Position Statement: Exercise Guidelines for Osteoporosis Management and Fall Prevention in Osteoporosis Patients
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Background: The effectiveness of exercise for improving osteoporosis and fall prevention in patients diagnosed with osteoporosis or osteopenia has not been fully summarized. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology has developed exercise guidelines for patients with osteoporosis or osteopenia and provide evidence-based recommendations. Methods: A systematic review identified randomized controlled trials (RCT) assessing the effect of resistance, impact, balance, aerobic training, and physical activity in osteoporosis and osteopenia on bone quality, physical performance, quality of life, and fall prevention. PubMed, Embase, KoreaMed, and RISS were searched from January 2000 to August 2022. Ten key questions were established to review the evidence and formulate recommendations. Results: The 50 RCTs reported that even with osteoporosis and osteopenia, resistance and impact training consistently maximized bone strength, improved body strength and balance, and eventually reduced fall incidences. Resistance exercise combining 3 to 10 types of free weight and mechanical exercise of major muscle groups performed with an intensity of 50% to 85% 1-repetition maximum, 5 to 12 repetitions/set, 2 to 3 days/week, for 3 to 12 months is recommended. Impact exercises such as jumping chin-ups with drop landings and jump rope performed 50 jumps/session for at least 6 months with 3 or more days/week are recommended. Conclusions: A multi-component exercise mainly comprised of resistance and impact exercise seems to be an effective strategy to attenuate the risk factors of osteoporosis and osteopenia. The integration of exercise guidelines and individualized exercise plans has significant potential to reduce the morbidity and mortality of osteoporosis.
Abstract
Background: The effectiveness of exercise for improving osteoporosis and fall prevention in patients diagnosed with osteoporosis or osteopenia has not been fully summarized. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology has developed exercise guidelines for patients with osteoporosis or osteopenia and provide evidence-based recommendations. Methods: A systematic review identified randomized controlled trials (RCT) assessing the effect of resistance, impact, balance, aerobic training, and physical activity in osteoporosis and osteopenia on bone quality, physical performance, quality of life, and fall prevention. PubMed, Embase, KoreaMed, and RISS were searched from January 2000 to August 2022. Ten key questions were established to review the evidence and formulate recommendations. Results: The 50 RCTs reported that even with osteoporosis and osteopenia, resistance and impact training consistently maximized bone strength, improved body strength and balance, and eventually reduced fall incidences. Resistance exercise combining 3 to 10 types of free weight and mechanical exercise of major muscle groups performed with an intensity of 50% to 85% 1-repetition maximum, 5 to 12 repetitions/set, 2 to 3 days/week, for 3 to 12 months is recommended. Impact exercises such as jumping chin-ups with drop landings and jump rope performed 50 jumps/session for at least 6 months with 3 or more days/week are recommended. Conclusions: A multi-component exercise mainly comprised of resistance and impact exercise seems to be an effective strategy to attenuate the risk factors of osteoporosis and osteopenia. The integration of exercise guidelines and individualized exercise plans has significant potential to reduce the morbidity and mortality of osteoporosis.
