Table 1 Description of included studies comparing physical activity with a control intervention

Allison 2013

5/10 [41]

RCT

50/35

Setting: Community; United Kingdom

Health status: Healthy

A. High impact exercise

n= 50 (randomised); 35 (analysed)

Age: 69.9 (4.0)

Female: 0%

B. No exercise Contralateral leg of each participant was used as control

A. High impact unilateral exercise programme (brief hopping exercise sessions)

Frequency: 7 times/week

Intensity: 5 sets of 10 multidirectional hops with a 15s rest period. Encouraged participants to continue to hop as high and as fast as they could.

Session duration: ~15 min

Delivered by: NR

Duration of the intervention (wks): 52

Primary exercise type: Balance and function including bone loading (multidirectional hopping)

B. No exercises performed with the control leg

1. Femoral neck BMD

2. Trochanter BMD

3. Total hip BMD

4. Femoral neck BMC

5. Trochanter BMC

6. Total hip BMC

12

Final score (mean ± SD)

1. Femoral neck BMD^c

A. Exercise: 0.954 ± 0.017

B. Control: 0.945 ± 0.018

2. Trochanter BMD

A. Exercise: 0.923 ± 0.017

B. Control: 0.923 ± 0.018

3. Total hip BMD

A. Exercise: 1.030 ± 0.017

B. Control: 1.027 ± 0.018

4.Femoral neck BMC^c

A. Exercise: 5.54 ± 0.13

B. Control: 5.49 ± 0.14

5. Trochanter BMC

A. Exercise: 16.45 ± 0.54

B. Control: 16.49 ± 0.57

6. Total hip BMC:

A. Exercise: 40.49 ± 0.91

B. Control: 40.35 ± 0.97

^dArmamento-Villareal 2012

7/10 [88]

RCT

107/107

Setting: Community; United States

Health status: Obese older adults

A. Exercise group

n= 26

Age: 70 (0.8)

Female: 61%

B. Diet group (weight loss)

n= 26

Age: 70 (0.8)

Female: 65%

C. Diet and exercise

n= 28

Age: 70 (0.8)

Female: 57%

D. Control

n= 27

Age: 69 (0.8)

Female: 67%

A. Exercise Group involving aerobic exercises, progressive resistance training, and exercises to improve flexibility and balance.

Frequency: 3 times/week

Intensity: aerobic dance: from 65% of peak heart rate to 70%-85% of peak heart rate; resistance: from 1 to 2 sets at a resistance of approximately 65% of one-repetition maximum, with 8-12 reps to 2-3 sets at a resistance of 80% of one-repetition maximum, with 6 to 8 reps

Session duration: 90 min

Delivered by: Physical therapist

Duration of the intervention (wks): 52

Primary exercise type: Multiple (endurance plus flexibility plus resistance plus balance and function)

D. Control - no intervention or advice

1. Femoral neck BMD

2. Intertrochanter BMD

3. Femoral shaft BMD

12

Change (% ± SD)

1. Femoral neck BMD

A. Exercise: 1.00 ± 0.76

B. Diet: -2.09 ± 1.07

C. Diet and exercise: -0.13 ± 0.91

D. Control: -0.08 ± 0.82

2. Intertrochanter BMD

A. Exercise: 1.83 ± 0.59

B. Diet: -2.09 ± 1.06

C. Diet and exercise: -1.06 ± 0.98

D. Control: -0.18 ± 0.73

3. Femoral shaft BMD

A. Exercise: 1.83 ± 0.59^c

B. Diet: -2.47 ± 0.51

C. Diet and exercise: -0.92 ± 0.83

D. Control: 0.48 ± 0.61

Binder 2004

7/10 [43]

RCT

90/78

Setting: Hospital; home care programme and community; United States

Health Status: People with a recent proximal femur fracture

A. Physical Therapy and exercise training

n= 46 (randomised); 46 (analysed)

Age: 80 (7)

Female: 72%

B. Control - Home exercise

n= 44 (randomised); 44 (analysed)

Age: 81 (8)

Female: 77%

A. Supervised physical therapy and exercise training involving flexibility, balance, coordination, movement speed and progressive resistance exercises.

Frequency: 3 times/week

Intensity: the resistance training started from 1-2 sets of 6-8 reps each exercise at 65% of 1RM; progressed to 8-12 reps 3 sets at 85%-100% of initial 1-RM.

Session duration: 45 to 90 min

Delivered by: Physical therapist

Duration of the intervention (wks): 26

Primary exercise type: Multiple (balance/function plus resistance)

B. Low-intensity home exercise programme

1. Whole body BMD

2. Hip BMD

6

Final score (mean ± SD)

1. Whole body BMD

A. Physical therapy and exercise training: 1.03 ± 0.13

B. Home exercise programme: 1.00 ± 0.11

2. Hip BMD

A. Physical therapy and exercise training: 0.64 ± 0.18

B. Home exercise programme: 0.69 ± 0.12

No significant group x time effects

Blumenthal 1991

6/10 [44]

RCT

101/84

Setting: NR; United States

Health status: Healthy

A. Aerobic Training

n= 33 (randomised)

B. Yoga and flexibility

n= 34 (randomised)

C. Control

n= 34 (randomised)

Age (whole sample): 67 (range: 60-83)

Female: NR

A. Aerobic training: Endurance training involving bicycle ergometry, brisk walking/jogging, and arm ergometry.

Frequency: 3 times/week

Intensity: 70% heart rate reserve

Session duration: 60 min

Delivered by: NR

Duration of intervention (wks): 16

Primary exercise type: Endurance training

B. Yoga: Supervised non-aerobic yoga programme.

Frequency: at least 2 times/week

Intensity: NR

Session duration: 60 min

Delivered by: NR

Duration of intervention (wks): 16

Primary exercise type: Balance and function

C. Waiting list control: did not receive any form of treatment and were instructed not to change their physical activity habits and specifically not to engage in any aerobic exercise for the 4-month period.

1. Distal radius BMD (mg/ cm²)

4, 8, 14

1. Distal radius BMD: no between-group differences.

Quantitative estimates not reported for between-group comparisons.

Sub-analysis was performed comparing participants who decided to continue to exercise or not for men and women separately (randomisation was broken for this analysis):

Female:

Mean ± SD at eight months:

Females who continued the programme: 0.7 ± 0.2

Females who discontinued the programme: 0.8 ± 0.1

Mean ± SD at fourteen months:

Females who continued the programme: 0.7 ± 0.3

Females who discontinued the programme: 0.9 ± 0.2

Men

Mean ± SD at eight months:

Men who continued the programme: 1.2 ± 0.2

Men who discontinued the programme: 1.1 ± 0.2

Mean ± SD at fourteen months:

Men who continued the programme: 1.4 ± 0.4

Men who discontinued the programme: 1.0 ± 0.3

Between-group difference: p<0.05

Bunout 2001

4/10 [45]

RCT

149/98

Setting: Outpatient clinic; Chile

Health Status: Healthy

A. Resistance training

n= 28 randomised; 16 (analysed)

Age: 74.4 (3.3)

Female: 75%

B. Control

n= 31 (randomised); 25 (analysed)

Age: 74.0 (3.7)

Female: 48%

C. Supplementation + Resistance training

n= 42 (randomised); 31 (analysed)

Age: 73.7(3.0)

Female: 40%

D. Supplementation

n= 42 (randomised); 26 (analysed)

Age: 74.7(3.7)

Female: 62%

A. Endurance training consisting of exercise for upper and lower body, respiratory muscle training and walking.

Frequency: 2 times/week

Intensity: Graded by a coach using the Borg scale

Session duration: 60 min

Delivered by: Specialised coach

Duration of the intervention (wks): 78

Primary exercise type: Multiple (balance and function plus endurance)

B. No training

1. Whole body BMD

2. Whole body BMC

18

1. Whole body BMD

Decreased significantly in all groups (p = 0.006), but the decline was less marked in the strength training combined with nutritional supplements compared with the other groups (statistically significant).

Results reported in a graph and not possible to extract quantitative estimates.

2. Whole body BMC: NR

De Jong 2000

5/10 [46]

RCT

217/143

Setting: Community; Netherlands

Health status: People with frailty and BMI ≤ 25

A. Exercise

n= 55 (randomised); 36 (analysed)

Age: 76.5 (4.6)

Female: 69%

B. Control

n= 44 (randomised); 33 (analysed)

Age: 78.8 (6.7)

Female: 67%

C. Exercise + nutrition

n= 60 (randomised); 39 (analysed)

Age: 79.8 (5.8)

Female: 74%

D. Nutrition

n= 58 (randomised); 35 (analysed)

Age: 79.6 (5.0)

Female: 69%

A. Supervised group-based exercise programme involving muscle strength, coordination, flexibility, speed, endurance with use of ropes, weights and elastic bands.

