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Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis

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Abstract

Our objective was to assess the effects of differing modes of impact exercise on bone density at the hip and spine in premenopausal women through systematic review and meta-analysis. Electronic databases, key journals and reference lists were searched for controlled trials investigating the effects of impact exercise interventions on lumbar spine (LS), femoral neck (FN) and total hip (TH) bone mineral density (BMD) in premenopausal women. Exercise protocols were categorised according to impact loading characteristics. Weighted mean difference (WMD) meta-analyses were undertaken. Heterogeneity amongst trials was assessed. Fixed and random effects models were applied. Inspection of funnel plot symmetry was performed. Trial quality assessment was also undertaken. Combined protocols integrating odd- or high-impact exercise with high-magnitude loading (resistance exercises), were effective in increasing BMD at both LS and FN [WMD (fixed effect) 0.009 g cm−2 95% CI (0.002–0.015) and 0.007 g cm−2 95% CI (0.001–0.013); P = 0.011 and 0.017, respectively]. High-impact only protocols were effective on femoral neck BMD [WMD (fixed effect) 0.024 g cm−2 95% CI (0.002–0.027); P < 0.00001]. Funnel plots showed some asymmetry for positive BMD outcomes. Insufficient numbers of protocols assessing TH BMD were available for assessment. Exercise programmes that combine odd- or high-impact activity with high-magnitude resistance training appear effective in augmenting BMD in premenopausal women at the hip and spine. High-impact-alone protocols are effective only on hip BMD in this group. However, diverse methodological and reporting discrepancies are evident in published trials.

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References

  1. Peck WA, Burckhardt P, Christiansen C, Fleisch HA, Genant HK, Gennari C, Martin TJ, Martinin L, Morita R, Ogata A, Rapado A, Schulman I, Stern PH, Young RTT (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650

    Article  Google Scholar 

  2. Heaney RP, Abrams S, wson-Hughes B, Looker A, Marcus R, Matovic V, Weaver C (2000) Peak bone mass. Osteoporos Int 11:985–1009

    Article  CAS  PubMed  Google Scholar 

  3. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR (2004) American College of Sports Medicine position stand on physical activity and bone health. Med Sci Sports Exer 36:1985–1996

    Article  Google Scholar 

  4. Lanyon LE, Rubin CT (1984) Static vs dynamic loads as an influence on bone remodelling. J Biomech 17:897–905

    Article  CAS  PubMed  Google Scholar 

  5. Frost HM (1988) Vital biomechanics: proposed general concepts for skeletal adaptations to mechanical usage. Calcif Tissue Int 42:145–156

    Article  CAS  PubMed  Google Scholar 

  6. Nikander R, Sievänen H, Heinonen A, Kannus P (2005) Femoral neck structure in adult female athletes subjected to different loading modalities. J Bone Miner Res 20:520–528

    Article  PubMed  Google Scholar 

  7. Martyn-St James M, Carroll S (2008) A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med. doi:10.1136/bjsm.2008.052704

  8. Bailey CA, Brooke-Wavell K (2008) Exercise for optimising peak bone mass in women. Proc Nutr Soc 67:9–18

    Article  CAS  PubMed  Google Scholar 

  9. Higgins JPT, Green S (ed) (2008) Cochrane Reviewers’ Handbook 5.0.1 [updated September 2008]. In: The Cochrane library, issue 4. Wiley, Chichester

  10. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup D (2000) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Br J Surg 87:1448–1454

    Article  CAS  PubMed  Google Scholar 

  11. Shea B, Bouter LE, Grimshaw JM, Francis D, Oritz Z, Wells GA, Tugwell PS, Boers M (2006) Scope for improvement in the quality of reporting of systematic reviews. From the Cochrane Musculoskeletal Group. J Rheumatol 33:9–15

    PubMed  Google Scholar 

  12. Wallace BA, Cumming RG (2000) Systematic review of randomised trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif Tissue Int 67:10–18

    Article  CAS  PubMed  Google Scholar 

  13. Wolff I, Van C, Kemper HCG, Kostense PJ, Twisk JWR (1999) The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int 9:1–12

    Article  CAS  PubMed  Google Scholar 

  14. Deeks JJ, Higgins JPT, Altman DG (ed) (2006) Analysing and presenting results. Cochrane handbook for systematic reviews of inventions 5.0.0 [updated February 2008]. Chapter 9. In: The Cochrane library, issue 4. Wiley, Chichester

  15. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  16. Shadish WR, Haddock CK (1994) Combining estimates of effect size. In: Cooper H, Hedges LV (eds) The handbook of research synthesis. New York, pp 261–284

  17. Vainionpää A, Korpelainen R, Vihriälä E, Rinta-Paavola A, Leppäluoto J, Jämsä T (2006) Intensity of exercise is associated with bone density change in premenopausal women. Osteoporos Int 1–9

  18. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  Google Scholar 

  19. Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  20. Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    CAS  PubMed  Google Scholar 

  21. Bassey EJ, Rothwell MC, Littlewood JJ, Pye DW (1998) Pre- and postmenopausal women have different bone mineral responses to the same high-impact exercise. J Bone Miner Res 13:1805–1813