참고문헌 (73)
- Eschard JP, "Nursing care. Diagnosis and treatment of osteoporosis in the elderly", Soins Gerontol, 31, pp.17~21 (2001)
- Tromp AM, "Fall-risk screening test : a prospective study on predictors for falls in community-dwelling elderly", J Clin Epidemiol, 54, pp.837~844 (2001)[DOI]
- Bliuc D, "Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women", JAMA, 301, pp.513~521 (2009)[DOI]
- Klop C, "Mortality in British hip fracture patients, 2000-2010: A population-based retrospective cohort study", Bone, 66, pp.171~177 (2014)[DOI]
- Cauley JA, "Risk of mortality following clinical fractures", Osteoporos Int, 11, pp.556~561 (2000)[DOI]
- Lindsay R, "Risk of new vertebral fracture in the year following a fracture", JAMA, 285, pp.320~323 (2001)[DOI]
- Liu-Ambrose T, "Older women with osteoporosis have increased postural sway and weaker quadriceps strength than counterparts with normal bone mass : overlooked determinants of fracture risk?", J Gerontol A Biol Sci Med Sci, 58, pp.M862~M866 (2003)[DOI]
- Bonaiuti D, "Exercise for preventing and treating osteoporosis in postmenopausal women", Cochrane Database Syst Rev, 3, pp.CD000333~ (2002)[DOI]
- Giangregorio LM, "Too fit to fracture : Exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture", Osteoporos Int, 25, pp.821~835 (2014)[DOI]
- Turner CH, "Exercises for improving bone strength", Br J Sports Med, 39, pp.188~189 (2005)[DOI]
- Kohrt WM, "Muscle forces or gravity : What predominates mechanical loading on bone?", Med Sci Sports Exerc, 41, pp.2050~2055 (2009)[DOI]
- Martyn-St James M, "Effects of different impact exercise modalities on bone mineral density in premenopausal women : a meta-analysis", J Bone Miner Metab, 28, pp.251~267 (2010)[DOI]
- Vuori I, "Effects of unilateral strength training and detraining on bone mineral density and content in young women : a study of mechanical loading and deloading on human bones", Calcif Tissue Int, 55, pp.59~67 (1994)[DOI]
- Zhao R, "The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women : a meta-analysis", Osteoporos Int, 26, pp.1605~1618 (2015)[DOI]
- Nowalk MP, "A randomized trial of exercise programs among older individuals living in two long-term care facilities : the FallsFREE program", J Am Geriatr Soc, 49, pp.859~865 (2001)[DOI]
- Kohrt WM, "American College of Sports Medicine Position Stand : Physical activity and bone health", Med Sci Sports Exerc, 36, pp.1985~1996 (2004)[DOI]
- Bonaiuti D, "SIMFER Rehabilitation treatment guidelines in postmenopausal and senile osteoporosis", Eura Medicophys, 41, pp.315~337 (2005)
- Kim SY, "NECA’s guidance for undertaking systematic review and meta-analyses for intervention" (2011), National Evidence-based Healthcare Collaborating Agency
- 민석기, "Position Statement: Exercise Guidelines to Increase Peak Bone Mass in Adolescents", 대한골대사학회지, 26(4), pp.225~239 (2019), 대한골대사학회
- Beck BR, "Exercise and Sports Science Australia(ESSA)position statement on exercise prescription for the prevention and management of osteoporosis", J Sci Med Sport, 20, pp.438~445 (2017)[DOI]
- U. S. Department of Health and Human Services, "Physical activity guidelines for Americans", U. S. Department of Health and Human Services, ~ (2018)
- Compston J, "UK clinical guideline for the prevention and treatment of osteoporosis", Arch Osteoporos, 12, pp.43~ (2017)[DOI]
- Kanis JA, "European guidance for the diagnosis and management of osteoporosis in postmenopausal women", Osteoporos Int, 30, pp.3~44 (2019)[DOI]
- Camacho PM, "American Association of Clinical Endocrinologists", American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update executive summary, 2020, pp.26, 564~570
- Higgins JPT, "Cochrane handbook for systematic reviews of interventions. Version 6.1" (2019), The Cochrane Collaboration
- Liu-Ambrose TY, "Both resistance and agility training increase cortical bone density in 75-to 85-year-old women with low bone mass : a 6-month randomized controlled trial", J Clin Densitom, 7, pp.390~398 (2004)[DOI]
- Mosti MP, "Maximal strength training in postmenopausal women with osteoporosis or osteopenia", J Strength Cond Res, 27, pp.2879~2886 (2013)[DOI]
