;
RCT
ACE Report #9116

Immediate effects on bone metabolism biomarkers noted with resistance training and walking


Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

Direct effects of physical training on markers of bone metabolism and serum sclerostin concentrations in older adults with low bone mass

BMC Musculoskelet Disord. 2016 Jun 8;17(1):254

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Synopsis

150 women with osteoporosis or osteopenia were randomized to one of three groups; one group underwent a single session of resistance exercises, one group underwent a single session of simply walking, and one group was a control with no intervention. The purpose of this study was to examine and compare pre- and post-intervention serum levels of bone-specific alkaline phosphatase (BALP), C-terminal cross-linked telopeptide of type I collagen (CTX) and sclerostin between groups. No group demonstrated a significant change in BALP levels. CTX levels were significant increased from pre- to post-intervention in the resistance exercises group, whereas sclerostin levels were significantly increased from pre- to post-intervention in the walking group.

Publication Funding Details +
Funding:
Non-Industry funded
Sponsor:
Faculty of Health Sciences, University of Pecs
Conflicts:
None disclosed

Risk of Bias

4.5/10

Reporting Criteria

16/20

Fragility Index

N/A

Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

1/4

Randomization

3/4

Outcome Measurements

4/4

Inclusion / Exclusion

4/4

Therapy Description

4/4

Statistics

Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Analysis of bone metabolism through serum markers, such as bone-specific alkaline phosphatase (BALP), C-terminal cross-linked telopeptide of type I collagen (CTX), has been recently popular in the evaluating various treatment efficacies for patients at high risk of fracture, such as those with osteopenia or osteoporosis. Weight-bearing and resistance exercises are thought to play a crucial role in the regulation and changes of these markers for overall improvement of bone metabolism and health. Nonetheless, very few randomized controlled trials have been performed evaluating these effects.

What was the principal research question?

In women with osteoporosis or osteopenia, what immediate effect does a single session of either resistance training or walking have on bone metabolism biomarkers, compared to no intervention?

Study Characteristics -
Population:
150 women with osteoporosis or osteopenia.
Intervention:
Resistance training group: First, participants took part in an 8-min warm-up targeting major muscle groups. This was followed by 30-min of various muscle strengthening and core stabilizing exercises (see publication for full program). Lastly, an 8-min cool-down consisted of walking and stretching exercises. (n=50; Mean age: 60.2+/-6.9) Walking group: Participants walked for 46-min on even ground at a rate of 100 steps/min. Rhythm was aided by a metronome. (n=50; Mean age: 58.7+/-6.3)
Comparison:
Control group: Participants did not receive any intervention. (n=50; Mean age: 57.8+/-8.4)
Outcomes:
Serum concentrations of bone-specific alkaline phosphatase (BALP), C-terminal cross-linked telopeptide of type I collagen (CTX), and sclerostin were measured.
Methods:
RCT
Time:
Blood samples were collected within 5 minutes of completing allocated intervention.

What were the important findings?

  • Pre- to post-intervention change in serum BALP concentration was not significant in the resistance training group (41.7+/-12.8 tp 41.8+/-12.0%; p=0.33), the walking group (41.8+/-7.6 to 42.1+-8.4%; p=0.05), or the control group (42.2+/-10.4 to 42.1+/-10.2; p=0.19).
  • Post-hoc pair-wise comparisons demonstrated no significant between group differences in the change in serum BALP concentration.
  • Pre- to post-intervention change in serum CTX concentration was significant in the resistance training group (303.6+/-156.8 to 276.4+/-143.6pg/mL; p<0.001), but not in the walking group (247.3+/-106.2 to 253.9+/-107.5pg/mL; p=0.11) or the control group (256.1+/-110.2 to 256.7+/-111.2pg/mL; p=0.37)
  • Post-hoc pair-wise comparisons demonstrated significant between group differences in the change in CTX levels for the resistance training group compared to the walking group (p<0.01) and the control group (p<0.01); the difference between the walking group and control group was not significant (p=0.20).
  • Pre- to post-intervention change in serum sclerostin concentration was significant in the walking group (23.6+/-10.0 to 29.9+/-10.8pmol/L;p<0.01), but not in the resistance training group (26.8+/-14.0 to 29.6+/-15.7pmol/L; p=0.08) or the control group (24.0+/-8.8 to 24.2+/-8.8pmol/L; p=0.49).
  • Post-hoc pair-wise comparisons demonstrated a significant between group difference in the change in sclerostin level between the walking group and the control group (p<0.01), but not between the resistance and control group (p=0.1), or the resistance and walking group (p=0.11).

What should I remember most?

In women with osteoporosis or osteopenia, physical exercise was associated with immediate, significant effects on biomarkers of bone metabolism, with serum CTX levels significantly reduced among those who underwent a session of resistance training, and serum sclerostin levels significantly increased among those who underwent a session of walking exercise. However, neither intervention demonstrated a significant effect on serum BALP levels.

How will this affect the care of my patients?

The results of this study suggest that exercise programs, either resistance raining or simply walking, may result significant changes in bone metabolism biomarkers among individuals with low bone mass. Nonetheless, the current results do not establish whether possible transient changes in biomarkers of bone turnover or formation have a significant impact, short-term or sustained, on bone mineral density in these individuals. Therefore, it is unknown how efficacious programs such as these are for improving bone mass and, more importantly, reducing fracture risk in the osteoporotic and osteopenic population. As such, subsequent trials evaluating the effects of the studied interventions on these critical outcomes are needed.

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