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Current Osteoporosis Reports

Erschienen in:

03.10.2017 | Nutrition, Exercise and Lifestyle in Osteoporosis (S Shapses and J Lappe, Section Editors)

Exercise Frequency and Fracture Risk in Older Adults—How Often Is Enough?

verfasst von: Wolfgang Kemmler, Simon von Stengel, Matthias Kohl

Erschienen in: Current Osteoporosis Reports | Ausgabe 6/2017

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Abstract

Purpose of Review

Due to older people’s low sports participation rates, exercise frequency may be the most critical component for designing exercise protocols that address fracture risk. The aims of the present article were to review and summarize the independent effect of exercise frequency (ExFreq) on the main determinants of fracture prevention, i.e., bone strength, fall frequency, and fall impact in older adults.

Recent Findings

Evidence collected last year suggests that there is a critical dose of ExFreq that just affects bone (i.e., BMD). Corresponding data for fall-related fracture risk are still sparse and inconsistent, however.

Summary

The minimum effective dose (MED) of ExFreq that just favorably affects BMD at the lumbar spine and femoral neck has been found to vary between 2.1 and 2.5 sessions/week. Although this MED cannot necessarily be generalized to other cohorts, we speculate that this “critical exercise frequency” might not significantly vary among adult cohorts.

We use the 90% quantile of the control group as the boundary value to distinguish between normal bone change and exercise effect.

The authors calculated that 700 subjects are needed to detect a 25% reduction (from 50 to 37%) in the percentage of people that had at least one fall during the interventional period (β-1 80%; α 5%). Applying slightly more positive expectations (33%) in subjects with higher fall risk will still result in a necessary sample size of 230 people per group. However, considering the results of the bone-strengthening studies listed above, a mean difference between the groups in the range of 2 ± 2.5% (for 12 months) corresponds to a necessary sample size (β-1 80%; α 5%) of 25 participants per group.

• Kemmler W, Haberle L, von Stengel S. Effects of exercise on fracture reduction in older adults : A systematic review and meta-analysis. Osteoporos Int. 2013;24(7):1937–50. This paper provides an overview of exercise effects on clinical low-trauma fractures in older adults CrossRefPubMed

• Kemmler W, Bebenek M, Kohl M, Von Stengel S. Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int. 2015;26(10):2491–9. First and only exercise trial that determined significant exercise effects on clinical low-trauma fractures in older adults CrossRefPubMed

Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356(18):1809–22.CrossRefPubMed

McCloskey EV, Johansson H, Oden A, Austin M, Siris E, Wang A, et al. Denosumab reduces the risk of osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX. J Bone Miner Res. 2012;27(7):1480–6.CrossRefPubMed

Neer RM, Arnaud CD, Zanchetta JR. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434–41.CrossRefPubMed

•• Marques EA, Mota J, Carvalho J. Exercise effects on bone mineral density in older adults: a meta-analysis of randomized controlled trials. Age. 2011;34(6):1493–515. To our opinion the best overview and most sophisticated meta-analysis in the area of exercise and BMD. CrossRefPubMedPubMedCentral

•• Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146. Very extensive review that focus on the effect of exercise on falls and fall-related injuries in older adults .

Groen BE, Smulders E, de Kam D, Duysens J, Weerdesteyn V. Martial arts fall training to prevent hip fractures in the elderly. Osteoporos Int. 2010;21(2):215–21.CrossRefPubMed

• Kemmler W, von Stengel S. Exercise and osteoporosis-related fractures: perspectives and recommendations of the sports and exercise scientist. Phys Sportmed. 2011;39(1):142–57. Summary of specific exercise recommendations to optimally adress fracture determinants in older adults. CrossRef

10.

Clark DO. Physical activity and its correlates among urban primary care patients aged 55 years or older. J Gerontol B Psychol Sci Soc Sci. 1999;54(1):S41–8.CrossRefPubMed

11.

Statistisches-Bundesamt. Gesundheit in Deutschland [Health in Germany]. In: Report, editor. Robert Koch Institut. Berlin: 2006.

12.

Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol. 2006;97(6):643–63.CrossRefPubMed

13.

Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9(3):226–37.CrossRefPubMedPubMedCentral

14.

Borde R, Hortobagyi T, Granacher U. Dose-response relationships of resistance training in healthy old adults: a systematic review and meta-analysis. Sports Med. 2015;45(12):1693–720.CrossRefPubMedPubMedCentral

15.

• Gentil P, Arruda A, Souza D, Giessing J, Paoli A, Fisher J, et al. Is there any practical application of meta-analytical results in strength training? Front Physiol. 2017;8:1. Very critical statement with respect to the application of meta-analysis in the area of resistance exercise studies. PubMedPubMedCentral

16.

• Beck BR, Daly RM, Singh MA, Taaffe DR. Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis. J Sci Med Sport. 2016;20(5):438–455. Excellent summary of exercise recommendations to optimally adress bone in older adults.

17.

Giangregorio LM, Papaioannou A, Macintyre NJ, Ashe MC, Heinonen A, Shipp K, et al. Too fit to fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int. 2014;25(3):821–35.CrossRefPubMedPubMedCentral

18.

Hagihara Y, Fukuda S, Goto S, Iida H, Yamazaki M, Moriya H. How many days per week should rats undergo running exercise to increase BMD? Osteoporos Int. 2005;23:289–94.

19.

Raab-Cullen DM, Akhter MP, Kimmel DB, Recker RR. Bone response to alternate-day mechanical loading of the rat tibia. J Bone Miner Res. 1994;9(2):203–11.CrossRefPubMed

20.

Umemura Y, Nagasawa S, Honda A, Singh R. High-impact exercise frequency per week or day for osteogenic response in rats. J Bone Miner Metab. 2008;26(5):456–60.CrossRefPubMed

21.

Cullen DM, Smith RT, Akhter MP. Bone-loading response varies with strain magnitude and cycle number. J Appl Physiol. 2001;91(5):1971–6.PubMed

22.

Bebenek M, Kemmler W, von Stengel S, Engelke K, Kalender W. Effect of exercise and Cimicifuga racemosa (CR BNO 1055) on postmenopausal risk factors and complaints—the randomized controlled TRACE Study. Menopause. 2010;17(4):791–800.PubMed

23.

Bemben DA, Bemben MG. Dose-response effect of 40 weeks of resistance training on bone mineral density in older adults. Osteoporos Int. 2011;22(1):179–86.CrossRefPubMed

24.

Cussler EC, Going SB, Houtkooper LB, Stanford VA, Blew RM, Flint-Wagner HG, et al. Exercise frequency and calcium intake predict 4-year bone changes in postmenopausal women. Osteoporos Int. 2005;16(12):2129–41.CrossRefPubMed

25.

Bailey CA, Brooke-Wavell K. Optimum frequency of exercise for bone health: randomised controlled trial of a high-impact unilateral intervention. Bone. 2010;46(4):1043–9.CrossRefPubMed

26.

Kemmler W, Riedel H. Körperliche Belastung und Osteoporose - Einfluß einer 10monatigen Interventionsmaßnahme auf ossäre und extraossäre Risikofaktoren einer Osteoporose. Dtsch Z Sportmed. 1998;49:270–7.

27.

Kemmler W, Bebenek M, von Stengel S, Engelke K, Kalender WA. Effect of block-periodized exercise training on bone and coronary heart disease risk factors in early post-menopausal women: a randomized controlled study. Scand J Med Sci Sports. 2013;23(1):121–9.CrossRefPubMed

28.

Kemmler W, von Stengel S. Exercise frequency, health risk factors, and diseases of the elderly. Arch Phys Med Rehabil. 2013;94(11):2046–53.CrossRefPubMed

29.

•• Kemmler W, von Stengel S. Dose-response effect of exercise frequency on bone mineral density in post-menopausal, osteopenic women. Scand J Med Sci Sports. 2014;24:526–34. The study that determined the minimum effective dose of exercise on BMD at the lumbar spine and femoral neck over a total length of 16 years. CrossRefPubMed

30.

