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Osteologie 2020; 29(03): 194-206
DOI: 10.1055/a-1177-4031
Originalarbeit

Dynamisches Krafttraining und Knochendichte an der Lendenwirbelsäule postmenopausaler Frauen

Eine Meta-Analyse unter besonderer Berücksichtigung trainingswissenschaftlicher KriterienDynamic Resistance Exercise and Bone Mineral Density at the Lumbar Spine in Postmenopausal WomenA systematic review and meta-analysis with special emphasis to exercise parameters
Wolfgang Kemmler
1   Institut für Medizinische Physik (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg
,
Mahdieh Shojaa
1   Institut für Medizinische Physik (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg
,
Matthias Kohl
2   Fakultät Medical and Life Sciences, Fachhochschule Furtwangen
,
Daniel Schoene
1   Institut für Medizinische Physik (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg
,
Simon von Stengel
1   Institut für Medizinische Physik (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg
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Zusammenfassung

Ziel dieser Metaanalyse war es (1) den Effekt eines dynamischen Krafttrainings (DRT) auf die Knochendichte (BMD) der Lendenwirbelsäule (LWS) einzuschätzen, (2) günstige Belastungs-komponenten zu identifizieren und (3) Trainingsempfehlungen abzuleiten.

Eine systematische Literaturrecherche schloss (a) kontrollierte Studien, (b) DRT ≥ 6 Monate mit mindestens einer Trainings- (TG) und einer Kontrollgruppe (KG), (c) LWS-BMD-Messung vor und nach der Intervention und (e) postmenopausale Frauen ein. Subgruppenanalysen wurden für Interventionsdauer, Art des DRT, Trainingshäufigkeit (TH), und -volumen sowie Reizintensität durchgeführt.

17 Artikel mit 20 TG und 18 KG konnten eingeschlossen werden. Die standardisierte Mittelwertdifferenz für die LWS-BMD zeigte einen signifikanten Effekt (0,59; 95%-CI: 0,26–0,92). Eine niedrige TH zeigte signifikant höhere Effekte auf die BMD als eine TH von ≥ 2 Einheiten/Woche.

Die Meta-Analyse zeigte einen moderaten DRT-Effekt auf die LWS-BMD. Ergebnisse der Subanalysen standen zum Teil im Gegensatz zur vorliegenden Literatur. Subanalysen meta-analytischer Auswertung scheinen zur Generierung erfolgversprechender Trainingsprotokolle nicht geeignet zu sein.

Abstract

Exercise might be the most promising non-pharmacologic agent in fracture prevention of older people. Dynamic resistance exercise (DRT) is a recognised component of most exercise protocols, be it in fall prevention or bone strengthening exercise protocols. However, the most optimum DRT protocol to address Bone Mineral Density (BMD) in postmenopausal women has yet to be fully validated. Hence the aim of this systematic review and meta-analysis aimed (1) to determine the effect of dynamic resistance exercise (DRT) on BMD at the lumbar spine (LS) in postmenopausal women (b) to identify exercise component particularly effective to trigger favourable LS-BMD changes and (3) to derive evidence-based recommendations for optimised training protocols.

A systematic review of the literature according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement included 8 different databases (PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest und Primo) without language restrictions. We included (a) controlled trials of isolated DRT with at least one exercise and one control group, (b) interventions of six months or longer, (c) BMD assessments at the LS at least before and after the study, (d) studies that focused on postmenopausal women and/or reported dedicated results for this group. Primary outcome measure for the meta-analysis was standardised mean difference (SMD) for BMD-changes at lumbar spine (LS). Further we conducted sub-analysis to determine modulators of the exercise effect on BMD using subgroup-analysis. We included ‘intervention length’, ‘type of DRT’, ‘training frequency’, ‘exercise intensity’ and ‘exercise volume’ split into two or three meaningful categories in the analyses.

In summary, 17 articles with 20 exercise and 18 control groups were eligible. We observed a significant effect (p < .001) of moderate size (SMD: (0.59; 95%-CI: 0.26-0.92) for LS-BMD changes. Apart from one exception we did not observe significant or relevant (p < .20) differences between the categories of the given modulators. Lower training frequency (< 2 sessions/week) resulted in significantly higher BMD changes at LS, however, compared to higher training frequency (≥ 2 sessions/week).

The work provided further evidence for a significant, albeit only moderate, DRT effect on LS-BMD in postmenopausal women. We attribute this suboptimum result to the high variation within the eligible studies with trials that did not properly apply basic exercise principle in their research. Unfortunately, sub-analysis did not result in reliable data. In contrast to all present studies, lower training frequency was significantly more favourable to increase BMD at LS compared with higher training frequency. We conclude that sub-analyses of meta-analytical evaluation were unable to identify promising exercise components and thus derive optimum training protocols for bone strengthening due to the close interaction of exercise parameters.

Schlüsselwörter

Krafttraining - Osteoporose - Knochendichte - Trainingskomponenten

Key words

Resistance exercise - osteoporosis - bone mineral density - exercise components


Publication History

Article published online:
16 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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