Frequency: 2 times/week

Intensity: Moderate to high; 7 of a 10-point Borg scale

Session duration: 45 min

Delivered by: Skilled teachers and supervisor

Duration of the intervention (wks): 17

Primary exercise type: Balance and function

B. Social programme involving creative and social activities as well as educational sessions.

1. Whole body BMD

4.5

Change score (mean change ± SD)

1. Whole body BMD

A. Exercise: 0.000 ± 0.022

B. Control: -0.003 ± 0.018

C. Combination group: 0.003 ± 0.023

D. Nutrition group: 0.006 ± 0.014

No between-group differences in the relevant comparisons to this review (ie, exercise vs control and combination vs nutrition)

Duckham 2015

6/10 [47]

RCT

319/283

Setting: General practice; United Kingdom

Health status: Healthy

A. Home based exercise (OEP)

n= 88 (randomised); 75 (analysed)

Age: 71.4 (4.9)

Female: 68%

B. Community based exercise (FaME)

n= 105 (randomised); 94 (analysed)

Age: 71.8 (5.5)

Female: 60%

C. Control: Usual care

n= 126 (randomised); 114 (analysed)

Age: 72.2 (5.5)

Female: 54%

A. OEP: Home exercise programme consisting of leg strengthening, balance exercise, and walking.

Frequency: 3 sessions/week of home exercise; at least 2 sessions/week of walking

Intensity: Walking moderate pace

Session duration: 30 min/home exercise session, and 30 min/walking session

Delivered by: Trial research staff in the one-off training

Duration of the intervention (wks): 24

Primary exercise type: Balance and function

B. FaME: Falls and exercise management programme involving progressive resistance training, flexibility training, functional floor skill and adapted Tai Chi. Additionally, FaME intervention included home exercise based on EOP and walking.

Frequency: 3-5 times/week [One exercise class, two home exercise session and at least two sessions of walking per week]

Intensity: walking at moderate pace

Session duration: 60 min/exercise class; 30 min/home exercise session; 30 min/walking session

Delivered by: Postural stability instructor

Duration of the intervention (wks): 24

Primary exercise type: Balance and function

C. Usual care

Participants not offered the FaME or OEP programmes

1. Femoral neck BMD

2. Trochanter BMD

3. Total hip BMD

4. Upper neck BMD

5. Lumbar spine BMD

6. Distal radius BMD

7. Whole body BMD

8. Whole body BMC

6

Mean difference (95% CI)

1. Femoral neck BMD

A. OEP: -0.003 (-0.011 to 0.005)

B. Community based: -0.002 (-0.010 to 0.005)

2. Trochanter BMD

A. OEP: -0.005 (-0.032 to 0.022)

B. Community based: 0.000 (-0.025 to 0.026)

3. Total hip BMD

A. OEP: -0.008 (-0.034 to 0.019)

B. Community based: 0.003 (-0.022 to 0.028)

4. Upper neck BMD

A. OEP: 0.003 (-0.018 to 0.023)

B. Community based: 0.006 (-0.013 to 0.026)

5. Lumbar spine BMD

A. OEP: 0.003 (-0.012 to 0.019)

B. Community based: 0.005 (-0.010 to 0.020)

6. Distal radius

A. OEP: 0.001 (-0.008 to 0.010)

B. Community based: -0.009 (-0.018 to -0.000)^c

7. Whole body BMD

A. OEP: 0.003 (-0.002 to 0.008)

B. Community based: -0.003 (-0.007 to 0.002)

8. Whole body BMC

A. OEP: 0.8 (-22.0 to 23.6)

B. Community based: -6.6 (-27.9 to 14.7)

Englund 2005

5/10 [48]

RCT

48/40

Setting: Community; Sweden

Health status: Healthy

A. Exercise (COMB)

n= 24 (randomised); 21 (analysed)

Age: 72.8 (3.6)

B. Control

n= 24 (randomised); 19 (analysed)

Age:73.2 (4.9)

Female: 100%

A. Supervised exercise programme involving a combination of strengthening, aerobic, balance and coordination exercises

Frequency: 2 times/week

Intensity: 2 sets of 8-12 reps (strengthening exercise)

Session duration: 50 min

Delivered by: Physiotherapist

Duration of the intervention (wks): 47

Primary exercise type: Multiple (balance and function plus resistance plus endurance)

B. No training

1. Lumbar Spine BMD

2. Femoral neck BMD

3. Trochanter BMD

4. Ward’s triangle BMD

5. Whole body BMD

6. Arms BMD

7. Whole body BMC

12

Mean difference (95% CI) (on % changes)

1. Lumbar spine BMD: 2.1 (-0.4 to 3.4)

2. Femoral neck BMD: 0 (-3.8 to 2.6)

3. Trochanter BMD: 3.4 (-1.2 to 7.3)

4. Ward's triangle BMD: 2.2 (1.8 to 12.9)^c

5. Whole body BMD: 0.1 (-1.3 to 2.2)

6. Arms BMD: 0 (-1.9 to 2.8)

7. Whole body BMC: 1.3 (-0.3 to 3.1)

Helge 2014

5/10 [50]

RCT

27/23

Setting: Community; Denmark

Health status: Healthy

A. Football group

n= 9 (randomised); 9 (analysed)

Age: 68.0 (4.0)

B. Resistance training

n= 9 (randomised); 8 (analysed)

Age: 69.1 (3.1)

C. Control

n= 8 (randomised); 6 (analysed)

Age: 67.4 (2.7)

Female: 0%

A. Football group: Supervised progressive football training

Frequency: 1.7 (0.3) times/week (range: 1.2-2.2)

Intensity: 82% of maximum heart rate (range 64 to 90%)

Session duration: 45 to 60 min

Delivered by: NR

Duration of the intervention (wks): 52

Primary exercise type: Balance and function (football)

B. Resistance training: Progressive resistance training for core and upper and lower body

Frequency: 1.9 (0.2) times/week (range: 1.4-2.2)

Intensity: started from 3 sets of 16-20 RM to 4 sets of 8 RM

Session duration: 45 to 60 min

Delivered by: NR

Duration of the intervention (wks): 52

Primary exercise type: Resistance (seated)

C. Inactive control

1. Whole body BMD

2. Right femoral neck BMD

3. Left femoral neck BMD

4. Right femoral shaft BMD

5. Left femoral shaft BMD

6. Total right proximal femur BMD

7. Total left proximal femur BMD

12

Final score (mean ± SE)

1. Whole body BMD

A. Football: 1.211 ± 0.036

B. Resistance: 1.225 ± 0.024

C. Control: 1.268 ± 0.030

2. Right femoral neck BMD

A. Football: 0.921 ± 0.034

B. Resistance: 1.000 ± 0.042

C. Control: 1.008 ± 0.063

3. Left femoral neck BMD

A. Football: 0.939 ± 0.034

B. Resistance: 1.006 ± 0.036

C. Control: 1.018 ± 0.043

4. Right femoral shaft BMD

A. Football: 1.156 ± 0.042

B. Resistance: 1.229 ± 0.056

C. Control: 1.254 ± 0.059

5. Left femoral shaft BMD

A. Football: 1.143 ± 0.043

B. Resistance: 1.229 ± 0.057

C. Control: 1.282 ± 0.045

6. Total right proximal femur BMD

A. Football: 0.982 ± 0.031

B. Resistance: 1.066 ± 0.048

C. Control: 1.083 ± 0.048

7. Total left proximal femur BMD

A. Football: 0.989 ± 0.031

B. Resistance: 1.069 ± 0.048

C. Control: 1.117 ± 0.041

Jessup 2003

5/10 [52]

RCT

18/16

Setting: Retirement Community; United States

Health Status: Healthy

A. Multi-component intervention

n= 9 (randomised); 8 (analysed)

Age: 69.1 (2.8)

B. Control

n= 9 (randomised); 8 (analysed)

Age: 69.4 (4.2)

Female: 100%

A. Supervised exercise programme involving resistance training, load-bearing walking with use of weights vest, stair-climbing, and balance training.

