Immediate effects on bone metabolism biomarkers noted with resistance training and walking .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2017;5(5):2 BMC Musculoskelet Disord. 2016 Jun 8;17(1):254150 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.
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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?
- 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).
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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