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

From: 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

Reference PEDro score Study design
Allocated/Analysed
Participants (n, age mean (SD), % women, setting, health status) Intervention
Primary exercise type according to ProFANEa
Controlb Outcomes Follow up (mo) Results
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 BMDc
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 BMCc
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 ± 0.59c
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 BMDc
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 BMDc
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 BMCc
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 BMDc
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 BMDc
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/BWc
A. General exercise: 0.921
B. General exercise and weight: 1.734
C. Control: -2.577
2. Distal radius BMCc
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 BMCc
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 BMDc
A. Exercise group: 1.54 ± 2.37
B. Control: -4.43 ± 0.93
2. Trochanter BMDc
A. Exercise group: -0.24 ± 1.02
B. Control: -3.43% ± 1.09
3. Total hip BMDc
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 BMDc
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 BMDc
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 ± 0.64c
B. Resistance: 0.09 ± 0.62c
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
  1. BMC bone mineral content (g), BMD bone mineral density (g/cm2 unless specified), BMI body mass index (kg/m2), BW bone width, NR not reported, RCT randomised controlled trial. In studies where other groups or other outcomes not of interest to this study were included (example supplement, or whole-body vibration) we only included and extracted information for the groups and for the comparisons that were relevant to this study (i.e., those where the effect of physical activity could be evaluated). When data was available for more than one time-point, we extracted the post-intervention data and any additional follow-up. Mean estimates were extracted in the following hierarchical order: mean difference, change score and final score
  2. aExercise is a physical activity that is planned, structured and repetitive and aims to improve or maintain physical fitness. There is a wide range of possible types of exercise, and exercise programmes often include one or more types of exercise. We categorised exercise based on a modification of the Prevention of Falls Network Europe (ProFaNE) taxonomy that classifies exercise type as: i) gait, balance, and functional training; ii) strength/ resistance (including power); iii) flexibility; iv) three- dimensional (3D) exercise (e.g., Tai Chi, Qigong, dance); v) general physical activity; vi) endurance; and vii) other kind of exercises. The taxonomy allows for more than one type of exercise to be delivered within a programme. We also considered whether the exercise explicitly included bone loading eg hopping or heel drops
  3. bA control intervention is one that is not thought to improve bone health, such as general health education, social visits, very gentle exercise, or ’sham’ exercise not expected to impact on bone health.
  4. cindicates statistically significant between-group differences at p < 0.05
  5. dindicates studies that were found in the expanded search for individual studies conducted in March 2020 in PubMed
  6. eindicates studies that were found in the updated search for systematic reviews conducted in July 2020 in PubMed, Embase, CINAHL, SPORTDiscus
  7. § and ‡ and ¶ indicate articles reporting results from the same study