Although muscle strength, lean mass and bone mineral content/density (BMC/BMD) are consistently reported as major outcomes of resistance training (RT), 💸 there is still no agreement on the RT regimen that is capable of achieving this result in men and women 💸 of different ages.
This study describes the effects of RT on muscle strength, lean mass and bone mineralization, highlighting the relationships 💸 between them and analyzing the effectiveness of the RT protocol.
Information searches were conducted in open access online academic libraries, using 💸 the BMC/BMD indices combined with muscle strength, body composition, and resistance exercises.
The results showed changes in BMC/BMD in 72% of 💸 the studies published in the last decade.
Among these, 77% recommended loads ≥ 80% 1-RM, 61% involved older individuals (> 60 💸 years) and 61% had planning protocols of between 3 and 5 months (-12-20 weeks).
The results also highlight muscle strength as 💸 a promising index of variations in BMC/BMD, with a moderate to high level of association (r 2 >0.
5), which are 💸 specific for men and women in relation to the body region with best responsiveness.
Among the studies published in last decade, 💸 about 61% had protocols involving only RT, and of these, 82% observed combined changes in BMC/BMD, body composition and muscle 💸 strength.
This review therefore concludes that RT is important for improving muscle strength, increasing lean mass (whole-body and regional) and preventing 💸 risk factors that could impair the mineral integrity of the bone tissue, in individuals of all ages and sexes.
Level of 💸 Evidence I; Systematic review of Level I RCTs (and study results were homogenous).
Apesar de a força muscular, a massa magra 💸 e o conteúdo/densidade mineral óssea (BMC/BMD) serem sistematicamente relatados como os principais resultados do treinamento resistido (TR), ainda não há 💸 acordo sobre o protocolo de TR capaz de promover esse resultado em homens e mulheres de diferentes faixas etárias.
O presente 💸 estudo descreve os efeitos do TR sobre força, massa magra e mineralização óssea, destacando as relações entre eles e analisando 💸 a eficiência do protocolo de TR.
As pesquisas das informações foram feitas em bancos de dados acadêmicos de acesso aberto, usando 💸 os indexadores "BMC/BMD" combinados com força muscular, composição corporal e exercícios resistidos.
Os resultados mostraram mudanças no BMC/BMD em 72% dos 💸 estudos publicados no último decênio.
Entre estes, 77% recomendaram cargas ≥ 80% DE 1 RM, 61% envolveram idosos (> 60 anos) 💸 e 61% tiveram protocolos de planejamento entre 3 e 5 meses (-12 a 20 semanas).
Os resultados também destacam a força 💸 muscular como um índice promissor de variações de BMC/BMD, com nível moderado a alto de associação (r 2 >0,5), que 💸 são específicos para homens e mulheres em relação à região corporal com melhor responsividade.
Entre os estudos publicados no último decênio, 💸 cerca de 61% tinham protocolo que envolveu apenas TR e deles, 82% observaram alterações conjuntas de BMC/BMD, composição corporal e 💸 força muscular.
Portanto, esta revisão conclui que o TR é importante para melhorar a força muscular, aumentar a massa magra (regional 💸 e corporal) e prevenir fatores de risco que podem comprometer a integridade mineral do tecido ósseo, em qualquer faixa etária 💸 e de ambos os sexos.
Nível de Evidência I; Revisão sistemática de ECRC (Estudos clínicos randomizados e controlados).
A pesar de que 💸 la fuerza muscular, la masa magra y el contenido/densidad mineral ósea (CMO/DMO) se informan sistemáticamente como los principales resultados del 💸 entrenamiento resistido (ER), todavía no hay acuerdo sobre el protocolo de ER capaz de promover ese resultado en hombres y 💸 mujeres de diferentes grupos de edad.
El presente estudio describe los efectos del ER sobre la fuerza muscular, masa magra y 💸 mineralización ósea, destacando las relaciones entre ellos y la eficiencia del protocolo de ER.
La investigación de las informaciones fue hecha 💸 en bases de datos académicas de acceso abierto, usando los indexadores "BMC/BMD" combinados con fuerza muscular, composición corporal y ejercicios 💸 resistidos.
Los resultados mostraron cambios en el CMO/DMO en 72% de los estudios publicados en el último decenio.
Entre estos, 77% recomendaron 💸 cargas ≥ 80% 1 RM, 61% involucraron a persona mayores (>60 años) y 61% tenían protocololos de planificación de entre 💸 3 y 5 meses (-12-20 semanas).
Los resultados también destacan la fuerza como un índice prometedor de variaciones de CMO/DMO, con 💸 nivel moderado a alto de asociación (r 2 >0,5), que son específicos para hombres y mujeres en relación a región 💸 corporal con mejor respuesta.
Entre los estudios publicados en el último decenio, alrededor de 61% tenían protocolo que involucra sólo ER 💸 y de ellos, el 82% observaron alteraciones conjuntas de CMO/DMO, composición corporal y fuerza muscular.
Por lo tanto, esta revisión concluye 💸 que el ER es importante para mejorar la fuerza muscular, aumentar la masa magra (regional y corporal) y prevenir factores 💸 de riesgo que pueden comprometer la integridad mineral del tejido óseo, en cualquier grupo de edad y de ambos sexos.
Nivel 💸 de Evidencia I; Revisión sistemática de ECRC (Estudios clínicos randomizados y controlados).
INTRODUCTION
Bone mineral content (BMC) is a component of body 💸 composition, structuring the fat-free mass (IGM) when associated with lean mass (musculature and viscera).11.
Lee N, Radford-Smith GL, Forwood M, Wong 💸 J, Taaffe DR.
Body composition and muscle strength as predictors of bone mineral density in Crohn's disease.J Bone Miner Metab.2009;27(4):456-63.2.
Medical Advisory 💸 Secretariat.
Utilization of DXA bone mineral densitometry in Ontario: an evidence-based analysis.
Ont Heath Technol Assess Ser.2006;6(20):1-180.-33.
Makovey J, Naganathan V, Sambrook P.
Gender 💸 differences in relationships between body composition components, their distribution and bone mineral density: a cross-sectional opposite sex twin study.Osteoporos Int.
2005;16(12);1495-505.
Bone 💸 mineral density (BMD), in turn, reflects the integrity of the bone tissue, being an indication of the structural remodeling capacity 💸 and, therefore, an index of the risk of propensity to the pathologies and lesions associated with the tissue.11.
Lee N, Radford-Smith 💸 GL, Forwood M, Wong J, Taaffe DR.
Body composition and muscle strength as predictors of bone mineral density in Crohn's disease.J 💸 Bone Miner Metab.2009;27(4):456-63.,44.
Marques EA, Gudnason V, Sigurdsson G, Lang T, Johannesdottir F, Siggeirsdottir K, et al.
Are bone turnover markers associated 💸 with volumetric bone density, size, and strength in older men and women? The AGES–Reykjavik study.Osteoporos Int.2016;27(5):1765-76.