Frequency: 3 times/week

Intensity: 8-10 reps of 50% of 1RM, progressed to 75% of 1RM (resistance training

Session duration: 60 to 90 min exercise training session; 30 to 45 min walking

Delivered by: Co-investigator and/or research assistant

Duration of the intervention (wks): 32 weeks

Primary exercise type: Multiple (balance and function plus resistance plus endurance)

B. Control

1. Femoral neck BMD

2. Lumbar spine BMD

8

Change score (ANCOVA, p-value)

1. Femoral neck BMD

A. Exercise: 1.7

B. Control: -0.04

F (1, 15) = 7.38, P=0.016

2. Lumbar spine BMD

A. Exercise: 0.11

B. Control: -0.003

F (1, 15) = 2.70, P=0.121

Final score (mean ± SD)

1. Femoral neck BMD

A. Exercise: 0.74 ± 0.05

B. Control: 0.74 ± 0.13

2. Lumbar spine BMD

A. Exercise: 0.88 ± 0.08

B. Control: 1.14 ± 0.32

Karinkanta 2007¶

7/10 [53]

RCT

149/144

Setting: Community; Finland

Health Status: healthy and excluded participants with osteoporosis

A. Balance-jumping training

n= 37(randomised); 35 (analysed)

Age: 72.9 (2.3)

B. Resistance training

n= 37 (randomised); 37(analysed)

Age: 72.7 (2.5)

C. Combined Balance-jumping and resistance training

n= 38 (randomised); 36 (analysed)

Age: 72.9 (2.2)

D. Control

n= 37 (randomised); 36 (analysed);

Age: 72.0 (2.1)

Female: 100%

A. Balance-jumping training: Balance training including static and dynamic balance exercise, agility training, impact exercises and changes of direction exercise.

Intensity: NR

Primary exercise type: Balance and function including bone loading (jumps)

B. Resistance training: Tailored progressive resistance training programme for large muscle groups.

Intensity: Initially 2 sets of 10-15 reps at intensity 50-60% of 1RM, progressed to 3 sets of 8-10 reps at 75-80% of 1RM. Rate of perceived exertion: above 18 out of 20

Primary exercise type: Resistance

C. Combined Balance-jumping and resistance training: A combination of A & B on alternate weeks.

Primary exercise type: Multiple (balance and function plus resistance)

For all exercise groups:

Frequency: 3 times/week

Session duration: 50 min

Delivered by: Exercise leaders

Duration of the intervention (wks): 52

D. Control: maintain their pre-study level of physical activity during the 12-month trial

1. Femoral neck BMC

2. Distal tibia trabecular density (mg/cm³)

12

Final score (mean ± SD)

1. Femoral neck BMC

A. Balance: 2.73 ± 0.40

B. Resistance: 2.71 ± 0.33

C. Combined: 2.65 ± 0.29

D. Control: 2.67 ± 0.44

2. Distal tibia trabecular density (mg/cm³)

A. Balance: 224 ± 34

B. Resistance: 219 ± 26

C. Combined: 215 ± 39

D. Control: 226 ± 33

^eKarinkanta 2009¶

5/10 [98]

RCT

149/126

Setting: Community; Finland

Health Status: Healthy and excluded participants with osteoporosis

A. Balance jumping training group

n= 37 (randomised); 33 (analysed)

Age: 72.9 (2.3)

B. Resistance training group

n= 37 (randomised); 34 (analysed)

Age: 72.7 (2.5)

C. Combined resistance and balance jumping training group

n= 38 (randomised); 32 (analysed)

Age: 72.9 (2.2)

D. Non-training control group

n= 37 (randomised); 27(analysed)

Age: 72.0 (2.1)

Female: 100%

A. Balance-jumping training: Balance training (static and dynamic), agility training, impact exercises and changes of direction exercise.

Intensity: NR

Primary exercise type: Balance and function including bone loading (jumps)

B. Resistance training: Tailored progressive resistance for large muscle groups.

Intensity: Initially 2 sets of 10-15 reps at intensity 50-60% of 1RM, progressed to 3 sets of 8-10 reps at 75-80% of 1RM. Rate of perceived exertion: above 18 out of 20

Primary exercise type: Resistance

C. Combined Balance-jumping and resistance training: A combination of A & B on alternate weeks.

Primary exercise type: Multiple (balance and function plus resistance including bone loading)

For all exercise groups:

Frequency: 3 times/week

Session duration: 50 min

Delivered by: Exercise leaders

Duration of the intervention (wks): 52

D. Control: maintain their pre-study level of physical activity

1. Femoral neck section moduls (Z) (mm³)

2. Tibia midshaft desnity-weighted polar section modulus (BSI) (mm³)

24

% Mean difference compared to control (95% CI)

1. Femoral neck Z

A. Balance: 3.6 (-0.8 to 8.2)

B. Resistance: 3.5 (-0.8 to 8.1)

C. Combined: 0.3 (-4.0 to 4.8)

2. Tibia midshaft BSI

A. Balance: 0.2 (-1.1 to 1.6)

B. Resistance: 0.3 (-1.0 to 1.6)

C. Combined:0.6 (-0.7 to 1.9)

^dKemmler 2012§

4/10 [94]

Quasi-randomised trial

137/85

Setting: Community; Germany

Health Status: Osteopenia

A. Exercise group

n= 86 (randomised); 41 (analysed)

Age: 55.0 (3.4)

B. Control-no training

n= 51 (randomised); 44 (analysed)

Age: 55.8 (3.1)

Female: 100%

A. Supervised group class that includes warm-up/ endurance, jumping and resistance exercise + home training that includes rope skipping, isometric exercises, elastic belt and stretching exercises

Frequency: Supervised group classes: 2 times/week; home training 2 times/week

(supervised group classes: 3 times/week; home training 1 time/week in the year 4 and 5)

Intensity:

Aerobic dance: 70% to 85% maximum heart rate and peak ground reaction forces (GRF) at approximately 3 to 4 times bodyweight;

Multilateral jumping: 4 sets of 15 reps and GRF at approximately 4 times of bodyweight;

Resistance: from 1 to 4 sets, 4 to 12 reps, 70% to 90% 1 RM (2 to 3 minute-rest) to 2 to 3 sets, 20 to 25 reps, 50% to 55% 1 RM (1 to 2-minute rest)

Session duration: 60 to 65 min/ supervised group session;

20 min/home training session

Delivered by: Certified trainers

Duration of intervention (wks): 49 to 50 weeks/year throughout the 12 years

Primary exercise type: Multiple (endurance plus resistance with bone loading)

B. No training: maintain own’s habitual lifestyle

1. Lumbar spine (L1-L4) BMD

2. Femoral neck BMD

144

Mean difference (95% CI)

1. Lumbar spine BMD

0.030 (0.011 to 0.049)^c

2. Femoral neck BMD

0.024 (0.009 to 0.039)^c

^dKemmler 2016§

4 /10 [93]

Quasi-randomised trial

137/67

Setting: Community; Germany

Health status: Osteopenia

A. Exercise group

n= 86 (randomised); 39 (analysed)

Age: 55.0 (3.5)

B. Control-no training

n= 51 (randomised); 28 (analysed)

Age: 56.0 (3.0)

Female: 100%

A. Supervised group class (aerobic dance exercise, jumping and resistance exercise) + Home training (rope skipping, isometric and dynamic resistance exercise and stretching/ flexibility exercise) five months after study started

Frequency:

Year 4 and 5: supervised group classes: 3 times/week; home training 1 time/week

All other years: supervised group classes: 2 times/week; home training 2 times/week

Intensity:

Aerobic dance: 70% to 85% maximum heart rate and 2 to 3 bodyweight peak ground reaction forces (GRF)

Multilateral jumping: 4 sets of 15 reps at GRF of 3 to 4.5 bodyweightResistance exercise: from 1 to 4 sets of 4 to 12 reps at intensity of 70% to 90% 1 RM (2- to 3-minute rest) to 2 to 3 sets of 20 to 25 reps at an intensity of 50% to 55% 1 RM (1- to 2-minute rest)

Session duration: 60 to 65 min/ supervised group session; 20 to 25 min/home training session

Delivered by: NR

Duration of intervention (wks): 49 to 50 weeks/year throughout the 16 years

Primary exercise type: Multiple (endurance plus resistance with bone loading)

B. No training – maintain present lifestyle

1. Lumbar spine BMD

2. Total hip BMD

192

Absolute mean difference between groups (95% CI)

1. Lumbar spine BMD

Period 1 (baseline to year 4): 2.37 (0.97 to 3.77)^c

Period 2 (year 5 to year 8): 0.81 (0.15 to -1.76)

Period 3 (year 8 to year 12): 0.78 (0.03 to -1.58)

Period 4 (year 12 to year 16): 0.75 (0.12 to 1.38) ^c

2. Total hip BMD

Period 1 (baseline to year 4): 0.92 (0.24 to -2.08)

Period 2 (year 5 to year 8): 0.81 (0.12 to 1.92)^c

Period 3 (year 8 to year 12): 0.16 (0.59 to -0.91)

Period 4 (year 12 to year 16): 1.15 (0.08 to 2.22) ^c

^dKim 2018

6 /10 [95]

Pilot RCT

51/41

Setting: Outpatient department of a hospital; South Korea

Health status: Diagnosis of Stage I to III prostate cancer receiving androgen deprivation therapy without osteoporosis

A. Home-based exercise intervention for preventing osteoporosis (HEPO) intervention

n= 26 (randomised); 23 (analysed)

Age: 70.5 (5.0)

B. Control-stretching exercise (STR)

n= 25 (randomised); 18 (analysed)

Age: 71.0 (5.5)

Female: 0%

A. Home-based exercise (HEPO). A core program (weight-bearing exercise and resistance exercise) + optional program (stabilization/ balance exercise and circuit resistive calisthenics). Two 30-minute education sessions with a workbook preceded the start of the exercise and ten 15-minute sessions of telephone counselling

Frequency: 3 to 5 times/week

Intensity: The weight-bearing goal involved at least 150 minutes per week of moderate-intensity work, starting at an intensity of 11 to 12 on the rate of perceived exertion scale and increasing for 6 months to 13 to 15.