    Article  CAS  PubMed  Google Scholar 

  22. Friedlander AL, Genant HK, Sadowsky S, Byl NN, Gler CC (1995) A two-year program of aerobics and weight training enhances bone mineral density in young women. J Bone Miner Res 10:574–585

    Article  CAS  PubMed  Google Scholar 

  23. Heinonen A, Kannus P, Sievänen H, Oja P, Pasanen M, Rinne M, Uusi-Rasi K, Vuori I (1996) Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 348:1343–1347

    Article  CAS  PubMed  Google Scholar 

  24. Kato T, Terashima T, Yamashita T, Hatanaka Y, Honda A, Umemura Y (2006) Effect of low-repetition jump training on bone mineral density in young women. J Appl Phys 100:839–843

    Google Scholar 

  25. Sugiyama T, Yamaguchi A, Kawai S (2002) Effects of skeletal loading on bone mass and compensation mechanism in bone: a new insight into the mechanostat theory. J Bone Miner Metab 20:196–200

    Article  PubMed  Google Scholar 

  26. Vainionpää A, Korpelainen R, Leppäluoto J, Jämsä T (2005) Effects of high-impact exercise on bone mineral density: a randomized controlled trial in premenopausal women. Osteoporos Int 16:191–197

    Article  PubMed  Google Scholar 

  27. Weaver CM, Teegarden D, Lyle RM, McCave GP, McCabe L, Proulx W, Kern M, Sedlock D, Naderson DD, Hillberry BM, Peacock M, Johnston CC (2001) Impact of exercise on bone health and contraindication of oral contraceptive use in young women. Med Sci Sports Exerc 33:873–880

    Google Scholar 

  28. Winters-Stone KM, Snow CM (2006) Site-specific response of bone to exercise in premenopausal women. Bone 39:1203–1209

    Article  PubMed  Google Scholar 

  29. Winters KM, Titus M, Snow CM (1996) Progressive jump and lower body resistance training hip bone mass in premenopausal women. Med Sci Sports Exer 31:S83

    Google Scholar 

  30. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gotzsche PC, Lang T, for the CONSORT Group (2001) The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 134:663–694

    CAS  PubMed  Google Scholar 

  31. Martyn-St James M, Carroll S (2006) Progressive high-intensity resistance training and bone mineral density changes among premenopausal women: a meta-analysis. Evidence of discordant site-specific skeletal effects. Sports Med 36:683–704

    Article  PubMed  Google Scholar 

  32. Kleijnen J, Gøtzsche P, Kunz RA, Oxman AD, Chalmers I (1997) So what’s so special about randomisation? In: Non-random reflections on health services research: on the 25th anniversary of Archie Cochrane’s effectiveness and efficiency. BMJ Publishing, London, pp 93–106

  33. Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC (2008) Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336:601–605

    Article  PubMed  Google Scholar 

  34. Akobeng AK (2005) Understanding randomised controlled trials. Arch Dis Child 90:840–844

    Article  CAS  PubMed  Google Scholar 

  35. Borer KT (2005) Physical activity in the prevention and amelioration of osteoporosis in women: interaction of mechanical, hormonal and dietary factors. Sports Med 35:779–830

    Article  PubMed  Google Scholar 

  36. Bassey EJ (1994) Increase in femoral bone density in young women following high-impact exercise. Osteoporos Int 4:72–75

    Article  CAS  PubMed  Google Scholar 

  37. Frost HM (1990) Skeletal structure adaptations to mechanical usage (SATMU); 1. Redifining Wolff’s law: the bone modeling problem. Anat Record 226:403–413

    Article  CAS  Google Scholar 

  38. Umemura Y, Nagasawa S, Honda A, Singh R (2008) High-impact exercise frequency per week or day for osteogenic response in rats. J Bone Miner Metab 26:456–460

    PubMed  Google Scholar 

  39. Neville AM, Burrows M, Holder RL, Bird S, Simpson D (2003) Does lower-body BMD develop at the expense of upper-body BMD in female runners? Med Sci Sports Exerc 35:1733–1739

    Article  Google Scholar 

  40. Moher D, Schulz KF, Altman D, for the CONSORT Group (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 285:1987–1991

    Article  CAS  PubMed  Google Scholar 

  41. Sterne JAC, Egger M, Moher D (2008) Chapter 10: addressing reporting biases. In: Higgins JPT (ed) Cochrane handbook for systematic reviews of interventions version 5.0.1 [updated September 2008]. http://www.cochrane-handbook.org

  42. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61:991–996

    Article  PubMed  Google Scholar 

  43. Hergenroeder AC, Smith EO, Shypailo R, Jones LA, Klish WJ, Ellis K (1997) Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone, or placebo over 12 months. Am J Obstet Gynecol 176:1017–1025

    Article  CAS  PubMed  Google Scholar 

  44. Nappi CM, Sardo ADSM, Greco EM, Tommaselli GAM, Giordano EM, Guida MM (2005) Effects of an oral contraceptive containing drospirenone on bone turnover and bone mineral density. Obstet Gynecol 105:53–60

    CAS  PubMed  Google Scholar 

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Correspondence to Marrissa Martyn-St James.

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Martyn-St James, M., Carroll, S. Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis. J Bone Miner Metab 28, 251–267 (2010). https://doi.org/10.1007/s00774-009-0139-6

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