At present, the loss of 💸 bone tissue integrity by the reduction of the mineral mass does not has been associated only with the aging process 💸 or hormonal disorders, but also with the reduction of fat mass (FM) and lean mass (LM), due to dietary interventions 💸 for body weight loss and sedentary lifestyle, respectively.11.
Lee N, Radford-Smith GL, Forwood M, Wong J, Taaffe DR.
Body composition and muscle 💸 strength as predictors of bone mineral density in Crohn's disease.J Bone Miner Metab.2009;27(4):456-63.,55.
Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, 💸 Vicente-Rodriguez G.
Effects of training on bone mass in older adults: a systematic review.Sports Med.2012;42(4):301-25.,66.
Proctor DN, Melton LJ, Khosla S, Crowson 💸 CS, O'Connor MK, Riggs B L.
Relative influence of physical activity, muscle mass and strength on bone density.Osteoporos Int.2000;11(11):944-52.
In general terms, 💸 resistance or resistive types of physical exercise tends to induce BMD changes due to mechanical stress on the bones, evidencing 💸 the exercise potential in the maintenance of BMC/BMD with aging.55.
Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodriguez G.
Effects of 💸 training on bone mass in older adults: a systematic review.Sports Med.2012;42(4):301-25.
The role of aerobic exercise at moderate intensity (ie: walking) 💸 is to induce BMC/BMD changes by increasing the gravitational load on the skeleton.77.
Villareal DT, Aguirre L, Gurney AB, Waters DL, 💸 Sinacore DR, Colombo E, et al.
Aerobic or resistance exercise, or both, in dieting obese older adults.N Engl J Med.
2017;376(20):1943-55.8.
Chien MY, 💸 Wu YT, Hsu AT, Yang RS, Lai JS.
Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women.Calcifi Tissue Int.2000;67(6):443-8.-99.
Martin 💸 D, Notelovitz M.
Effects of aerobic training on bone mineral density of postmenopausal women.J Bone Miner Res.1993;8(8):931-6.
However, the results show small 💸 effective changes and speculate that higher intensity exercises would bring greater benefits to prevention/treatment of disorders associated with BMD reduction, 💸 although there are no conclusive studies on the exercise intensity most suitable.77.
Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore 💸 DR, Colombo E, et al.
Aerobic or resistance exercise, or both, in dieting obese older adults.N Engl J Med.
2017;376(20):1943-55.8.
Chien MY, Wu 💸 YT, Hsu AT, Yang RS, Lai JS.
Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women.Calcifi Tissue Int.2000;67(6):443-8.9.
Martin D, 💸 Notelovitz M.
Effects of aerobic training on bone mineral density of postmenopausal women.J Bone Miner Res.1993;8(8):931-6.-1010.
Marques EA, Wanderley F, Machado L, 💸 Sousa F, Viana JL, Moreira-Gonçalves D, et al.
Effects of resistance and aerobic exercise on physical function, bone mineral density, OPG 💸 and RANKL in older women.Exp Gerontol.2011;46(7):524-32.
In turn, resistance exercise has prescriptions that are effective for the regulation of BMD, which 💸 includes exercises with high loads: 12 to 15 RMs or 70-80% 1RM.1111.
Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg 💸 RA, Evans WJ.
Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial.JAMA.
1994;272(24):1909-14.12.
Bocalini DS, Serra 💸 AJ, dos Santos L, Murad N, Levy RF.
Strength training preserves the bone mineral density of postmenopausal women without hormone replacement 💸 therapy.J Aging Health.2009;21(3):519-27.13.
de Matos O, Lopes da Silva DJ, Martinez de Oliveira J, Castelo-Branco C.
Effect of specific exercise training on 💸 bone mineral density in women with postmenopausal osteopenia or osteoporosis.Gynecol Endocrinol.2009;25(9):616-20.-1414.
Menkes A, Mazel S, Redmond RA, Koffler K, Libanati CR, 💸 Gundberg CM, et al.
Strength training increases regional bone mineral density and bone remodeling in middle-aged and older men.
J Appl Physiol 💸 (1985).1993;74(5):2478-84.
Although the relationship between muscle strength and BMC/BMD has been evidenced, it is assumed that between young, active, or athletic 💸 individuals with intact bone health, increased strength does not play a decisive role to further increments in bone structures.
This assumption 💸 is in line with the demonstration of the existence of a setpoint, in addition to which the mechanical stimulus does 💸 not result in gains in bone mass.
This setpoint, in turn, is one of the main foundations of the "mechanostat" theory,1515.Frost 💸 HM.
Muscle, bone, and the Utah paradigm: a 1999 overview.
Med Sci Sports Exerc..2000;32(5):911-7.
which governs the Utah paradigm for skeletal physiology, relating 💸 mechanical stress to bone remodeling, within a limit of normality for mass/density, which has been used to justify the lack 💸 of cause and effect relationship between strength and/or MM associations to BMC/BMD of adult individuals enrolled in regular sports training 💸 programs.1616.Burr DB.
Muscle strength, bone mass, and age-related bone loss.J Bone Miner Res.
1997;12(10):1547-51.17.Schoenau E.
From mechanostat theory to development of the "Functional 💸 Muscle-Bone-Unit".
J Musculoskelet Neuronal Interact.2005;5(3):232-8.-1818.Lang TF.
The bone-muscle relationship in men and women.J Osteoporos.2011;2011:70235.
Thus, although muscle strength and LM are considered as 💸 dominant mechanical stimuli, BMC/BMD are also related to other non-mechanical stimuli (metabolic or hormonal), which modulate both bone and muscle 💸 metabolism, or simply modulate responsiveness of bone tissue (BMC/BMD variations) to mechanical stress.1616.Burr DB.
Muscle strength, bone mass, and age-related bone 💸 loss.J Bone Miner Res.
1997;12(10):1547-51.,1919.
Slemenda C, Longcope C, Peacock M, Hui S, Johnston CC.
Sex steroids, bone mass, and bone loss.
A prospective 💸 study of pre-, peri-, and postmenopausal women.J Clinl Invest.1996;97(1):14-21.
Therefore, this systematic review aims to describe the fundamentals of the cause-effect 💸 relationship between the patterns of changes in LM and muscle strength with variations of BMC/BMD, sustaining the mechanical effect of 💸 resistance exercise as a modulating factor of the activation of the bone remodeling system, and able to adjust the balance 💸 for bone mass gain directly and independently of age, sex and bone health statusMETHODS
Sources of bibliographic survey
The information was obtained 💸 from scientific health databases, such as the Athena and Parthenon systems (periodicals catalogs and the State and Federal Public Libraries 💸 network of the State of São Paulo), which include the Turnitin, Scielo, MEDLINE, Capes, SportDiscus, Scopus and DOAJ (Directory of 💸 Open Access Journals).