Kemmler W, von Stengel S, Kohl M. Exercise frequency and bone mineral density development in exercising postmenopausal osteopenic women. Is there a critical dose of exercise for affecting bone? Results of the Erlangen Fitness and Osteoporosis Prevention Study. Bone. 2016;89:1–6.CrossRefPubMed

31.

Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA. Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med. 2010;170(2):179–85.CrossRefPubMed

32.

Kemmler W, Engelke K, von Stengel S. Long-term exercise and bone mineral density changes in postmenopausal women—are there periods of reduced effectiveness? J Bone Miner Res. 2016;31(1):215–22.CrossRefPubMed

33.

Schmitt NM, Schmitt J, Dören M. The role of physical activity in the prevention of osteoporosis in postmenopausal women—an update. Maturitas. 2009;63:34–8.CrossRefPubMed

34.

• Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bull. 2011;22(3–4):78–83. Summary of exercise recommmendations to reduce falls in older people. CrossRef

35.

Giangregorio LM, Thabane L, Adachi JD, Ashe MC, Bleakney RR, Braun EA, et al. Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Phys Ther. 2014;94(9):1337–52.CrossRefPubMedPubMedCentral

36.

Cumming RG, Thomas M, Szonyi G, Salkeld G, O'Neill E, Westbury C, et al. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc. 1999;47(12):1397–402.CrossRefPubMed

37.

Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized, controlled trial of tai chi for the prevention of falls: the Central Sydney tai chi trial. J Am Geriatr Soc. 2007;55(8):1185–91.CrossRefPubMed

38.

Means KM, Rodell DE, O'Sullivan PS. Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program. Am J Phys Med Rehabil. 2005;84(4):238–50.CrossRefPubMed

39.

Kemmler W. Meta-analysis and exercise related sports medicine [Meta-Analysen im trainingswissenschaftlichen und sportmedizinischen Spannungsfeld]. Dt Ztschr Sport Med. 2013;64(3):96–8.

40.

Groen BE, Weerdesteyn V, Duysens J. Martial arts fall techniques decrease the impact forces at the hip during sideways falling. J Biomech. 2007;40(2):458–62.CrossRefPubMed

41.

Leavitt FJ. Can martial arts falling techniques prevent injuries? Inj Prev. 2003;9(3):284.CrossRefPubMedPubMedCentral

42.

van der Zijden AM, Groen BE, Tanck E, Nienhuis B, Verdonschot N, Weerdesteyn V. Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls. J Biomech. 2012;45(9):1650–5.CrossRefPubMed

43.

Weerdesteyn V, Groen BE, van Swigchem R, Duysens J. Martial arts fall techniques reduce hip impact forces in naive subjects after a brief period of training. J Electromyogr Kinesiol. 2008;18(2):235–42.CrossRefPubMed

44.

Rütten A, Abu-Omar K, Meierjürgen R, Lutz A, Adlwarth R. Was bewegt die Nicht-Beweger? Präv Gesundheitsforsch. 2009;4:245–50.CrossRef

45.

Bolam KA, van Uffelen JG, Taaffe DR. The effect of physical exercise on bone density in middle-aged and older men: a systematic review. Osteoporos Int. 2013;24(11):2749–62.CrossRefPubMed

46.

Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc. 2011;43(2):249–58.CrossRefPubMedPubMedCentral

47.

Marcus R. Exercise: moving in the right direction. J Bone Miner Res. 1998;13(12):1793–6.CrossRefPubMed

48.

Börjesson M, Hellenius ML, Jansson E, Karlson J, Leijon M, Staehle A, et al. Physical activity in the prevention and treatment of disease. Professional-Associations-for-Physical-Activity, editor. Stockholm: Swedish Institute of Health; 2010.

Titel: Exercise Frequency and Fracture Risk in Older Adults—How Often Is Enough?
verfasst von: Wolfgang Kemmler
Simon von Stengel
Matthias Kohl
Publikationsdatum: 03.10.2017
Verlag: Springer US
Erschienen in: Current Osteoporosis Reports / Ausgabe 6/2017
Print ISSN: 1544-1873
Elektronische ISSN: 1544-2241
DOI: https://doi.org/10.1007/s11914-017-0407-7

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