The resistance exercise protocol started at free weight and gradually increased to loads of 10% of body weight.

Session duration: ~40 min

Delivered by: Exercise physiologist

Duration of the intervention (wks): 24

Primary exercise type: Resistance with bone loading

B. Whole body stretching exercise (STR)

1. Lumbar spine (L1-L4) BMD

2. Femoral neck BMD

3. Total hip BMD

6

Change score (mean ± SD)

1. Lumbar spine (L1-L4) BMD

A. HEPO: -0.027 ± 0.007

B. STR: -0.031 ± 0.008

2. Femoral neck BMD

A. HEPO: -0.014 ± 0.007

B. STR: -0.015 ± 0.008

3. Total hip BMD

A. HEPO: -0.008 ± 0.006

B. STR: -0.011 ± 0.006

Kohrt 1997

3/10 [55]

Quasi-randomised trial

39/30

Setting: NR; United States

Health Status: Healthy

A. Ground reaction forces training

n= 14 (randomised); 12 (analysed)

Age: 66.0 (1.0)

B. Joint reaction forces training

n= 13 (randomised); 9 (analysed)

Age: 65.0 (1.0)

C. Control

n= 12 (randomised); 9 (analysed)

Age: 68.0 (1.0)

Female: 100%

A. Ground reaction forces training: Individualised exercise training focusing on activities that involved ground-reaction forces, such as walking, jogging and/or stair climbing.

Frequency: 3 to 5 times/week Intensity: 60-70% to 80-85% maximum heart rate

Session duration: 30-45 minutes/day

Delivered by: NR

Duration of the intervention (wks): 36

Primary exercise type: Multiple (balance and function plus endurance plus flexibility)

B. Joint reaction forces training: Individualised exercise training including activities that involved joint-reaction forces, such as weightlifting and rowing.

Frequency: 3 to 5 sessions/week

Intensity: Weightlifting: 2-3 sets of 8-12 reps; Rowing: 60-70% to 80-85% of maximum heart rate

Session duration: NR for the total session duration; however; rowing took 15 to 20 min

Delivered by: NR

Duration of the intervention (wks): 36

Primary exercise type: Multiple (resistance plus endurance plus flexibility)

C. No exercise

1. Whole body BMD

2. Lumbar spine L2–L4 BMD

3. Femoral neck BMD

4. Trochanter BMD

5. Ward’s BMD

6. Ultra-distal wrist BMD

7. One-third distal wrist BMD

12

Between-group analysis relative to control

1. Whole body BMD

A. Ground reaction: p < 0.05

B. Joint reaction: p < 0.01

2. Lumbar spine L2–L4 BMD

A. Ground reaction: p < 0.05

B. Joint reaction: p < 0.01

3. Femoral neck BMD

A. Ground reaction: p < 0.01

B. Joint reaction: no difference

4. Trochanter BMD

A. Ground reaction: no difference

B. Joint reaction: no difference

5. Ward’s BMD

A. Ground reaction: p < 0.01

B. Joint reaction: p < 0.05

6. Ultra-distal wrist BMD

A. Ground reaction: no difference

B. Joint reaction: no difference

7. One-third distal wrist BMD

A. Ground reaction: no difference

B. Joint reaction: no difference

Quantitative estimates were not reported (chance scores are provided in a graph)

^dKorpelainen 2010‡

7/10 [96]

RCT

160/100

Setting: Community; Finland

Health status: Women with hip and radius osteopenia

A. Exercise group

n= 84 (randomised); 55 (analysed)

Age: 72.7 (1.1)

B. Control group

n= 76 (randomised); 45 (analysed)

Age: 72.6 (1.2)

Female: 100%

A. Supervised balance, leg strength, and impact training and home exercise

Frequency: 1 time/week of training session; 1 time/day of home exercise training

Intensity: NR

Session duration: 60 min/ supervised session, and 20 min/ home exercise following program

Delivered by: Physical therapist

Duration of the intervention: 24 weeks/year

Primary exercise type: Multiple (balance and function plus resistance with bone loading)

B. Control

1. Femoral neck BMD

2. Trochanter BMD

3. Total proximal femur BMD

4. Femoral neck BMC

5. Trochanter BMC

6. Total proximal femur BMC

48, 60, 72

Mean difference (95% CI)

1. Femoral neck BMD

At 4 year: 0.01 (-0.02 to 0.03)

At 5 year: 0.01 (-0.03 to 0.02)

At 6 year: 0.00 (-0.02 to 0.02)

2. Trochanter BMD

At 4 year: 0.01 (-0.02 to 0.03)

At 5 year: 0.01 (-0.02 to 0.03)

At 6 year: 0.01 (-0.02 to 0.04)

3. Total proximal femur BMD

At 4 year: 0.01 (-0.01 to 0.04)

At 5 year: 0.01 (-0.02 to 0.03)

At 6 year: 0.01 (-0.01 to 0.04)

4. Femoral neck BMC

At 4 year: -0.01 (-0.14 to 0.11)

At 5 year: -0.03 (-0.16 to 0.09)

At 6 year: -0.01 (-0.13 to 0.11)

5. Trochanter BMC

At 4 year: -0.22 (-0.87 to 0.23)

At 5 year: -0.30 (-0.51 to 0.60)

At 6 year: -0.25 (-0.78 to 0.33)

6. Total proximal femur BMC

At 4 year: 0.01 (-1.56 to 0.76)

At 5 year: 0.01 (-1.72 to 0.74)

At 6 year: 0.01 (-1.68 to 0.81)

^dKorpelainen 2006‡

6/10 [79]

RCT

160/136

Setting: Community; Finland

Health status: Women with hip and radius osteopenia

A. Exercise group

n= 84 (randomised); 69(analysed)

Age: 72.9 (1.1)

B. Control group

n= 76 (randomised); 67 (analysed)

Age: 72.8 (1.2)

Female: 100%

A. Supervised balance, jumping, and impact group training

Frequency: 1 time/week of training session; 1 time/day of home exercise training

Intensity: NR

Session duration: 60 min/training session, and 20 min/home training

Delivered by: Physical therapist

Duration of the intervention (wks): 24 weeks/year [exercise took place at home for other times during the year and in total there were 72 weeks supervised group exercise] for 30 months.

Primary exercise type: Multiple (balance and function plus resistance with bone loading)

B. Control

1. Femoral neck BMD

2. Trochanter BMD

3. Total proximal femur BMD

4. Femoral neck BMC

5. Trochanter BMC

6. Total proximal femur BMC

7. Distal radius BMD

8. Ultradistal radius BMD

30

Mean difference (95% CI)

1. Femoral neck BMD

0.007 (-0.010 to 0.024)

2. Trochanter BMD

0.011 (-0.014 to 0.035)

3. Total proximal femur BMD

0.004 (-0.021 to 0.030)

4. Femoral neck BMC

-0.018 (-0.134 to 0.100)

5. Trochanter BMC

0.043 (-0.514 to 0.600)^c

6. Total proximal femur BMC

-0.332 (-1.433 to 0.769)

7. Distal radius BMD

-0.003 (-0.017 to 0.011)

8. Ultradistal radius BMD

-0.004 (-0.018 to 0.008)

Kwon 2008

3/10 [56]

Quasi-randomised trial

40/NR

Setting: Community; Korea

Health status: Healthy

A. Multicomponent intervention

n= 20 (randomised)

Age: 77.4 (2.56)

B. Control

n= 20 (randomised)

Age: 77.0 (3.33)

Female: 100%

A. Combined training programme consisting of aerobic exercise, resistance training (free weights) and balance exercise.

Frequency: 3 times/week

Intensity:

Aerobic exercises: started with 40-55% and up to 65-75% heart rate reserve;