After the Local Ethics Committee of the University approved this research (CAEE: 70076317.1.0000.
5398), the bibliographic survey was perform 💸 following the procedures presented in Figure 1A, which are further detailed bellow:Figure 1
Procedure for data acquisition (Panel A) and selection 💸 criteria (inclusion/exclusion) of the articles (Panel B).
Insertion of keywords: Bone Density, Bone mineral content, Bone remodeling and Bone metabolism.
Combination with 💸 terms of interest: Body composition, Lean mass, Fat mass, Muscle strength, Absortiometry (DXA), Young, Young adults, Adults, Elderly, Menopause, Osteoporosis, 💸 Aerobic training, Resistance exercise, Training high intensity; Impact exercises.
From the summaries found, the texts were included or excluded according to 💸 the criteria presented in Figure 1B and described as follows:
Criteria for selection of bibliographic material
Inclusion criteria were: (1) BMC/BMD as 💸 the main descriptor; and (2) age, gender, ethnicity, and physical training as secondary descriptors.
In addition the texts should: (1) be 💸 available in its entirety, (2) associate at least three descriptors in the approach, (3) present the description of the training 💸 program, and (4) on BMC/BMD, body composition and muscle strength, in any combination including BMC/BMD.
Also, approaches involving strategies of food 💸 control and supplementation was admit.
Were adopt as exclusion criterion: (1) texts that did not addressed the effect of resistance exercise, 💸 (2) animal research and engineering trials, (3) texts outside the Sports Science area, clinical pathology and rehabilitation, or individuals under 💸 drug therapy, and (4) texts without English version.
RESULTS
A total of 39,147 references indexed by the BMC/BMD descriptors were sampled.
Of these, 💸 178 references met eligibility for addressing BMC/BMD in a context of intervention with resistive exercise in the last decade (Figure 💸 1A).
From the inclusion/exclusion criteria, 60 references were analyzed, of which 30% (18 studies) presented interventions with resistance training (RT), published 💸 in the last five (Table 1) or ten years (Table 2).
Of these, 50% has training planning between 3-5 months (-12-20 💸 weeks), and the others between 6 and 48 months.
Regarding the characteristics of the population, 33% of these studies involved women 💸 and 38% involved a mixed population, and in 55% of the studies the participants was > 60 years old.
Regarding the 💸 prescription of resistance exercise, -78% used high intensity of load (≥ 80% 1RM and ≤ 8 maximum repetitions).
The changes of 💸 BMC/BMD were observe in 72% of the 18 studies on Tables 1 and 2.
In these studies, 77% prescribed loads ≥ 💸 80% 1RM, 61% involved elderly (> 60 years) and 61% planned intervention between 3-5 months (-12-20 weeks).
Only one study (5%) 💸 reported the presence of blacks among participants.
Among the studies highlighted in Tables 1 and 2, approximately 61% applied only RT, 💸 and of these 82% observed changes of BMD/BMC together with changes of body composition and muscle strength.
Those studying RE combined 💸 with aerobic exercise amounted 16.7%, of which 66.
7% observed changes in BMD/BMC, body composition and muscle strength.
Finally, the studies using 💸 RT combined with the impact exercise (jump and variations) are 22.
2%, from which 75% showed improvements in BMD/BMC, body composition 💸 and muscle strength.
Thumbnail Table 1
Resistance Training (RT) and bone mineral density response (BMD) intervention studies, over last 5 years.
Thumbnail Table 💸 2
Resistance training (RT) and bone mineral density response (BMD) intervention studies, over last 10 years.
DISCUSSION
Age, Sex and bone remodeling: fundamental 💸 theoretical interrelationships with body composition and exercise
It has been observed that BMD reduction is positively associated with age, showing rates 💸 of 0.6%, 1.1% and 2.
1% of loss, respectively, for the age groups between 60-69, 70- 79 and ≥80 years.55.
Gómez-Cabello A, 💸 Ara I, González-Agüero A, Casajús JA, Vicente-Rodriguez G.
Effects of training on bone mass in older adults: a systematic review.Sports Med.2012;42(4):301-25.
These 💸 changes often culminate with osteoporosis, but tend to be minimized by regular physical activity and maintenance of MG and LM 💸 patterns.55.
Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodriguez G.
Effects of training on bone mass in older adults: a systematic 💸 review.Sports Med.2012;42(4):301-25.,3636.
Slemenda C, Longcope C, Peacock M, Hui S, Johnston CC.
Sex steroids, bone mass, and bone loss.
A prospective study of 💸 pre-, peri-, and postmenopausal women.
J Clinical Investigation.1996;97(1):14-21.37.
Horber FF, Gruber B, Thomi F, Jensen EX, Jaeger P.
Effect of sex and age 💸 on bone mass, body composition and fuel metabolism in humans.Nutrition.1997;13(6):524-34.-3838.
Taaffe DR, Cauley JA, Danielson M, Nevitt MC, Lang TF, Bauer 💸 DC, et al.
Race and sex effects on the association between muscle strength, soft tissue, and bone mineral density in healthy 💸 elders: the health, aging, and body composition study.J Bone Miner Res.2001;16(7):1343-52.
When analyzing the association between aging, decline in physical activity, 💸 and BMC and LM reductions, Proctor et al.66.
Proctor DN, Melton LJ, Khosla S, Crowson CS, O'Connor MK, Riggs B L.
Relative 💸 influence of physical activity, muscle mass and strength on bone density.Osteoporos Int.2000;11(11):944-52.
observed that between 20 and 80 years of age 💸 there is a trend of reduction in physical activity between 34-38% for women and men, while reduction in LM (18-17%) 💸 and BMC (16- 30%).
In the study by Proctor et al.66.
Proctor DN, Melton LJ, Khosla S, Crowson CS, O'Connor MK, Riggs 💸 B L.
Relative influence of physical activity, muscle mass and strength on bone density.Osteoporos Int.2000;11(11):944-52.
this decline was quantified.
For these authors, BMC/BMD 💸 declines 30% between 20 and 80 years in women, but only 16% in this same age range among men.
The reduction 💸 in LM is 18% and 17%, and physical activity is 34% and 38%, respectively among women and men in the 💸 same age range described above.
That is, men tend to maintain a more stable LM-BMC ratio in fat-free mass composition when 💸 compared to women, but the mobility and vitality of men are more susceptible to BMC/BMD and LM reductions, impacting maintenance 💸 of physical activity levels more than in women.3737.
Horber FF, Gruber B, Thomi F, Jensen EX, Jaeger P.
Effect of sex and 💸 age on bone mass, body composition and fuel metabolism in humans.Nutrition.1997;13(6):524-34.
However, among women, after the menarche and with the predominance 💸 of estrogen secretion on growth and sex hormones, there is a stabilization of bone mineralization and LM, concomitant with the 💸 accumulation of FM, which is in line with the observation that young women tend to maintain healthy BMC/BMD levels with 💸 the increase of LM.3939.
