10.7 %; p = 0.069), differences did not reach statistically significant levels for body fat parameters. Considering the clinical effectiveness for impacting sarcopenia and the good acceptance of this technology by this non-sportive cohort of elderly women, we conclude that for elderly subjects unable or unwilling to perform dynamic strength exercises, electromyostimulation may be a less off-putting alternative to maintain lean body mass and strength.

Age- and Activity-Related Differences in the Mechanisms Underlying Maximal Power Production in Young and Older Adults

The purpose of this study was to examine the interactions between aging, activity levels and maximal power production during cycling. Participants were divided into younger adults (YA), older active adults (OA,) and older sedentary adults (OS). Absolute maximum power was significantly greater in YA compared with OS and OA; no differences were found between OA and OS. The age-related difference in maximum power was accompanied by greater absolute peak knee extension and knee flexion powers. Relative joint power contributions revealed both age- and activity-related differences. YA produced less relative hip extension power than older adults, regardless of activity level. The OS participants produced less relative knee flexion power than active adults, regardless of age. The results show the age-related decline in muscular power production is joint specific and that activity level can be a modifier of intersegmental coordination, which has implications for designing interventions for the aging population.

Exercise as a remedy for sarcopenia

PURPOSE OF REVIEW

Although prolongation of life is a significant public health aim, at the same time the extended life should involve preservation of the capacity to live independently. Consequently, the identification of cost-effectiveness interventions to prevent frailty is one of the most important public health challenges. In the present review, we present the available evidence regarding the impact of physical exercise on the components of frailty syndrome and, in particular, as a remedy for sarcopenia.

RECENT FINDINGS

Resistance exercise training is more effective in increasing muscle mass and strength, whereas endurance exercises training is superior for maintaining and improving maximum aerobic power. Based on these evidences, recommendations for adult and frail older people should include a balanced program of both endurance and strength exercises, performed on a regular schedule (at least 3 days a week).

SUMMARY

Regular exercise is the only strategy found to consistently prevent frailty and improve sarcopenia and physical function in older adults. Physical exercises increase aerobic capacity, muscle strength and endurance, by ameliorating aerobic conditioning and/or strength. In older patients, exercise and physical activity produce at least the same beneficial effects observed in younger individuals.

Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial

Multimodal exercise programs incorporating traditional progressive resistance training (PRT), weight-bearing impact training and/or balance training are recommended to reduce risk factors for falls and fracture. However, muscle power, or the ability to produce force rapidly, has emerged as a more crucial variable to functional decline than muscle strength or mass. The aim of this 12-month community-based randomized controlled trial, termed Osteo-cise: Strong Bones for Life, was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT, combined with an osteoporosis education and behavioral change program, on bone mineral density (BMD), body composition, muscle strength and functional muscle performance in older adults. Falls incidence was evaluated as a secondary outcome. A total of 162 older adults (mean ± SD; 67 ± 6 years) with risk factors for falls and/or low BMD were randomized to the Osteo-cise program (n = 81) or a control group (n = 81). Exercise consisted of fitness center-based HV-PRT, weight-bearing impact and challenging balance/mobility activities performed three times weekly. After 12 months, the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD (1.0% to 1.1%, p < 0.05), muscle strength (10% to 13%, p < 0.05), functional muscle power (Timed Stair Climb, 5%, p < 0.05) and dynamic balance (Four Square Step Test 6%, p < 0.01; Sit-to-Stand, 16%, p < 0.001) relative to controls. There was no effect on total body lean mass or mobility (timed-up-and-go), and no difference in falls rate (incidence rate ratio [IRR], 1.22; 95% confidence interval [CI], 0.72-2.04). In conclusion, this study demonstrates that the Osteo-cise: Strong Bones for Life community-based, multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and/or low BMD. Although this did not translate into a reduction in the rate of falls, further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture.

Whole-body electromyostimulation as a means to impact muscle mass and abdominal body fat in lean, sedentary, older female adults: subanalysis of the TEST-III trial

BACKGROUND

The primary aim of this study was to determine the effect of 12 months of whole-body electromyostimulation (WB-EMS) exercise on appendicular muscle mass and abdominal fat mass in subjects specifically at risk for sarcopenia and abdominal obesity, but unable or unwilling to exercise conventionally.

METHODS

Forty-six lean, nonsportive (<60 minutes of exercise per week), elderly women (aged 75 ± 4 years) with abdominal obesity according to International Diabetes Federation criteria were randomly assigned to either a WB-EMS group (n=23) which performed 18 minutes of intermittent, bipolar WB-EMS (85 Hz) three sessions in 14 days or an "active" control group (n=23). Whole-body and regional body composition was assessed by dual energy X-ray absorptiometry to determine appendicular muscle mass, upper leg muscle mass, abdominal fat mass, and upper leg fat mass. Maximum strength of the leg extensors was determined isometrically by force plates.

RESULTS

After 12 months, significant intergroup differences were detected for the primary end-points of appendicular muscle mass (0.5% ± 2.0% for the WB-EMS group versus -0.8% ± 2.0% for the control group, P=0.025) and abdominal fat mass (-1.2% ± 5.9% for the WB-EMS group versus 2.4% ± 5.8% for the control group, P=0.038). Further, upper leg lean muscle mass changed favorably in the WB-EMS group (0.5% ± 2.5% versus -0.9% ± 1.9%, in the control group, P=0.033), while effects for upper leg fat mass were borderline nonsignificant (-0.8% ± 3.5% for the WB-EMS group versus 1.0% ± 2.6% for the control group, P=0.050). With respect to functional parameters, the effects for leg extensor strength were again significant, with more favorable changes in the WB-EMS group (9.1% ± 11.2% versus 1.0% ± 8.1% in the control group, P=0.010).

CONCLUSION

In summary, WB-EMS showed positive effects on the parameters of sarcopenia and regional fat accumulation. Further, considering the good acceptance of this technology by this nonsportive elderly cohort at risk for sarcopenia and abdominal obesity, WB-EMS may be a less off-putting alternative to impact appendicular muscle mass and abdominal fat mass, at least for subjects unwilling or unable to exercise conventionally.

Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis

Accelerometers objectively monitor physical activity and sedentary patterns and are increasingly used in the research setting. It is important to maintain consistency in data analysis and reporting, therefore, we: (1) systematically identified studies using accelerometry (ActiGraph, Pensacola, FL, USA) to measure moderate-to-vigorous physical activity (MVPA) and sedentary time in older adults, and (2) based on the review findings, we used different cut-points obtained to analyze accelerometry data from a sample of community-dwelling older women. We identified 59 articles with cut-points ranging between 574 and 3,250 counts/min for MVPA and 50 and 500 counts/min for sedentary time. Using these cut-points and data from women (mean age, 70 years), the median MVPA minutes per day ranged between 4 and 80 min while percentage of sedentary time per day ranged between 62 % and 86 %. These data highlight (1) the importance of reporting detailed information on the analysis assumptions and (2) that results can differ greatly depending on analysis parameters.