Resistance exercise: 8-12 reps at 75% of 1RM

Session duration: 60 min

Delivered by: NR

Duration of the intervention (wks): 24

Primary exercise type: Multiple (balance and function plus endurance plus resistance)

B. Control

1. Whole body BMD

2. Lumbar (L2-L4) spine BMD

3. Femoral neck BMD

4. Ward’s triangle BMD

5. Greater trochanter BMD

6

Final score (mean ± SD)

1. Whole body BMD

A. Exercise: 0.92 ± 0.07

B. Control: 0.88 ± 0.05

2. Lumbar (L2-L4) spine BMD

A. Exercise: 0.85 ± 0.15

B. Control: 0.85 ± 0.10

3. Femoral neck BMD

A. Exercise:0.68 ± 0.12

B. Control: 0.70 ± 0.07

4. Ward’s triangle BMD

A. Exercise: 0.48 ± 0.10

B. Control: 0.46 ± 0.08

5. Greater trochanter BMD^c

A. Exercise: 0.59 ± 0.05

B. Control: 0.58 ± 0.12

Lau 1992

4/10 [57]

RCT

60/50

Setting: Hostel; Hong Kong

Health Status: Healthy

A. Exercise group and placebo calcium supplementation

n= 11 (analysed)

Age: mean age (range): 79 (76-81)

B. Calcium supplementation

n= 12 (analysed)

Age: mean age(range): 75 (72-79)

C. Calcium supplementation and exercise

n= 15 (analysed)

Age: mean age(range): 76 (73-80)

D. Control

n= 12 (analysed)

Age: mean age (range): 75 years (71-78)

Female: 100%

A. Supervised exercise involving moving the upper trunk while standing.

Frequency: 4 times/week

Intensity: Submaximal exertion effort

Session duration: 15 min

Delivered by: NR

Duration of the intervention (wks): 40

Primary exercise type: Balance and function

Control

1. Femoral neck BMD

2. Wards triangle BMD

3.Intertrochanteric area BMD

4. Lumbar spine (L2-L4) BMD

10

Change score (%; mean, 95% CI)

1. Femoral neck BMD

A. Exercise: -6.6 (-12 to 0.8)

B. Control: -1.1 (-7.4 to 5.3)

C. Supplement: -3.5 (-9 to 1.8)

D. Supplement and exercise: 5.0 (-0.77 to 10)

2. Wards triangle BMD

A. Exercise: -6.0 (-15 to 3.2)

B. Control: -2.4 (-10 to 5.9)

C. Supplement: 2.5 (-5.9 to 11)

D. Supplement and exercise: 17 (3 to 31)

3.Intertrochanteric area BMD

A. Exercise: 0.1 (-6.5 to 6.7)

B. Control: 0.25 (-3.3 to 3.8)

C. Supplement: 2 (-1.6 to 5.7)

D. Supplement and exercise: 11 (1.3 to 22)

4. Lumbar spine BMD

A. Exercise: -1.9 (-6.7 to 2.8)

B. Control: -2.5 (-6.5 to 1.4)

C. Supplement: -0.08 (-5.2 to 5.1)

D. Supplement and exercise: -1.1 (-3.7 to 1.4)

Lord 1996

4/10 [58]

RCT

179/138

Setting: Community, Australia

Health Status: Healthy

A. Multicomponent exercise

n= 90 (randomised); 68 (analysed)

Age: 71.7 (5.4)

B. Control

n= 89 (randomised); 70 (analysed)

Age: 71.5 (5.3)

Female: 100%

A. Supervised group-based exercise programme involving aerobic exercise, balance training, strengthening exercise, and stretching.

Frequency: 2 times/week

Intensity: NR

Session duration: 60 min

Delivered by: Instructors trained to provide the programme

Duration of the intervention (wks): 52 (only 42 weeks for exercise as there were breaks in between)

Primary exercise type: Balance and function

No exercise

1. Femoral neck BMD

2. Trochanter BMD

3. Lumbar spine (L2-L4) BMD

12

Final score (mean ± SD) / Change score (mean % change ± SD)

1. Femoral neck BMD

A. Exercise: 0.791 ± 0.122 / 1.52 ± 5.19

B. Control: 0.776 ± 0.110 / 3.12 ± 6.52

2. Trochanter BMD

A. Exercise: 0.707 ± 0.127 / 0.69 ± 4,64

B. Control: 0.672 ± 0.123 / 0.73 ± 5.28

3. Lumbar spine (L2-L4) BMD

A. Exercise: 1.036 ± 0.209 / 1.07 ± 2.59

B. Control: 1.008 ± 0.189 / 0.36 ± 3.91

Marques 2011

5/10 [59]

RCT

60/60

Setting: Community; Portugal

Health Status: Healthy

A. Multi-component training

n= 30 (randomised and analysed)

Age: 70.1 (5.4)

B. Control

n= 30 (randomised and analysed)

Age: 68.2 (5.7)

Female: 100%

A. Progressive multicomponent exercise training consisting of moderate to high impact weight-bearing activities, endurance, balance exercise, and agility training.

Frequency: 2 times/week

Intensity: Stepping exercise: at 120-125 beats/min.

Weight bearing and strength exercise: from 2 sets of 8 reps to 3 sets of 15 reps

Session duration: 60 min

Delivered by: Physical education instructors specialised in physical activity for older adults

Duration of the intervention (wks): 32

Primary exercise type: Balance and function with bone loading (heel drops)

B. Control

1. Femoral neck BMD

2. Total femur BMD

3. Trochanter BMD

4. Intertrochanteric BMD

5. Lumbar spine (L1-L4) BMD

8

Final score (mean ± SD)

1. Femoral neck BMD^c

A. Exercise: 0.717 ± 0.085

B. Control: 0.671 ± 0.051

2. Total femur BMD

A. Exercise: 0.832 ± 0.104

B. Control: 0.823 ± 0.058

3. Trochanter BMD

A. Exercise: 0.628 ± 0.081

B. Control: 0.628 ± 0.034

4. Intertrochanteric BMD

A. Exercise: 0.989 ± 0.148

B. Control: 0.977 ± 0.075

5. Lumbar spine (L1-L4) BMD

A. Exercise: 0.868 ± 0.094

B. Control: 0.863 ± 0.065

McCartney 1995

3/10 [60]

RCT

68/NR

Setting: NR; Canada

Health status: Healthy

A. Exercise

n= 37 (randomised)

Age: 73 (3)

Female: 54%

B. Control

n= 31(randomised)

Age: 72 (3)

Female: 74%

A. Progressive resistance training for upper and lower body, and abdominals. Completed in as a circuit.

Frequency: 2 sessions/week

Intensity: 2 sets of each exercise at 50% of 1RM to 3 sets of 80% 1RM

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 42 weeks

Primary exercise type: Resistance

B. Control

Offered a supervised walking programme.

Frequency: 2 sessions/week

Intensity: low

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 42 weeks

1. Lumbar spine (L2-4) BMD

2. Whole body BMD

3. Lumbar spine (L2-4) BMC

4. Whole body BMC

10.5

No significant changes in BMD and BMC as a result of the training programme. Quantitative estimates not reported.

McMurdo 1997

4/10 [61]

RCT

118/92

Setting: Community; United Kingdom Health status: Healthy

A. Exercise and calcium supplementation

n= 44 (analysed)

B. Calcium supplementation

n= 48 (analysed)

Age: 64.5 (range 60-73)

Female: 100%

A. Exercise programme involving weight bearing exercise to music and calcium supplementation (1000 mg calcium daily, as calcium carbonate)

Frequency: 3 times/week

Intensity: NR

Session duration: 45 min

Delivered by: NR

Duration of the intervention (wks): 30 (three 10-week terms)

Primary exercise type: Balance and function

B. Taking calcium supplementation (1000 mg calcium daily, as calcium carbonate)

1. Lumbar BMD

2. Distal forearm (non-dominant) BMC

3. Ultra distal forearm (non-dominant) BMC

24

Change score (mean % change ± 95% CI)

1. Lumbar BMD

A. Exercise and calcium: -0.91 (-6.8 to 5.0)

B. Calcium: -2.65 (-5.7 to 0.4)

2. Distal forearm (non-dominant) BMC

A. Exercise and calcium: -2.18 (-3.0 to -1.4)

B. Calcium: -1.38 (-2.2 to -0.6)

3. Ultra distal forearm BMC^c

A. Exercise and calcium: 1.14 (-0.8 to 3.1)

B. Calcium: -2.6 (-4.6 to -0.6)

^eNichols 1995

4/10 [99]

RCT

34/28

Setting: Community; United States

Health status: Healthy and active

A. Weight training group

n= 17(randomised); 9 (analysed at 12-month)