Young D, Hopper JL, Macinnis RJ, Nowson CA, Hoang NH, Wark JD.
Changes in body composition as determinants 💸 of longitudinal changes in bone mineral measures in 8 to 26-year-old female twins.Osteoporos Int.2001;12(6):506-15.
Therefore, these authors conclude that the level 💸 of physical activity may be a potentially better factor than variations in sex hormones to explain the modulation of BMD 💸 in both regions exposed to body weight (i.e.
: hip and spine), and those not exposed (i.e.
: bone radio), since exercise 💸 is able to modify LM.
Evidence of the association between body composition and bone remodeling
It is well established that indicators of 💸 body constitution, such as LM and FM (total or regional), are relevant factors in the prevention of disorders of bone 💸 metabolism, including pathologies such as osteoporosis.4040.
Chen Z, Lohman TG, Stini WA, Ritenbaugh C, Aickin M.
Fat or lean tissue mass: which 💸 one is the major determinant of bone mineral mass in healthy postmenopausal women? J Bone Miner Res.1997;12(1):144-51.41.Reid IR.
Relationships among body 💸 mass, its components, and bone.Bone.2002;31(5):547-55.-4242.
Gnudi S, Sitta E, Fiumi N.
Relationship between body composition and bone mineral density in women with 💸 and without osteoporosis: relative contribution of lean and fat mass.
J Bone Miner Metabol.2007;25(5):326-32.
Admittedly, LM exerts a mechanical stimulus capable of 💸 favoring bone mineralization, while FM seems to exert an indirect influence by the modulation of hormones such as estrogen, leptin 💸 and insulin, which stimulate the deposition of minerals in the bone.4343.
Beck TJ, Oreskovic TL, Stone KL, Ruff CB, Ensrud K, 💸 Nevitt MC, et al.
Structural adaptation to changing skeletal load in the progression toward hip fragility: the study of osteoporotic fractures.J 💸 Bone Miner Res.2001;16(6):1108-19.44.
Thomas T, Burguera B, Melton LJ 3rd, Atkinson EJ, O'Fallon WM, Riggs BL, et al.
Role of serum leptin, 💸 insulin, and estrogen levels as potential mediators of the relationship between fat mass and bone mineral density in men versus 💸 women.Bone.2001;29(2):114-20.-4545.
Migliaccio S, Greco EA, Wannenes F, Donini LM, Lenzi A.
Adipose, bone and muscle tissues as new endocrine organs: role of 💸 reciprocal regulation for osteoporosis and obesity development.
Horm Mol Biol Clin Investig.2014;17(1):39-51.Proctor et al.66.
Proctor DN, Melton LJ, Khosla S, Crowson CS, 💸 O'Connor MK, Riggs B L.
Relative influence of physical activity, muscle mass and strength on bone density.Osteoporos Int.2000;11(11):944-52.
showed high and significant 💸 correlations between MM and BMC for males (r=0.
77) and females (r=0.74).
The study by Lee et al.11.
Lee N, Radford-Smith GL, Forwood 💸 M, Wong J, Taaffe DR.
Body composition and muscle strength as predictors of bone mineral density in Crohn's disease.J Bone Miner 💸 Metab.2009;27(4):456-63.
corroborated this association, concluding that MM is a significant and independent determinant of total and regional bone mineral mass, presenting 💸 low coefficients (r22.
Medical Advisory Secretariat.
Utilization of DXA bone mineral densitometry in Ontario: an evidence-based analysis.
Ont Heath Technol Assess Ser.2006;6(20):1-180.<0.
5) but 💸 significant (p<0.
01) for associations between appendiculae mass (kg) and total BMD, pelvic and forearm.
These associations between body composition and bone 💸 mineral mass were also observed by Makovey et al.33.
Makovey J, Naganathan V, Sambrook P.
Gender differences in relationships between body composition 💸 components, their distribution and bone mineral density: a cross-sectional opposite sex twin study.Osteoporos Int.
2005;16(12);1495-505.
in populations of both sexes in different 💸 age groups.
According to the results of these authors, both LM and FM positively influence BMC, with explanatory potential of 52% 💸 for the variances between LM and BMC and of 20% between FM and BMC.
Among older women, non-obese, with and without 💸 osteoporosis, both LM and FM try to associate with BMD (r22.
Medical Advisory Secretariat.
Utilization of DXA bone mineral densitometry in Ontario: 💸 an evidence-based analysis.
Ont Heath Technol Assess Ser.2006;6(20):1-180.=0.379, p<0.001) and BMC (r22.
Medical Advisory Secretariat.
Utilization of DXA bone mineral densitometry in Ontario: 💸 an evidence-based analysis.
Ont Heath Technol Assess Ser.2006;6(20):1-180.=0.538, p<0.
001) for the whole body, but FM becomes relevant when there is a 💸 low amount of LM in the body.4242.
Gnudi S, Sitta E, Fiumi N.
Relationship between body composition and bone mineral density in 💸 women with and without osteoporosis: relative contribution of lean and fat mass.
J Bone Miner Metabol.2007;25(5):326-32.
In the study by Taaffe et 💸 al.3838.
Taaffe DR, Cauley JA, Danielson M, Nevitt MC, Lang TF, Bauer DC, et al.
Race and sex effects on the association 💸 between muscle strength, soft tissue, and bone mineral density in healthy elders: the health, aging, and body composition study.J Bone 💸 Miner Res.2001;16(7):1343-52.
, involving elderly (70-79 years) of both sexes and different ethnicities, the LM was determinant for the BMD of 💸 femur, lower and upper limbs and whole body.
These authors also observed that the association with (regional or whole-body) is potentially 💸 influenced by the region of body, sex and treatment of the variable, but not ethnicity.
When analyzing, specifically, BMD of femur 💸 (region with function of sustaining the body), the authors report that total LM (r = 0.
41), total FM (r = 💸 0.
38), LM in the upper limbs (r = 0.
35) and FM in the upper limbs (r = 0.
36) are all 💸 influential factors (p <0.
001), but only the increase in LM promoted changes between 5.7% and 5.
9% in femur BMD, since 💸 the increase in FM affecting only femoral BMD (4.0-4.4%).
Another important factor is the distribution pattern of LM.
There are regional trends 💸 indicating the role of LM increase in the alterations of BMC at the same region, due to hormonal and mechanical 💸 stimulus delivered by greater muscle mass activity.4646.
Matsuo T, Douchi T, Nakae M, Uto H, Oki T, Nagata Y.
Relationship of upper 💸 body fat distribution to higher regional lean mass and bone mineral density.J Bone Miner Metab.2003;21(3):179-83.
However, this regionalization of the stimulus 💸 is more evident among men than women.
In the study of Guimarães et al.4747.
Guimarães BR, Pimenta LD, Massini DA, Santos DD, 💸 Siqueira LODC, Simionato AR.et al.