- de Matos O, "Effect of specific exercise training on bone mineral density in women with postmenopausal osteopenia or osteoporosis", Gynecol Endocrinol, 25, pp.616~620 (2009)[DOI]
- Harding AT, "Effects of supervised high-intensity resistance and impact training or machine-based isometric training on regional bone geometry and strength in middle-aged and older men with low bone mass : The LIFTMOR-M semi-randomised controlled trial", Bone, 136, pp.115362~ (2020)[DOI]
- Kemmler W, "Effects of high-intensity resistance training on osteopenia and sarcopenia parameters in older men with osteosarcopenia-one-year results of the randomized controlled franconian osteopenia and sarcopenia trial(FrOST)", J Bone Miner Res, 35, pp.1634~1644 (2020)[DOI]
- Kistler-Fischbacher M, "High-intensity exercise and geometric indices of hip bone strength in postmenopausal women on or off bone medication : The MEDEX-OP randomised controlled trial", Calcif Tissue Int, 111, pp.256~266 (2022)[DOI]
- Garber CE, "American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise", Med Sci Sports Exerc, 43, pp.1334~1359 (2011)[DOI]
- Watson S, "High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis : The LIFTMOR randomized controlled trial", J Bone Miner Res, 34, pp.572~ (2019)[DOI]
- Murlasits Z, "Effect of resistance training frequency on physiological adaptations in older adults", J Exerc Sci Fit, 10, pp.28~32 (2012)[DOI]
- Borba-Pinheiro CJ, "Resistance training programs on bone related variables and functional independence of postmenopausal women in pharmacological treatment : a randomized controlled trial", Arch Gerontol Geriatr, 65, pp.36~44 (2016)[DOI]
- Shaw JM, "ACSM’s resource manual for guidelines for exercise testing and prescription", pp.288~293 (1998), Williams and Wilkins
- Basat H, "The effects of strengthening and high-impact exercises on bone metabolism and quality of life in postmenopausal women : a randomized controlled trial", J Back Musculoskelet Rehabil, 26, pp.427~435 (2013)[DOI]
- Hettchen M, "Changes in menopausal risk factors in early postmenopausal osteopenic women after 13 months of high-intensity exercise : The randomized controlled ACTLIFE-RCT", Clin Interv Aging, 16, pp.83~96 (2021)[DOI]
- Moreira LD, "The benefits of a high-intensity aquatic exercise program(HydrOS)for bone metabolism and bone mass of postmenopausal women", J Bone Miner Metab, 32, pp.411~419 (2014)[DOI]
- Sen EI, "Effects of whole-body vibration and high impact exercises on the bone metabolism and functional mobility in postmenopausal women", J Bone Miner Metab, 38, pp.392~404 (2020)[DOI]
- Watson SL, "High-intensity exercise did not cause vertebral fractures and improves thoracic kyphosis in postmenopausal women with low to very low bone mass : the LIFTMOR trial", Osteoporos Int, 30, pp.957~964 (2019)[DOI]
- Multanen J, "Effects of high-impact training on bone and articular cartilage : 12-month randomized controlled quantitative MRI study", J Bone Miner Res, 29, pp.192~201 (2014)[DOI]
- Multanen J, "Effect of progressive high-impact exercise on femoral neck structural strength in postmenopausal women with mild knee osteoarthritis : a 12-month RCT", Osteoporos Int, 28, pp.1323~1333 (2017)[DOI]
- Kistler-Fischbacher M, "A comparison of bone-targeted exercise with and without antiresorptive bone medication to reduce indices of fracture risk in postmenopausal women with low bone mass : The MEDEX-OP randomized controlled trial", J Bone Miner Res, 36, pp.1680~1693 (2021)[DOI]
- Madureira MM, "A 12-month randomized controlled trial of balance training in elderly women with osteoporosis : improvement of quality of life", Maturitas, 66, pp.206~211 (2010)[DOI]
- Mikó I, "Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women : a randomized controlled trial", Clin Rehabil, 31, pp.217~224 (2017)[DOI]
- Smulders E, "Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history : a randomized controlled trial", Arch Phys Med Rehabil, 91, pp.1705~1711 (2010)[DOI]