Age: 67.8 (standard error: 1.6)

B. Control

n= 17(randomised); 8 (analysed at 12-month)

Age: 65.2 (1.2)

Female: 100%

A. Supervised, isotonic training (leg flexion and extension, back extension, trunk flexion, bench press, latissimus dorsi pull-down, shoulder press and seated row)

Frequency: 3 times/week

Intensity: Commenced with one set of 10-12 reps at an intensity of 50% of 1RM and progressed to three sets at 80% of 1RM from third week

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 52

Primary exercise type: Resistance

B. Contunue current endurance exercise program

1. Lumbar spine (L2-4) BMD2. Femoral neck BMD

3. Trochanter BMD

4. Total body BMD

12

Final score (mean ± SE)

1. Lumnar spine BMD

A. Weight training: 1.025 ± 0.04

B. Control: 1.012 ± 0.03

2. Femoral neck BMD

A. Weight training: 0.776 ± 0.03

B. Control: 0.772 ± 0.02

3. Trochanter BMD

A. Weight training: 0.670 ± 0.02

B. Control: 0.666 ± 0.03

4. Total body BMD

A. Weight training: 0.976 ± 0.02

B. Control: 0.979 ± 0.03

Paillard 2004

5/10 [62]

RCT

21/21

Setting: Community; France

Health status: Healthy

A. Walking group

n= 11 (randomised and analysed)

Age: 65.5 (2)

B. Control

n= 10 (randomised and analysed)

Age: 66.8 (2)

Female: 0%

A. Individualised brisk walking programme

Frequency: 5 times/week

Intensity: Lactate threshold (minimum heart rate: 131 beats/minute; maximum heart rate: 156 beats/minute)

Session duration: 45 to 60 min

Delivered by: NR

Duration of the intervention (wks): 12

Primary exercise type: Endurance (walking)

B. Control

1. Hip BMD

2. Whole body BMD

3

Final score (mean ± SD)

1. Hip BMD

A. Walking: 0.84 ± 0.11

B. Control: 0.95 ± 0.12

2. Whole body BMD

A. Walking: 1.06 ± 0.11

B. Control: 1.02 ± 0.13

Park 2008

5/10 [63]

RCT

50/50

Setting: Community; Korea

Health status: Healthy

A. Multi-component training

n= 25 (randomised and analysed)

Age: 68.3 (3.6)

B. Control

n= 25 (randomised and analysed)

Age: 68.4 (3.4)

Female: 100%

A. Exercise training including stretching, strength training, weight-bearing exercise, balance and posture correction training.

Frequency: 3 times/week

Intensity: 65%-75% of the maximum heart rate

Session duration: 60 min

Delivered by: NR

Duration of the intervention (wks): 48

Primary exercise type: Multiple balance/ function plus endurance (weight-bearing)

B. Control

1. Femoral neck BMD

2. Ward’s triangle BMD

3. Trochanter BMD

4. Lumbar spine (L2 to L4) BMD

12

Final score (mean ± SD)

1. Femoral neck BMD^c

A. Exercise: 0.857 ± 0.078

B. Control: 0.748 ± 0.063

2. Ward’s triangle BMD

A. Exercise: 0.659 ± 0.086

B. Control: 0.576 ± 0.079

3. Trochanter BMD^c

A. Exercise: 0.725 ± 0.081

B. Control: 0.677 ± 0.062

4. Lumbar spine (L2 to L4) BMD

A. Exercise: 1.059 ± 0.082

B. Control: 0.891 ± 0.155

Pruitt 1995

4/10 [64]

RCT

40/26

Setting: Community; America

Healthy status: Healthy

A. High intensity resistance training

n= 15 (randomised); 8 (analysed)

Age: 67.0 (0.5)

B. Low intensity resistance training

n= 13 (randomised); 7 (analysed)

Age: 67.6 (1.4)

C. Control

n= 12 (randomised); 11 (analysed)

Age: 69.6 (4.2)

Female: 100%

A. High intensity resistance training: High intensity supervised resistance training comprising exercises for upper and lower extremities with the use of equipment.

Intensity: 2 sets of 7 reps at 80% 1RM

Primary exercise type: Resistance

B. Low intensity resistance training: Supervised resistance training comprising exercises for upper and lower extremities using equipment.

Intensity: 3 sets of 14 reps at 40% 1RM

For both A and B:

Frequency: 3 times/week

Session duration: 50 to 55 min

Delivered by: NR

Duration of the intervention (wks): 52

Primary exercise type: Resistance

C. No training

1. Total hip BMD

2. Femoral neck BMD

3. Ward’s triangle BMD

4. Lumbar spine (L2-L4) BMD

12

Change score (mean ± SD)

1. Total hip BMD

A. High intensity: 0.005 ± 0.014

B. Low intensity: 0.008 ± 0.012

C. Control: 0.007 ± 0.010

2. Femoral neck BMD

A. High intensity: -0.002 ± 0.154

B. Low intensity: 0.025 ± 0.008

C. Control: 0.005 ± 0.019

3. Ward’s triangle BMD

A. High intensity: 0.018 ± 0.032

B. Low intensity: 0.022 ± 0.045

C. Control: 0.008 ± 0.036

4. Lumbar spine (L2-L4) BMD

A. High intensity: 0.007 ± 0.018

B. Low intensity: 0.005 ± 0.027

C. Control: 0.000 ± 0.020

Rhodes 2000

5/10 [65]

RCT

44/38

Setting: Community; Canada

Health Status: Healthy

A. Resistance training

n= 22 (randomised); 20 (analysed)

Age: 68.8 (3.2)

B. Control

n= 22 (randomised); 18 (analysed)

Age: 68.2 (3.5)

Female: 100%

A. Supervised progressive resistance training comprising exercises for large muscle groups.

Frequency: 3 times/week

Intensity: 3 sets of 8 reps at 75 % 1 RM

Session duration: 60 min

Delivered by: Professional lifestyle and fitness consultants

Duration of the intervention (wks): 52

Primary exercise type: Resistance

B. No exercise programme and were instructed to maintain their normal lifestyle throughout the study duration.

1. Femoral neck BMD

2. Ward’s triangle BMD

3. Trochanter BMD

4. Lumbar spine (L2-L4) BMD

5. Femoral neck BMC

6. Ward’s triangle BMC

7. Trochanter BMC

8. Lumbar spine (L2-L4) BMC

12

Final score (mean ± SD)

1. Femoral neck BMD

A. Exercise: 0.83 ± 0.12

B. Control: 0.73 ± 0.10

2. Ward’s triangle BMD

A. Exercise: 0.70 ± 0.11

B. Control: 0.59 ± 0.12

3. Trochanter BMD

A. Exercise: 0.75 ± 0.11

B. Control: 0.67 ± 0.11

4. Lumbar spine (L2-L4) BMD

A. Exercise: 1.13 ± 0.18

B. Control: 1.01 ± 0.17

5. Femoral neck BMC

A. Exercise: 4.02 ± 0.22

B. Control: 3.48 ± 0.19

6. Ward’s triangle BMC

A. Exercise: 1.85 ± 0.19

B. Control: 1.51 ± 0.18

7. Trochanter BMC

A. Exercise: 9.04 ± 0.33

B. Control: 8.83 ± 0.36

8. Lumbar spine (L2-L4) BMC

A. Exercise: 45.86 ± 2.7

B. Control: 42.50 ± 2.6

Rikli 1990

1/10 [67]

Quasi-randomised trial

37/31

Setting: Local retirement community; United States

Health Status: Healthy

A. General exercise

n= 13 (randomised); 10 (analysed)

Age: 72.2 (5.57)

B. General exercise + weight

n= 13 (randomised); 10 (analysed)

Age: 71.6 (5.66)

C. Control

n= 11 (randomised); 11 (analysed)

Age: 70.8 (8.43)

Female: 100%

A. General exercise: Group-based aerobic exercise training for large muscle groups.

Frequency: 3 times/week

Intensity: 60-70% maximum heart rate

Session duration: 30 to 50 min

Delivered by: NR

Duration of the intervention (wks): 40

Primary exercise type: endurance

B. General exercise + weight: Group-based aerobic exercise training plus upper body progressive resistance training. The resistance training was performed without supervision.

