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.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of trials and observational studies
PubMed 33239014 · doi:10.1186/s12966-020-01040-4
What was done
A systematic review and meta-analysis was conducted to inform WHO physical activity guidelines for adults aged 65 years and older. Databases (PubMed, Embase, CINAHL, SPORTDiscus) were searched for studies published between 2008/2010 and 2020. Eligible studies evaluated physical activity volume, duration, frequency, or intensity compared to no intervention or lower-dose activity on osteoporosis-related outcomes such as bone mineral density. Methodological quality was appraised, study effects were pooled via meta-analysis, and evidence certainty was assessed using the GRADE framework.
What was found
The review included 59 studies (47 trials and 12 observational studies). Physical activity interventions improved overall bone health measures across 20 trials (standardised effect size [SES] 0.15, 95% CI 0.05 to 0.25; moderate-certainty evidence). For site-specific bone mineral density (BMD), physical activity improved lumbar spine BMD across 11 trials (SES 0.17, 95% CI 0.04 to 0.30; moderate-certainty evidence), while effects on femoral neck (hip) BMD were not statistically significant across 14 trials (SES 0.09, 95% CI -0.03 to 0.21; low-certainty evidence). Effective trial programs typically involved multiple exercise types or resistance training performed for 60+ minutes, 2–3 times per week, for at least 7 months.
Why it matters
This systematic review supported the WHO physical activity guidelines by demonstrating that sustained, multi-component or resistance exercise provides modest bone density benefits in older adults, predominantly at the lumbar spine.
Limits
The observed effect sizes were modest (SES 0.15–0.17), and the confidence interval for femoral neck BMD crossed zero. The abstract does not provide total participant sample sizes or report clinical fracture outcomes, and literature searches were restricted to studies published from 2008/2010 onwards.
Cited by
- supports Sedentary behavior accelerates bone loss, while placing bones under heavy loads stimulates bone growth.