Muscular strength and regional lean mass influence bone mineral health among young females.
Rev Bras Med Esporte.2018;24(3):186-91.
, 💸 involving young adult women, the total body LM variable showed higher associations (r - 0.55 to 0.
93) with total and 💸 regional BMC/BMD (i.e.
, lower and upper limbs, hip, and thoracic and lumbar vertebrae) than the upper limb LM (r - 💸 0.57 to 0.
88) and lower limbs (r - 0.53 to 0.87).
Although the effect of regional variables on body composition was 💸 not analyzed by Chaves et al.4848.
Chaves LM, Gomes L, Oliveira RJ, Marques MB.
Relação entre variáveis da composição corporal e densidade 💸 mineral óssea em mulheres idosas.
Rev Bras Med Esporte.2005;11(6):352-6.
, the authors had already observed the potential of total body MM in 💸 determining variations in femoral colony BMD (r = 0.
44) among elderly women (60- 70 years), leading the authors to emphasize 💸 the benefit of musculature to postmenopausal bone tissue.
On the other hand, among men, Guimarães et al.4949.
Guimarães BR, Pimenta LD, Massini 💸 DA, Dos Santos D, Siqueira LODC, Simionato AR, et al.
Muscle strength and regional lean body mass influence on mineral bone 💸 health in young male adults.PloS One.
2018;13(1):e0191769.
observed a greater potential of regional LM in determining BMC/BMD of specific body sites.
This potential 💸 highlights the importance of LM of lower and upper limbs that show associations both to local (LM vs.
BMC/BMD from the 💸 same region, with r - 0.70 to 0.
86) and remote body regions (LM vs.
BMC/BMD from different body regions, ranging from 💸 0.60 to 0.83).
In addition, Xiang et al.5050.
Xiang J, Chen Y, Wang Y, Su S, Wang X, Xie B, et al.
Lean 💸 mass and fat mass as mediators of the relationship between physical activity and bone mineral density in postmenopausal women.
J Womens 💸 Health (Larchmt).2017;26(5):461-6.
demonstrated that BMD for the whole-body, or specific regions such as the spine and hip, is positively influenced by 💸 physical activity and mediated by the variation of total LM and FM in the body, regardless of age and height, 💸 including the postmenopausal phase, when compared to those women with lower indexes of these parameters and in the same phases 💸 of life.
These authors concluded, therefore, that LM is a mediator with effect between 19% and 48% on variations of BMD 💸 of the whole body and regions like spine and hip, in addition to being associated positively (0.112 to 0.
759) with 💸 physical activity.
In relation to MG, these authors describe a negative effect (-0.524 to -0.
940) on BMD variations (22% to 33%), 💸 when mediated by the level of physical activity.
Therefore, these authors suggest that postmenopausal women are at risk for the development 💸 of osteoporosis when they have low levels of physical activity.
Evidence of the association between muscle strength and bone remodeling
Strength and 💸 muscle mass have been considered as mechanical stimuli with a dominant effect on bone mass (BMC) or bone density (BMD) 💸 variations, and related to other non-mechanical stimuli (metabolic or hormonal), able to modulate not only bone metabolism and muscle, but 💸 also the responsiveness of bone tissue to mechanical stress, especially among young and adults of both sexes.1616.Burr DB.
Muscle strength, bone 💸 mass, and age-related bone loss.J Bone Miner Res.
1997;12(10):1547-51.17.Schoenau E.
From mechanostat theory to development of the "Functional Muscle-Bone-Unit".
J Musculoskelet Neuronal Interact.2005;5(3):232-8.18.Lang 💸 TF.
The bone-muscle relationship in men and women.J Osteoporos.2011;2011:70235.-1919.
Slemenda C, Longcope C, Peacock M, Hui S, Johnston CC.
Sex steroids, bone mass, 💸 and bone loss.
A prospective study of pre-, peri-, and postmenopausal women.J Clinl Invest.1996;97(1):14-21.,4141.Reid IR.
Relationships among body mass, its components, and 💸 bone.Bone.2002;31(5):547-55.For Matsui et al.5151.
Matsui Y, Takemura M, Harada A, Ando F, Shimokata H.
Effects of knee extensor muscle strength on the 💸 incidence of osteopenia and osteoporosis after 6 years.
J Bone Miner Metabol.2014;32(5):550-5.
the reduction of knee extensor strength is associated with femoral 💸 colon osteopenia between 763 males and 476 females, ranging in age from 40 to 81 years, in a 6-year longitudinal 💸 study.
These authors also demonstrated that participants who already had osteopenia in the lumbar vertebrae developed osteoporosis with reduced strength of 💸 knee extensors, but the effect was significant only among men.
Thus, the authors concluded that quadriceps strength should be developed to 💸 avoid the loss of local bone mass (by direct action of mechanical stress on the bone) or remote (by the 💸 systemic action of the physical activity on the bone metabolism).
Regarding the type of exercise, Guimarães et al.4949.
Guimarães BR, Pimenta LD, 💸 Massini DA, Dos Santos D, Siqueira LODC, Simionato AR, et al.
Muscle strength and regional lean body mass influence on mineral 💸 bone health in young male adults.PloS One.
2018;13(1):e0191769.
observed local and remote associations between maximal strength in multi-articular resistance exercises and BMD 💸 among men of university age (- 25 years).
According to these authors, the strength for large upper limb muscles (right and 💸 upper-right supine muscles) are not only good indicators of upper limb BMC/BMD (r - 0.57 to 0.
72), but also BMC/BMD 💸 of lower limbs and sites susceptible to osteoporosis such as bones of the hip region (r - 0.36 to 0.47).
These 💸 authors also demonstrated that the strength for lower limb muscles (leg-press 45º) also exhibits local effect (BMC/BMD of lower limb, 💸 r - 0.42 to 0.
46) and remote (BMC/BMD upper limb and body , r = 0.35 to 0.
60), but with 💸 reduced potential relative to the upper limbs.
Among females, maximal strength in mono and multi-articular exercises for lower limbs (i.e.
: extensor 💸 chair and leg press 45º) were better indicators associated to BMC/BMD, both for the region engaged in the exercise (local 💸 effect, r = 0.67 to 0.
78) and for others regions of the body, as well as, for whole body (remote 💸 effect, r = 0.53 to 0.
85), when compared to associations evidenced for maximal strength in upper limbs (ie: bench press), 💸 with local effect only, but not negligible (r = 0.75 to 0.84).4747.
Guimarães BR, Pimenta LD, Massini DA, Santos DD, Siqueira 💸 LODC, Simionato AR.et al.
Muscular strength and regional lean mass influence bone mineral health among young females.
Rev Bras Med Esporte.2018;24(3):186-91.
In addition, 💸 the change in leg-press and knee extension muscle strength were associated to changes in femoral BMD (r = 0.37 0.46 💸 p <0.
01) for people of different ages and both sexes.5252.