Frequency: 3 times/week

Intensity: 60-70% maximum heart rate for aerobic activities

Session duration: 50 to 70 min

Delivered by: Assistants

Duration of the intervention (wks): 40

Primary exercise type: Multiple resistance plus endurance

C. No exercise

1. Distal radius BMC/BW

2. Distal radius BMC

10

Change score (%)

1. Distal radius BMC/BW^c

A. General exercise: 0.921

B. General exercise and weight: 1.734

C. Control: -2.577

2. Distal radius BMC^c

A. General exercise: 1.023

B. General exercise and weight: 1.743

C. Control: -2.499

Sakai 2010

4/10 [68]

RCT

94/84

Setting: Community, Japan

Health Status: Healthy

A. Exercise

n= 49 (randomised); 47 (analysed)

Age: 68.3 (0.8)

B. Control

n= 45 (randomised); 37 (analysed)

Age: 68.2 (0.5)

Female: 100%

A. Home balance exercises involving unipedal standing exercise with their eyes open (single leg standing)

Frequency: 3 sets/day; 7 days/week

Intensity: NA

Session duration: 2 min/set

Delivered by: NA (home exercise)

Duration of the intervention (wks): 26

Primary exercise type: Balance/function

B. Usual activity

1. Femoral neck BMD

2. Trochanter BMD

3. Intertrochanter BMD

4. Ward's triangle BMD

5. Total hip BMD

6

% mean difference (p-value)

1. Femoral neck: p=0.993

2. Trochanter: p=0.801

3. Intertrochanter: p=0.968

4. Ward’s triangle p=0.096

5. Total hip: p=0.889

Change score reported in a graph

Smith 1981

2/10 [70]

Quasi-randomised trial

80/51

Setting: Nursing home; United States

Health Status: Healthy

A. Physical activity group + placebo tablets

n= 19 (randomised); 12 (analysed)

Age: 82.9 (6.1)

B. Control (placebo tablet)

n= 26 (randomised); 18 (analysed)

Age: 81.9 (7.4)

C. Calcium and vitamin D

n= 17 (randomised); 10 (analysed)

Age: 80.7 (4.8)

D. Physical activity + calcium and vitamin D

n= 18 (randomised); 11 (analysed)

Age: 84.3 (5.1)

Female: 100%

A. Light-to-mild seated exercises including sideward leg spread, leg walk, running in place, arm cross, sideward bend and chair pull.

Frequency: 3 times/week

Intensity: 70% of the sampled VO₂ max

Session duration:30 min

Delivered by: NR

Duration of the intervention (wks): 156

Primary exercise type: Endurance (seated)

B. Placebo tablets

Received 360 mg of lactose, 5mg of magnesium stearate and 80 mg of microcrystalline cellulose in the placebo tablets

1. Radius BMC

36

Change score (%)

Radius BMC^c

A. Exercise: 2.29%

D. Control: - 3.29%

^eSnow 2000

3/10 [100]

Quasi-randomised trial

18/18

Setting: Community; United States

Health status: Healthy

A. Exercise group

n= 9 (randomised and analysed)

Age: 66.4 (1.7)

B. Control

n= 9 (randomised and analysed)

Age: 61.8 (2.5)

Female:100%

A. Year1: 9-month training (10 min of warm-up, 35 min of lower-body resistance training, including stepping, squats, chair raises, forward lunges, lateral lunges and toe raises, using the weighted vest, 10-15 min of cool-down activities. Jumping exercises were included during the fourth months of training without the weighted vests

Year 2-5 emphasied maintenance in lower body exercises utilising the weighted vest included more jumps per class than year 1 and encouraged use of the weighted vest while jumping.

Frequency: 3 times/week

Intensity: 3 to 5 sets of 10 to 15 reps using the weight vest.

Vest resistance set from 5% of body weight and was gradually increased (approximaltey 1 to 2% every 2 weeks) until 10% of body weight; Beyond 10% of body weight, resistance was increased at 0.5% to 1% every 2 weeks.

Session duration: 60

Delivered by: NR

Duration of the intervention (wks): 260

Primary exercise type: Resistance with bone loading (jumping)

B. Maintain and record their physical activity during the study and did not engage in weighted vest of jumping activity

1. Femoral neck BMD

2. Trochanter BMD

3. Total hip BMD

60

% change (mean ± SE)

1. Femoral neck BMD^c

A. Exercise group: 1.54 ± 2.37

B. Control: -4.43 ± 0.93

2. Trochanter BMD^c

A. Exercise group: -0.24 ± 1.02

B. Control: -3.43% ± 1.09

3. Total hip BMD^c

A. Exercise group: -0.82 ± 1.04

B. Control: -3.80% ± 1.03%

Taaffe 1996

4/10 [101]

RCT

36/21

Setting: Community; United States

Health status: Healthy

A. High intensity resistance training group

n= 12 (randomised); 7 (analysed)

Age: 67.0 (0.2)

B. Low intensity resistance training group

n= 13 (randomised); 7 (analysed)

Age: 67.6 (0.5)

C. Control

n= 11 (randomised); 7 (analysed)

Age: 69.6 (1.3)

Female: 100%

Supervised exercise training targeted thigh muscle strength including leg press, knee extension and knee flexion. Exercise sessions were bracketed by warm up and cool-down periods

A. Intensity: 1 set of 14 reps at an intensity of 40% 1RM and 2 sets of 7 reps at an intensity of 80% of 1RM

B. Intensity: 3 sets of 14 reps at an intensity of 40% of 1RM

For both groups

Frequency: 3 times/week

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 52

Primary exercise type: Resistance

D. Control

1. Middle third of the femur BMD

2. Thigh BMD

12

Change score (mean % ± SEM)

1. Middle third of the femur BMD^c

A. High intensity: 1.0± 1.0

B. Low inteisty: -2.2 ± 0.5

C. Control: -1.8 ± 0.6

2. NR

Taaffe 1999

5/10 [72]

RCT

53/46

Setting: Community; United States

Health status: Healthy

A. High-intensity resistance training (1 day per week)

n= 14 (randomised); 11 (analysed)

Age: 68.5 (3.6)

Female: 36%

B. High-intensity resistance training (2 days per week)

n= 14 (randomised); 12 (analysed)

Age: 69.4 (3.0)

Female: 29%

C. High-intensity resistance training (3 days per week)

n= 11 (randomised & analysed)

Age: 71.0 (4.1)

Female: 36%

D. Control

n= 14 (randomised); 12 (analysed)

Age: 68.9 (3.6)

Female: 43%

A, B & C. Supervised resistance training targeting the major upper and lower body muscle groups.

A. Frequency: 1 time/week

B. Frequency: 2 times/week

C. Frequency: 3 times/week

Intensity: Started at 60% of the 1RM and gradually increase in intensity to 3 sets of 8 reps at 80% of 1 RM

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 24

Primary exercise type: Resistance

D. Control

1. Lumbar spine (L2-L4) BMD

2. Total hip BMD

3. Midradius BMD

4. Total body BMC

6

Final score (mean ± SEM)

1. Lumbar spine (L2-L4) BMD

A. Resistance 1x/week: 1.025 ± 0.006

B. Resistance 2x/week: 1.033 ± 0.006

C. Resistance 3x/week: 1.032 ± 0.007

D. Control: 1.041 ± 0.006

2. Total hip BMD

A. Resistance 1x/week: 0.865 ± 0.010

B. Resistance 2x/week: 0.866 ± 0.006

C. Resistance 3x/week: 0.864 ± 0.010

D. Control: 0.873 ± 0.010

3. Midradius BMD

A. Resistance 1x/week: 0.605 ± 0.003

B. Resistance 2x/week: 0.604 ± 0.003

C. Resistance 3x/week: 0.608 ± 0.003

D. Control: 0.601 ± 0.003

4. Total body BMC

A. Resistance 1x/week: 2552 ± 15

B. Resistance 2x/week: 2530 ± 14

C. Resistance 3x/week: 2525 ± 14

D. Control: 2536 ± 14

Villareal 2003

4/10 [73]

Quasi-randomised trial

28/28

Setting: Community; United States

Health status: Mild to moderate physical frailty on hormone replacement therapy

A. Supervised multi-component training

n= 14 (randomised and analysed)

Age: 81 (3)

B. Control: Home exercise

n= 14 (randomised and analysed)

Age: 81 (3)

Female: 100%

A. Supervised exercise programme involving flexibility and balance exercises, resistance training and endurance exercises.

