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Exercise Interventions for Preventing and Treating Low Bone Mass in the Forearm: A Systematic Review and Meta-analysis

Published:August 26, 2019DOI:https://doi.org/10.1016/j.apmr.2019.07.007

      Abstract

      Objective

      To examine the effectiveness of exercises for improving forearm bone mass.

      Data Sources

      MEDLINE, EMBASE, CINAHL, AMED, Web of Science, and Cochrane CENTRAL were searched from their inception until December 2018.

      Study Selection

      Eligibility included adults undertaking upper limb exercise interventions (≥12wk) to improve bone mass.

      Data Extraction

      Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers. Included studies were quality appraised using Cochrane risk of bias tool.

      Data Synthesis

      Exercise interventions were classified into “resistance training” of high or low intensity (HIRT/LIRT, respectively) or “impact.” Random-effects meta-analysis of the percentage change in forearm bone mass from baseline was conducted. Twenty-six studies were included in the review, of which 21 provided suitable data for meta-analysis. Methodological quality ranged from “low” to “unclear” risk of bias. Exercise generally led to increases (moderate-quality evidence) in forearm bone mass (standard mean difference [SMD], 1.27; 95% CI, 0.66-1.88; overall effect Z value=4.10; P<.001). HIRT (SMD, 1.00; 95% CI, 0.37-1.62; Z value=3.11; P=.002), and LIRT (SMD, 2.36; 95% CI, 0.37-4.36; Z value=2.33; P<.001) led to moderate increases in forearm bone mass. Improvements resulting from impact exercises (SMD, 1.12; 95% CI, −1.27 to 3.50; Z value=0.92; P=.36) were not statistically significant (low-quality evidence).

      Conclusions

      There is moderate-quality evidence that exercise is effective for improving forearm bone mass. There is moderate-quality evidence that upper body resistance exercise (HIRT/LIRT) promotes forearm bone mass but low-quality evidence for impact exercise. Current evidence is equivocal regarding which exercise is most effective for improving forearm bone mass.

      Keywords

      List of abbreviations:

      BMC (bone mineral content), BMD (bone mineral density), DXA (dual-energy x-ray absorptiometry), HIRT (high-intensity resistance training), LIRT (low-intensity resistance training), 1RM (1 repetition maximum), pQCT (peripheral quantitative computed tomography), RCT (randomized controlled trial), ROI (region of interest), SMD (standardized mean difference), SPA (single photon absorptiometry)
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