Ryan AS, Ivey FM, Hurlbut DE, Martel GF, Lemmer JT, Sorkin 💸 JD, et al.
Regional bone mineral density after resistive training in young and older men and women.
Scand J Med Sci Sports.2004;14(1):16-23.
Effects 💸 of resistance training on body composition, muscle strength and bone remodeling
Resistance training has recognized prescriptions able to modulate bone mineralization, 💸 which is recommend to be perform with high loads, two to three sets per exercise for three times a week 💸 for 4 to 12 months, with load intensity ranging from 50 to 80% of 1-RM, and engaging upper-limbs (MS) and 💸 lower-limbs (MI) to achieve an increase of BMD up to 3.
8%, or prevented significant reductions (- 2.
5%), when compared to 💸 non-exercise persons.1111.
Nelson ME, Fiatarone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ.
Effects of high-intensity strength training on multiple risk 💸 factors for osteoporotic fractures: a randomized controlled trial.JAMA.
1994;272(24):1909-14.12.
Bocalini DS, Serra AJ, dos Santos L, Murad N, Levy RF.
Strength training preserves 💸 the bone mineral density of postmenopausal women without hormone replacement therapy.J Aging Health.2009;21(3):519-27.13.
de Matos O, Lopes da Silva DJ, Martinez 💸 de Oliveira J, Castelo-Branco C.
Effect of specific exercise training on bone mineral density in women with postmenopausal osteopenia or osteoporosis.Gynecol 💸 Endocrinol.2009;25(9):616-20.-1414.
Menkes A, Mazel S, Redmond RA, Koffler K, Libanati CR, Gundberg CM, et al.
Strength training increases regional bone mineral density 💸 and bone remodeling in middle-aged and older men.
J Appl Physiol (1985).1993;74(5):2478-84.,2222.
Watson SL, Weeks BK, Weis LJ, Horan SA, Beck BR.
Heavy 💸 resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: 💸 novel early findings from the LIFTMOR trial.Osteoporos Int.
2015;26(12):2889-94.,5353.
Zhao R, Zhao M, Xu Z.
The effects of differing resistance training modes on 💸 the preservation of bone mineral density in postmenopausal women: a meta-analysis.Osteoporos Int.2015;26(5):1605-18.
A classic example of this potential for RT is 💸 the study of Nickols-Richardson et al.5454.
Nickols-Richardson SM, Miller LE, Wootten DF, Ramp WK, Herbert WG.
Concentric and eccentric isokinetic resistance training 💸 similarly increases muscular strength, fat-free soft tissue mass, and specific bone mineral measurements in young women.Osteoporos Int.2007;18(6):789-96.
, involving young women 💸 in unilateral, high-load training program for a period of 5 months, in which improvements in BMD were observed in different 💸 body regions for both trained and non-trained body segment, highlighting the changes of whole-body BMD (+ 0.4% control and + 💸 0.
6% trained) and BMD in femur (0.5% control and 1.2% trained).
However, it is not all the studies that show changes 💸 in BMC and BMD due to resistance exercise.
For Chilibeck et al.5555.
Chilibeck PD, Calder A, Sale DG, Webber CE.
Twenty weeks of 💸 weight training increases lean tissue mass but not bone mineral mass or density in healthy, active young women.
Can J Physiol 💸 Pharmacol.1996;74(10):1180-5.
, a 20-week RT for 30-year-old women was sufficient to increase muscle strength (by - 70%), LM (by - 10%), 💸 but BMC and BMD for whole-body and different body regions have not changed.
Neither in the study by Fujimura et al.5656.
Fujimura 💸 R, Ashizawa N, Watanabe M, Mukai N, Amagai H, Fukubayashi T, et al.
Effect of resistance exercise training on bone formation 💸 and resorption in young male subjects assessed by biomarkers of bone metabolism.J Bone Miner Res.1997;12(4):656-62.
were changes found in BMC or 💸 BMD for whole-body or specific body regions after a 4-month RT program planned with loads between 60-80% 1RM.
On the other 💸 hand, among premenopausal women (35-45 years), the study of Winter-Stone5757.
Winters-Stone KM, Snow CM.
Site-specific response of bone to exercise in premenopausal 💸 women.Bone.2006;39(6):1203-9.
investigated an increase in femoral BMD in groups trained for 12 months with: (a) high-impact exercises for lower limbs, and 💸 (b) high-impact exercises for lower limbs combined with resisted upper limb exercise.
Among postmenopausal women at risk of osteoporosis, there was 💸 an increase in body and femoral BMD after an 11-month training program involving impact (staircase: 60 to 85% maximal heart 💸 rate) and contractile tension stimulus (load intensity referring to 8 to 12-RMs)5252.
Ryan AS, Ivey FM, Hurlbut DE, Martel GF, Lemmer 💸 JT, Sorkin JD, et al.
Regional bone mineral density after resistive training in young and older men and women.
Scand J Med 💸 Sci Sports.2004;14(1):16-23..
Among middle-aged men (54-61 years), Huuskonen et al.5858.
Huuskonen J, Väisänen SB, Kröger H, Jurvelin JS, Alhava E, Rauramaa R.
Regular 💸 physical exercise and bone mineral density: a four-year controlled randomized trial in middle-aged men.The DNASCO study.Osteoporos Int.2001;12(5):349-55.
observed an increase in 💸 femoral BMD in 3.
8%, after 4 months of resistance exercises planned with three weekly sessions and load between 5 and 💸 15 RM.
The studies highlighted in Boards 1 and 2 provide updated results corroborating the effects of RT on bone remodeling.
Studies 💸 that showed a greater effect of RT on BMC/BMD reported changes between 6 and 8%2121.
Huovinen V, Ivaska KK, Kiviranta R, 💸 Bucci M, Lipponen H, Sandboge S, et al.
Bone mineral density is increased after a 16-week resistance training intervention in elderly 💸 women with decreased muscle strength.
Eur J Endocrinol, 2016;175(6):571-82.,2222.
Watson SL, Weeks BK, Weis LJ, Horan SA, Beck BR.
Heavy resistance training is 💸 safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings 💸 from the LIFTMOR trial.Osteoporos Int.
2015;26(12):2889-94.,3232.
Almstedt HC, Canepa JA, Ramirez DA, Shoepe TC.
Changes in bone mineral density in response to 24 💸 weeks of resistance training in college-age men and women.
J Strength Cond Res.
2011;25(4):1098-103..
These studies encompassed a varied population as to age, 💸 sex and training protocols, using only resistance exercises, but with different loading intensities, with the exception of the Petersen et 💸 al.2424.
Petersen BA, Hastings B, Gottschall JS.
Low load, high repetition resistance training program increases bone mineral density in untrained adults.
J Sports 💸 Med Phys Fitness.2017;57(1-2):70-6.
study, which included exercise for cardiovascular endurance on a bicycle.For Petersen et al.2424.
Petersen BA, Hastings B, Gottschall JS.