Frequency: 3 times/week

Intensity:

Resistance training: from 1-2 sets of 8-12 reps at 65% of 1RM to 2-3 sets of 6-8reps at 75–85% of 1RM

Endurance: from 65–75 to 85–90% peak heart rate

Session duration: 90 to 120 min

Delivered by: Exercise physiologists

Duration of the intervention (wks): 36 weeks

Primary exercise type: Multiple (resistance plus balance/function plus endurance)

B. Home exercise programme focusing on flexibility

Frequency: 2-3 times/week

1. Total hip BMD

2. Femoral neck BMD

3. Trochanter BMD

4. Lumbar spine BMD

5. Whole body BMD

9

Change score (mean ± SD)

1. Total hip BMD

A. Exercise: 0.003 ± 0.011

B. Control: 0.009 ± 0.011

4. Lumbar spine BMD^c

A. Exercise: 0.034 ± 0.022

B. Control: 0.015 ± 0.022

5. Whole body BMD

A. Exercise: 0.015 ± 0.015

B. Control: 0.002 ± 0.015

No quantitative estimates reported for:

2. Femoral neck BMD

3. Trochanter BMD

(There were no significant group-by-time interaction effects)

Results reported in a graph

Villareal 2004

4/10 [74]

RCT

119/112

Setting: Community; United States

Health status: Mild-to-moderate physical frailty

A. Exercise training (ET)

n= 69 (randomised); 65 (analysed)

Age: 83 (4)

Female: 52%

B. Home exercise (HOME)

n= 50 (randomised); 47 (analysed)

Age: 83 (4)

Female: 55%

A. Supervised exercise programme involving flexibility and balance exercises, resistance training and endurance exercises.

Frequency: NR

Intensity:

Resistance training: started from 1-2 sets of 6-8 reps at 65-75% of 1RM to 3 sets of 8-12 reps at 85-100% 1RM

Endurance training: started from 15 mins at 65-75% of peak heart rate to 30 mins at 85-90% of peak heart rate

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 36

Primary exercise type: Multiple (resistance plus balance/function plus endurance)

B. Home exercise programme focusing on flexibility

1. Total hip BMD

2. Femoral neck BMD

3. Trochanter BMD

4. Lumbar spine (L2-L4) BMD

5. Whole Body BMD

9

Final score (mean ± SD)

1. Total hip BMD

A. Exercise: 0.85 ± 0.19

B. Control: 0.75 ± 0.15

2. Femoral neck BMD

A. Exercise: 0.70 ± 0.17

B. Control: 0.63 ± 0.11

3. Trochanter BMD

A. Exercise: 0.65 ± 0.17

B. Control: 0.58 ± 0.12

4. Lumbar spine (L2-L4) BMD

A. Exercise: 1.08 ± 0.28

B. Control: 0.97 ± 0.23

5. Whole Body BMD

A. Exercise: 1.09 ± 0.18

B. Control: 1.03 ± 0.17

von Stengel 2011

7/10 [78]

RCT

151/141

Setting: Community; Germany

Health Status: Healthy

A. Conventional multicomponent training

n= 50 (randomised); 47 (analysed)

Age: 68.6 (3)

B. Wellness control

n= 51 (randomised); 48 (analysed)

Age: 68.1 (2.7)

Female: 100%

A. Training sessions consisting of aerobic dancing; progressive coordination and balance training; functional gymnastics and isometric strength training; and progressive upper body exercises. Additionally, participants were requested to carry out a home training session.

Frequency: 4 times/week [i.e. 2 controlled training session/week; 2 home exercise/week]

Intensity:

Dance aerobic: 70–80% maximum heart rate;

Functional gymnastics and isometric strength: 6-10s of maximum exertion and 20-30s of active rest;

Upper body exercise: 3 sets 15 reps

Session duration: 60 min/training session; 20 min/home training session

Delivered by: Certified instructors

Duration of the intervention (wks): 72

Primary exercise type: Multiple (balance/function, plus flexibility plus resistance plus endurance (dance)

B: Low intensity wellness programme that includes

light physical exercises and a relaxation

programme

Frequency: 1 time/week

Intensity: Light

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 72

(10 weeks of training were intermitted by a break of 10 weeks and the training cycle was repeated throughout 72 weeks)

1. Total hip BMD

2. Lumbar spine (L1-L4) BMD

18

Mean difference (95% CI):

1. Total hip BMD: 0.002 (-0.007 to 0.012)

2. Lumbar spine: 0.015 (0.001 to 0.029)^c

^dWinters-Stone 2014

7/10 [97]

RCT

51/43

Setting: Community; United States

Health Status: Prostate cancer survivors receiving androgen deprivation therapy without osteoporosis

Age: 70.2

A. Progressive, moderate-intensity resistance + impact training (POWIR)

n=29 (randomised); 24(analysed)

B. Control- flexibility training (FLEX)

n= 22 (randomised); 12 (analysed)

Female: 0%

A. Progressive, moderate-intensity resistance for upper and lower body + impact training consisted of two footed jumps from the group to a target height 1” from the floor with a bent-knee landing with weighted vests

Frequency: 3 times/week (two supervised classes + one home-based session)

Intensity: Lower body training 1-2 sets of 8-12 reps from 0% to 15% of the body weight. Upper body training started from 1-2 sets of 12-14 reps at 13-15 RM to 1-2 sets of 8 to 10 reps at 8-10RM. Jumping started from 1-4 sets of 10 reps at 0-1% body weight to 9 to 10 sets of 10 reps at 10% body weight using weighted vest

Session duration: 60 min

Delivered by: Trained exercise instructors

Duration of the intervention (wks): 52

Primary exercise type: Resistance with bone loading

B. FLEX Control: Whole body stretching and relaxation

1. Lumbar spine (L1-L4) BMD

2. Total hip BMD

3. Greater trochanter BMD

4. Femoral neck BMD

12

Final score (mean ± SD)

1. Lumbar spine BMD

A. POWIR: 1.123 ± 0.241

B. FLEX: 1.094 ± 0.156

2. Total hip BMD

A. POWIR: 0.956 ± 0.135

B. FLEX: 0.971 ± 0.129

3. Greater trochanter BMD

A. POWIR: 0.776 ± 0.131

B. FLEX: 0.783 ± 0.112

4. Femoral neck BMD

A. POWIR: 0.752 ± 0.131

B. FLEX: 0.791 ± 0.098

Woo 2007

6/10 [75]

RCT

180/176

Setting: Community; Hong Kong

Heath status: Healthy

A. Tai Chi

n=60 (randomised); 58 (randomised)

Age: 68.2 years

B. Resistance training

n= 60 (randomised); 59 (randomised)

Age: 68.7 years

C. No Treatment

n= 60 (randomised); 59 (randomised)

Age: 68.1 years

Female: 50%

A. Tai Chi: 24-forms of Tai Chi using Yang style

Frequency: 3 times/week

Intensity: NR

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 52 weeks

Primary exercise type: 3D (Tai Chi)

B. Resistance training: Resistance training with the use of medium strength TheraBand

Frequency: 3 times/week

Intensity: 30 times with medium strength TheraBand

Session duration: NR

Delivered by: NR

Duration of the intervention (wks): 52 weeks

Primary exercise type: Resistance

C. No intervention

1. Total hip BMD

2. Total spine BMD

12

Change score (mean % change ± SE)

Men

1. Total hip BMD

A. Tai Chi: -0.48 ± 0.37

B. Resistance: -1.20 ± 0.38

C. Control: -0.15 ± 0.38

2. Total spine BMD

A. Tai Chi: 1.35 ± 0.40

B. Resistance: 1.27 ± 0.42

C. Control: 0.54 ± 0.42

Women

1. Total hip BMD

A. Tai Chi: 0.07 ± 0.64^c

B. Resistance: 0.09 ± 0.62^c

C. Control: -2.25 ± 0.60

2. Total spine BMD

A. Tai Chi: 0.10 ± 0.50

B. Resistance: 1.98 ± 0.48

C. Control: 0.98 ± 0.47

Yoo 2010

4/10 [76]

RCT

28/21

Setting: Community; Korea

Health status: Healthy

A. Exercise

n=14 (randomised); 11 (analysed)

Age: 70.9 (2.7)

B. Control

n= 14 (randomised); 10 (analysed)

Age: 71.1 (2.7)

Female: 100%

A. Supervised walking exercise programme involving walking ankle weights.

Frequency: 3 times/week

Intensity: Maintained at 60% of heart rate reserve

Session duration: 60 min

Delivered by: NR

Duration of the intervention (wks): 12

Primary exercise type: Endurance (walking with ankle weights)

B. Control

1. Femoral neck BMD

2. Femoral Ward’s BMD

3. Femoral trochanter BMD

4. Spine BMD

5. Whole body BMD

3

Final score (mean ± SD)

1. Femoral neck BMD

A. Exercise: 0.770 ± 0.132

B. Control: 0.729 ± 0.124

2. Femoral Ward’s BMD

A. Exercise: 0.580 ± 0.158

B. Control: 0.584 ± 0.164

3. Femoral trochanter BMD

A. Exercise: 0.708 ± 0.105

B. Control: 0.687 ± 0.136

4. Spine BMD

A. Exercise: 1.056 ± 0.188

B. Control: 1.010 ± 0.167

5. Whole body BMD

A. Exercise: 1.057 ± 0.077

B. Control: 1.028 ± 0.109