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The Effect of Impact Exercise (Alone or Multicomponent Intervention) on Health-Related Outcomes in Individuals at Risk of Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract

Background

Exercise is commonly recommended to prevent and manage osteoporosis. High magnitude strains at rapid rate and short bouts should theoretically elicit an osteogenic response; however, the effects of different levels of impact exercises on several outcomes in people at risk of fracture are still unknown.

Objective

To report the effect of impact exercise on falls, fractures, adverse events, mortality, bone mineral density (BMD), physical functioning, and health-related quality of life (QoL).

Methods

We included randomized controlled trials testing the effect of impact exercise compared with a non-exercise control on outcomes in adults ≥ 50 years with low BMD or fragility fractures. Two reviewers selected studies and extracted data. Where possible, we pooled outcomes using mean difference (MD) with a fixed-effects model and 95% confidence interval (CI). We reported risk of bias using Cochrane and certainty of evidence using GRADE.

Results

We included 29 trials; 19 studies evaluated impact exercise alone, and the remaining trials combined impact with resistance or balance training. Impact exercise alone or combined with resistance training improved Timed Up-and-Go values (MD − 0.95 s, 95% CI − 1.09 to − 0.81, low certainty evidence) and lumbar spine (MD 0.04 g/cm2, 95% CI 0.02–0.06, low certainty evidence) and femoral neck BMD (MD 0.04 g/cm2, 95% CI 0.02–0.07, low certainty evidence). Impact exercise did not improve health-related QoL assessed with QUALEFFO-41 (MD 0.06, 95% CI − 2.18 to 2.30, moderate certainty evidence). The effects of impact exercise on falls, fractures, and mortality are uncertain due to insufficient data. Many trials had a high risk of bias for two or more items.

Conclusions

There is low certainty evidence that impact exercise may improve physical function and BMD in people at risk of fracture. The effect of impact exercises on falls, fractures, and mortality remains unclear. Our findings should be interpreted with caution due to risk of bias and small sample sizes.

Trial Registration

Registered in Prospero (CRD42018115579) on January 30, 2019.

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Acknowledgements

The authors would like to acknowledge the assistance of Jeff Templeton, Sydney Mannell, Vivetha Ramesh, and Nora Thorpe in the screening and the data extraction phases of this project.

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Authors and Affiliations

  1. Department of Kinesiology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada

    Isabel B. Rodrigues, Matteo Ponzano & Lora M. Giangregorio

  2. College of Kinesiology, University of Saskatchewan, Saskatoon, SK, S7N 5B2, Canada

    Zeinab Hosseini & Philip D. Chilibeck

  3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Lehana Thabane

  4. Department of Family and Community Medicine, University of Toronto, Toronto, ON, M5G 1V7, Canada

    Debra A. Butt

  5. Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada

    Maureen C. Ashe

  6. University of Waterloo Library, University of Waterloo, Waterloo, ON, N2L 3G1, Canada

    Jackie Stapleton

  7. Schlegel-University of Waterloo, Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada

    Lora M. Giangregorio

  8. Department of Medicine, Bone and Mineral Medicine, Department of Diabetes and Endocrinology, University of Melbourne, Royal Melbourne Hospital, Victoria, 3050, Australia

    John Wark

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  1. Isabel B. Rodrigues
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Corresponding author

Correspondence to Lora M. Giangregorio.

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Authorship Contributions

IBR screened, analyzed, interpreted, and wrote the first draft of the manuscript. LG and LT assisted with statistical methods and analyses. PC, DB, MA, and LG reviewed the final analysis and revised the original manuscript. JS conducted the literature search. MP and ZH assisted in screening and revising the final manuscript. All authors read and approved the final manuscript.

Funding

Funding for this project was received from Osteoporosis Canada, the Canadian.

Availability of data and materials

Available upon request for research purposes. Institutes of Health Research, the Federation of Portuguese Canadian Business & Professionals, the University of Waterloo, and the Saskatchewan Health Research Foundation.

Conflict of interest

Isabel Rodrigues, Matteo Ponzano, Zeinab Hosseini, Lehana Thabane, Phil Chilibeck, Debra Butt, Maureen Ashe, Jackie Stapleton, John Wark and Lora Giangregorio declare that they have no conflicts of interest relevant to the content of this review.

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Funding sponsors did not provide a role, other than financial support, in developing this review.

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Rodrigues, I.B., Ponzano, M., Hosseini, Z. et al. The Effect of Impact Exercise (Alone or Multicomponent Intervention) on Health-Related Outcomes in Individuals at Risk of Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 51, 1273–1292 (2021). https://doi.org/10.1007/s40279-021-01432-x

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