Low 💸 load, high repetition resistance training program increases bone mineral density in untrained adults.
J Sports Med Phys Fitness.2017;57(1-2):70-6.
, the use of 💸 low loads (20% 1-RM) associated to the high number of repetitions showed similar effectiveness to other studies that employed intensity 💸 between 50-95% 1-RM2121.
Huovinen V, Ivaska KK, Kiviranta R, Bucci M, Lipponen H, Sandboge S, et al.
Bone mineral density is increased 💸 after a 16-week resistance training intervention in elderly women with decreased muscle strength.
Eur J Endocrinol, 2016;175(6):571-82.,3232.
Almstedt HC, Canepa JA, Ramirez 💸 DA, Shoepe TC.
Changes in bone mineral density in response to 24 weeks of resistance training in college-age men and women.
J 💸 Strength Cond Res.
2011;25(4):1098-103..
Additionally, the study of Almstedt et al.3232.
Almstedt HC, Canepa JA, Ramirez DA, Shoepe TC.
Changes in bone mineral density 💸 in response to 24 weeks of resistance training in college-age men and women.
J Strength Cond Res.
2011;25(4):1098-103.
which analyzed the alterations by 💸 sex, indicated that among men the effects were more pronounced.
For these authors, this could be explained to the differences in 💸 hormonal response, initial muscle strength level and food intake in men than women, making the response of BMC/BMD different from 💸 the stimulus of RT.
Even, it cannot be state that the effects of RT on BMC/BMD would vary according to the 💸 type of exercises and amount of muscle mass engaged in exercise, since only the study of Huovinen et al.2121.
Huovinen V, 💸 Ivaska KK, Kiviranta R, Bucci M, Lipponen H, Sandboge S, et al.
Bone mineral density is increased after a 16-week resistance 💸 training intervention in elderly women with decreased muscle strength.
Eur J Endocrinol, 2016;175(6):571-82.
used multi-joint exercises exclusively.
Meanwhile, the studies of Petersen et 💸 al.2424.
Petersen BA, Hastings B, Gottschall JS.
Low load, high repetition resistance training program increases bone mineral density in untrained adults.
J Sports 💸 Med Phys Fitness.2017;57(1-2):70-6.and Almstedt et al.3232.
Almstedt HC, Canepa JA, Ramirez DA, Shoepe TC.
Changes in bone mineral density in response to 💸 24 weeks of resistance training in college-age men and women.
J Strength Cond Res.
2011;25(4):1098-103.
included only small muscle exercises in the protocol, 💸 as well as exercises for pelvic region.
Indeed, training programs planned with exercises for the different body parts tend to be 💸 effectiveness for general conditioning proposes, with no risk to constraints bone remodeling of specific sites such as hip and lumbar 💸 vertebrae, for those were recommended to approach the specificity from impacting exercises (jumps and variations) and exercises for lower limbs 💸 (such as squatting and ground lifting).2929.
Mosti MP, Carlsen T, Aas E, Hoff J, Stunes AK, Syversen U.
Maximal strength training improves 💸 bone mineral density and neuromuscular performance in young adult women.
J Strength Cond Res.
2014;28(10):2935-45.
Another part of studies inserted in Board 1 💸 and 2 observed positive effects of 1 to 2% in average for the changes of BMC/BMD, as it be from 💸 isolated RT protocols, or combined with impact or cardiovascular endurance exercises using weight-bearing exercises (running, for example).
In these studies can 💸 be also highlight the fact that RT applied to the population of different age groups and both sexes obtained a 💸 similar magnitude of effect on BMC/BMD, no matter the protocol duration (12 to 24 months)3535.
Warren M, Petit MA, Hannan PJ, 💸 Schmitz KH.
Strength training effects on bone mineral content and density in premenopausal women.
Med Sci Sports Exerc.2008;40(7):1282-8.
, the frequency (2 vs.
3 💸 weekly sessions), the load (80 vs.40% 1-RM)3131.
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.
, the schedule of training progression to alter overload (linear vs.ondulatory)3434.
Vanni AC, Meyer F, Da Veiga 💸 AD, Zanardo VP.
Comparison of the effects of two resistance training regimens on muscular and bone responses in premenopausal women.Osteoporos Int.2010;21(9),1537-44.
, 💸 or even the variation of series (2 vs.3 series)2020.
Cunha PM, Ribeiro AS, Tomeleri CM, Schoenfeld BJ, Silva AM, Souza MF, 💸 et al.
The effects of resistance training volume on osteosarcopenic obesity in older women.J Sports Sci.
2018;36(14):1564-71.
, and finally by the way 💸 to perform resistance exercise (circuit vs.traditional)3030.
Romero-Arenas S, Blazevich AJ, Martínez-Pascual M, Pérez-Gómez J, Luque AJ, López-Román FJ, et al.
Effects of 💸 high-resistance circuit training in an elderly population.Exp Gerontol.2013;48(3):334-40..
It is also noted that the combination of impact exercises with RT for 💸 a period between 8 and 12 months did not demonstrated to be more effective strategy than the isolated RT to 💸 change BMC/BMD.For Hinton et al.2727.
Hinton PS, Nigh P, Thyfault J.
Effectiveness of resistance training or jumping-exercise to increase bone mineral density 💸 in men with low bone mass: A 12-month randomized, clinical trial.Bone.2015;79:203-12.
the changes in whole-body and regional BMD in middle-aged men 💸 after resistive and impact exercise training were different from baseline, but similar between groups, with the exception of hip BMD 💸 that altered most with the RT.
However, for Liang et al.3333.
Liang MTC, Braun W, Bassin SL, Dutto D, Pontello A, Wong 💸 ND, et al.
Effect of high-impact aerobics and strength training on BMD in young women aged 20–35 years.Int J Sports Med.2011;32(02):100-8.
, 💸 no changes were observed between trained groups (resistance and impact) with control group, involving young adult women.
Perhaps, the absence of 💸 changes on whole-body and regional BMD in the study of Liang et al.3333.
Liang MTC, Braun W, Bassin SL, Dutto D, 💸 Pontello A, Wong ND, et al.
Effect of high-impact aerobics and strength training on BMD in young women aged 20–35 years.Int 💸 J Sports Med.2011;32(02):100-8.
can be explained by the planned volume of jumps, which may interfere with the percentage of BMD changes 💸 in the hip and femoral trochanter, as observed by Bolam et al.2626.
Bolam KA, Skinner TL, Jenkins DG, Galvão DA, Taaffe 💸 DR.
The osteogenic effect of impact-loading and resistance exercise on bone mineral density in middle-aged and older men: a pilot study.Gerontology.2015;62(1):22-32.
in 💸 a population of middle-aged and elderly men.
Even because of the intensity of the load used in the RT, which requires 💸 loads between 80-85% 1-RM for multi-joint exercises in upper and lower limbs to significantly change the BMD of the lumbar 💸 vertebrae and femoral neck, according to the study of Watson et al.2222.
