Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials
Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials
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DOI：
10.1007/s11357-011-9311-8
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发表时间：
2012-12-01
期刊：
影响因子：
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通讯作者：
Carvalho, Joana
中科院分区：
文献类型：
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作者：
Marques, Elisa A.;Mota, Jorge;Carvalho, Joana
本研究的目的是评估具有不同冲击负荷特征的运动干预对老年人腰椎（LS）和股骨颈（FN）骨密度（BMD）的影响。我们检索了截至2011年2月的电子数据库和手工检索的选定期刊，以寻找研究冲击运动干预对老年人LS和FN BMD影响的随机对照试验（RCT）。运动方案根据冲击负荷特征进行分类。进行了加权平均差异（WMD）荟萃分析。对试验间的异质性和发表偏倚进行了检验。应用随机效应模型。还进行了审判质量评估。19项RCT（包括1577例受试者）符合入选标准。22个研究组比较报告了LS时的BMD数据。荟萃分析显示，该部位的BMD发生了显著变化（WMD 0.011 g/cm（2），95% CI 0.003 - 0.020; p = 0.007），尽管结果存在中度不一致性（I-2 = 52.2%）。FN的BMD数据来自19个老年人研究组的比较。结果不一致（I-2 = 63.6%），显示运动对该部位BMD的显著正效应（WMD 0.016 g/cm（2），95% CI 0.005 - 0.027; p = 0.004）。冲击活动与通过阻力训练进行的高强度关节反作用力负荷的联合负荷研究在LS时有效（WMD 0.016 g/cm（2），95% CI 0.002至0.036; p = 0.028），这些试验之间不存在不一致性。奇数冲击方案也有效地增加骨密度在LS（WMD 0.039 g/cm（2），95% CI 0.002 - 0.075; p = 0.038）和FN（WMD 0.036 g/cm（2），95% CI 0.012至0.061; p = 0.004），尽管异质性明显（I-2 = 87.5%和I-2 = 83.5%）。我们发现LS和FN的低冲击和抗阻运动研究结果之间具有一致性，尽管在任何研究中心的这些类型的方案中以及在FN提供组合负荷冲击运动的RCT中，BMD变化不显著。漏斗图显示无发表偏倚的证据。试验质量为中等至高等。我们的RCT荟萃分析结果支持运动增加老年人LS和FN BMD的疗效。
The purpose of the study was to assess the effects of exercise interventions with different impact loading characteristics on lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) in older adults. We searched electronic databases and hand searched selected journals up to February 2011 for randomized controlled trials (RCTs) investigating the effects of impact exercise interventions on LS and FN BMD in older adults. Exercise protocols were categorized according to impact loading characteristics. Weighted mean difference (WMD) meta-analyses were undertaken. Heterogeneity amongst trials and publication bias was tested. Random-effects models were applied. Trial quality assessment was also undertaken. Nineteen RCTs, including 1577 subjects, met the inclusion criteria. Twenty-two study group comparisons reported BMD data at the LS. Meta-analysis showed a significant change in BMD at this site (WMD 0.011 g/cm(2), 95% CI 0.003 to 0.020; p = 0.007), although results were moderately inconsistent (I-2 = 52.2%). BMD data at the FN were available from 19 study group comparisons among older adults. Results were inconsistent (I-2 = 63.6%) in showing a significant positive effect of exercise on BMD at this site (WMD 0.016 g/cm(2), 95% CI 0.005 to 0.027; p = 0.004). Combined loading studies of impact activity mixed with high-magnitude joint reaction force loading through resistance training were effective at LS (WMD 0.016 g/cm(2), 95% CI 0.002 to 0.036; p = 0.028), and no inconsistency existed among these trials. Odd-impact protocols were also effective in increasing BMD at LS (WMD 0.039 g/cm(2), 95% CI 0.002 to 0.075; p = 0.038) and FN (WMD 0.036 g/cm(2), 95% CI 0.012 to 0.061; p = 0.004), although heterogeneity was evident (I-2 = 87.5% and I-2 = 83.5%, respectively). We found consistency among results for low-impact and resistance exercise studies on LS and FN, although non-significant BMD changes were evident amongst these types of protocols at any site and amongst the RCTs that provided a combined loading impact exercise at FN. Funnel plots showed no evidence of publication bias. Trial quality was moderate to high. The findings from our meta-analysis of RCTs support the efficacy of exercise for increasing LS and FN BMD in older adults.