- Liu-Ambrose T, "Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial", J Am Geriatr Soc, 52, pp.657~665 (2004)[DOI]
- Carter ND, "Results of a 10 week community based strength and balance training programme to reduce fall risk factors : a randomised controlled trial in 65-75 year old women with osteoporosis", Br J Sports Med, 35, pp.348~351 (2001)[DOI]
- Evstigneeva L, "Effect of twelve-month physical exercise program on patients with osteoporotic vertebral fractures: a randomized, controlled trial", Osteoporos Int, 27, pp.2515~2524 (2016)[DOI]
- Papaioannou A, "Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures", Osteoporos Int, 14, pp.677~682 (2003)[DOI]
- Benedetti MG, "The effectiveness of physical exercise on bone density in osteoporotic patients", Biomed Res Int, 2018, pp.4840531~ (2018)[DOI]
- Chien MY, "Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women", Calcif Tissue Int, 67, pp.443~448 (2000)[DOI]
- 지용석, "1년간의 알레드로네이트 투여와 운동프로그램이 골다공증 노인여성의 골밀도 수준과 관련변인에 미치는 효과", 한국사회체육학회지, 19(2), pp.1455~1466 (2003), 한국사회체육학회
- Roghani T, "Effects of short-term aerobic exercise with and without external loading on bone metabolism and balance in postmenopausal women with osteoporosis", Rheumatol Int, 33, pp.291~298 (2013)[DOI]
- Wen HJ, "Effects of short-term step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass", Osteoporos Int, 28, pp.539~547 (2017)[DOI]
- 최필병, "장기간의 복합운동이 골다공증 노인의 신체부위별 골밀도와 심혈관질환 위험요인에 미치는 영향", 한국노년학, 31(2), pp.355~369 (2011), 한국노년학회
- 김찬양, "걷기운동과 밴드저항운동을 이용한 복합운동 적용이 골감소증 여성노인의 아이리신, 오스테오칼신 및 골밀도에 미치는 효과", 한국여성체육학회지, 33(2), pp.169~184 (2019), 한국여성체육학회[DOI]
- Feng F, "Comprehensive interventions including vitamin D effectively reduce the risk of falls in elderly osteoporotic patients", Orthop Surg, 13, pp.1262~1268 (2021)[DOI]
- Wayne PM, "Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial", BMC Complement Altern Med, 12, pp.7~ (2012)[DOI]
- Young CM, "Simple, novel physical activity maintains proximal femur bone mineral density, and improves muscle strength and balance in sedentary, postmenopausal Caucasian women", Osteoporos Int, 18, pp.1379~1387 (2007)[DOI]
- 정성우, "16주간의 복합운동 트레이닝이 골다공증-근감소성 비만 고령여성의 아이리신, 아디포카인, 골대사지표와 기능체력, 등속성 근기능에 미치는 영향", 한국체육과학회지, 26(5), pp.937~954 (2017), 한국체육과학회[DOI]
- Nakamura K, "Physical activity modifies the effect of calcium supplements on bone loss in perimenopausal and postmenopausal women : subgroup analysis of a randomized controlled trial", Arch Osteoporos, 14, pp.17~ (2019)[DOI]
- Brooke-Wavell K, "Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis", Br J Sports Med, 56, pp.837~846 (2022)[DOI]
- Sherrington C, "Effective exercise for the prevention of falls : a systematic review and meta-analysis", J Am Geriatr Soc, 56, pp.2234~2243 (2008)[DOI]
- Kelley GA, "Effects of ground and joint reaction force exercise on lumbar spine and femoral neck bone mineral density in postmenopausal women : a meta-analysis of randomized controlled trials", BMC Musculoskelet Disord, 13, pp.177~ (2012)[DOI]
- Silsupadol P, "Training of balance under single-and dual-task conditions in older adults with balance impairment", Phys Ther, 86, pp.269~281 (2006)
- Karlsson MK, "Physical activity, muscle function, falls and fractures", Food Nutr Res, 52, pp.1~7 (2008)[DOI]
- Rogers ME, "Training to reduce postural sway and increase functional reach in the elderly", J Occup Rehabil, 11, pp.291~298 (2001)[DOI]
- Sherrington C, "Exercise for preventing falls in older people living in the community", Cochrane Database Syst Rev, 1, pp.CD012424~ (2019)[DOI]
- Stanghelle B, "Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial", Osteoporos Int, 31, pp.1069~1078 (2020)[DOI]
- ElDeeb AM, "Effect of whole-body vibration exercise on power profile and bone mineral density in postmenopausal women with osteoporosis : A randomized controlled trial", J Manipulative Physiol Ther, 43, pp.384~393 (2020)[DOI]
- Jepsen DB, "The combined effect of Parathyroid hormone(1-34)and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis(PaVOS study) : a randomized controlled trial", Osteoporos Int, 30, pp.1827~1836 (2019)[DOI]