Watson SL, Weeks BK, Weis LJ, Horan SA, Beck 💸 BR.
Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone 💸 mass: novel early findings from the LIFTMOR trial.Osteoporos Int.
2015;26(12):2889-94.
In fact, when reviewing the results of BMD from studies including women 💸 in per- and post-menopausal period (- 50-75 years), planning interventions between 6 and 24 months and used impact exercises alone, 💸 or in combination to RT (example: 2-3 series, 6-8 repetitions at 70-80% 1-RM, coupled with step exercises or jump on 💸 boxes) were observed positive increments between 1% and 2% for the lumbar region and femoral neck.5353.
Zhao R, Zhao M, Xu 💸 Z.
The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis.Osteoporos Int.2015;26(5):1605-18.,5959.
Sañudo 💸 B, de Hoyo M, Del Pozo-Cruz J, Carrasco L, Del Pozo-Cruz B, Tejero S, et al.
A systematic review of the 💸 exercise effect on bone health: the importance of assessing mechanical loading in perimenopausal and postmenopausal women.Menopause.
2017;24(10):1208-16.
However, it was emphasized that 💸 RT (example: 2 sets, 8 repetitions at 80% 1-RM, and 2 weekly sessions) did not present the same effectiveness when 💸 employed alone, but it was enough to avoid reductions (increase ≤1 % trained group vs.
reductions of up to 2.5% control 💸 group).5353.
Zhao R, Zhao M, Xu Z.
The effects of differing resistance training modes on the preservation of bone mineral density in 💸 postmenopausal women: a meta-analysis.Osteoporos Int.2015;26(5):1605-18.,5959.
Sañudo B, de Hoyo M, Del Pozo-Cruz J, Carrasco L, Del Pozo-Cruz B, Tejero S, et 💸 al.
A systematic review of the exercise effect on bone health: the importance of assessing mechanical loading in perimenopausal and postmenopausal 💸 women.Menopause.
2017;24(10):1208-16.
However, the biological importance of these small changes, or even the unchanged of BMC/BMD values in response to RT can 💸 be understood by the fact that men and women up to 50 years of age have a BMC/BMD decline rate 💸 of 0, 3 to 1.
1% per year, which increases considerably among women after 50 years2727.
Hinton PS, Nigh P, Thyfault J.
Effectiveness 💸 of resistance training or jumping-exercise to increase bone mineral density in men with low bone mass: A 12-month randomized, clinical 💸 trial.Bone.2015;79:203-12.,3434.
Vanni AC, Meyer F, Da Veiga AD, Zanardo VP.
Comparison of the effects of two resistance training regimens on muscular and 💸 bone responses in premenopausal women.Osteoporos Int.2010;21(9),1537-44..
Furthermore, the majority of studies highlighted in Tables 1 and 2 show moderate (-10%) to 💸 high (> 80%) changes of muscle strength in association to the low changes (- 2 to 5%) in lean mass, 💸 being that sure for groups of elderly people of both sexes77.
Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, 💸 Colombo E, et al.
Aerobic or resistance exercise, or both, in dieting obese older adults.N Engl J Med.
2017;376(20):1943-55.
, just elderly men2525.
Stunes 💸 AK, Syversen U, Berntsen S, Paulsen G, Stea TH, Hetlelid KJ, et al.
High doses of vitamin C plus E reduce 💸 strength training-induced improvements in areal bone mineral density in elderly men.Eur J Appl Physiol.
2017;117(6):1073-84.or women2121.
Huovinen V, Ivaska KK, Kiviranta R, 💸 Bucci M, Lipponen H, Sandboge S, et al.
Bone mineral density is increased after a 16-week resistance training intervention in elderly 💸 women with decreased muscle strength.
Eur J Endocrinol, 2016;175(6):571-82.,3030.
Romero-Arenas S, Blazevich AJ, Martínez-Pascual M, Pérez-Gómez J, Luque AJ, López-Román FJ, et 💸 al.
Effects of high-resistance circuit training in an elderly population.Exp Gerontol.2013;48(3):334-40.
, groups of people with different ages and sex2424.
Petersen BA, Hastings 💸 B, Gottschall JS.
Low load, high repetition resistance training program increases bone mineral density in untrained adults.
J Sports Med Phys Fitness.2017;57(1-2):70-6.
, 💸 for young adults2929.
Mosti MP, Carlsen T, Aas E, Hoff J, Stunes AK, Syversen U.
Maximal strength training improves bone mineral density 💸 and neuromuscular performance in young adult women.
J Strength Cond Res.
2014;28(10):2935-45.and children2828.
Cunha GS, Sant'anna MM, Cadore EL, Oliveira NL, Santos CB, 💸 Pinto RS, et al.
Physiological adaptations to resistance training in prepubertal boys.Res Q Exerc Sport.2015;86(2):172-81..
Such changes, together with cardiovascular conditioning, are 💸 negatively associated with mortality from different causes, as the risk of falls and fractures among elderly.77.
Villareal DT, Aguirre L, Gurney 💸 AB, Waters DL, Sinacore DR, Colombo E, et al.
Aerobic or resistance exercise, or both, in dieting obese older adults.N Engl 💸 J Med.
2017;376(20):1943-55.,1010.
Marques EA, Wanderley F, Machado L, Sousa F, Viana JL, Moreira-Gonçalves D, et al.
Effects of resistance and aerobic exercise 💸 on physical function, bone mineral density, OPG and RANKL in older women.Exp Gerontol.2011;46(7):524-32.,2323.
Beaver, KM, Beavers DP, Martin SB, Marsh AP, 💸 Lyles MF, Lenchik L, et al.
Change in bone mineral density during weight loss with resistance versus aerobic exercise training in 💸 older adults.
J Gerontol A Biol Sci Med Sci.
2017;72(11):1582-85.,6060.
Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA.
Exercise and bone mass in adults.Sports 💸 Med.
2009;39(6):439-68.
CONCLUSION
Collectively, the studies corroborated the integration between the patterns of changes of LM and muscle strength with BMC/BMD modulation.
However, there 💸 are specific tendencies between men and women regarding bone growth up to adult life, as well as to the reduction 💸 of muscle and bone mass with aging.
Regarding the mode of exercise to promote such integrated development, studies indicating the RT 💸 engaging multi-articular motions with high load intensity, as the preponderant stimulus promoting bone remodeling directly, or otherwise indirectly by the 💸 increase of regional or whole-body lean mass, regardless of age, sex and ethnicity.
The specific guideline for RT approach 70-90% 1RM, 💸 2-3 sets per exercise, 1-3 minutes interval, 2-3 sessions per week for a period of 4 to 12 months, combining 💸 with impact exercises (such as a jump, if possible) to improve regional and whole-body BMC/BMD, as well as, for the 💸 prevention of osteoporosis after the 4th or 5th decades of life.
