Prescripción de ejercicio físico para mujeres posmenopáusicas con osteopenia u osteoporosis basada en una revisión sistemática de ensayos clínicos aleatorizados (Prescription of physical exercise for postmenopausal women with osteopenia or osteoporosis based on a systematic review of randomized clinical trials)
DOI:
https://doi.org/10.47197/retos.v52.102439Palabras clave:
Ejercicio, osteoporosis, envejecimientoResumen
Antecedentes: Analizar los métodos de ejercicios físicos que son eficientes para mejorar los niveles de densidad mineral ósea (DMO)/T-score de mujeres posmenopáusicas y elaborar un modelo de prescripción de ejercicio para mujeres con baja DMO y/u osteoporosis. Métodos: Se realizaron búsquedas en las bases de datos MEDLINE (a través de PubMed), ScienceDirect, Web of Science y Scopus de ensayos controlados aleatorios (ECA) que analizaron métodos de ejercicio físico que muestran eficiencia para la DMO en mujeres posmenopáusicas con baja DMO y/u osteoporosis. Resultados: Se seleccionaron nueve ECA. Los ejercicios más eficientes para mejorar la DMO fueron el entrenamiento de resistencia, multicomponente, aeróbico y vibratorio. El método menos eficaz fue el entrenamiento acuático (hidrogimnasia). Conclusión: Los ejercicios en gravedad normal tuvieron los mejores efectos sobre la DMO en comparación con los realizados en gravedad reducida. La frecuencia de entrenamiento adecuada debe ser de 3 veces por semana o más. El tiempo de intervención debe ser de unos 12 meses o más. La intensidad del entrenamiento debe estar entre moderada y alta. Además, la propuesta de prescripción de ejercicio relaciona la clasificación T-score, el nivel de actividad física y el uso de medicación, además de la anamnesis, que considera las fracturas previas de los pacientes y los factores de riesgo de fracturas.
Palabras clave: Ejercicio, densidad ósea, osteoporosis, posmenopausia, envejecimiento.
Abstract. Background: To analyze the methods of physical exercises that are efficient in improving the levels of bone mineral density (BMD)/T-score of postmenopausal women and to elaborate an exercise prescription model for women with low BMD and/or osteoporosis. Methods: We searched MEDLINE (via PubMed), ScienceDirect, Web of Science, and Scopus databases for randomized controlled trials (RCTs) that analyzed physical exercise methods that show efficiency for BMD in postmenopausal women with low BMD and/or osteoporosis. Results: Nine RCTs were selected. The most efficient exercises to improve the BMD were resistance, multicomponent, aerobic, and vibration training. The least efficient method was water training (hydrogymnastics). Conclusion: Exercises in normal gravity had the best effects on BMD compared to those performed in reduced gravity. Adequate training frequency should be 3 times/week or more. Intervention time should be around 12 months or more. The training intensity should be between moderate and high. Moreover, the exercise prescription proposal relates the T-score classification, level of physical activity, and use of medication, in addition to anamnesis, which considers the patients' previous fractures and risk factors for fractures.
Keywords: bone mineral density, osteoporosis, physical activity, older
Citas
ACSM. (1998). American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 30(6), 992–1008.
ACSM. (2021). Diretrizes do ACSM para os Testes de Esforço e sua Prescrição. GEN.
Bergström, I., Lombardo, C., & Brinck, J. (2009). Physical training decreases waist circumference in postmenopausal borderline overweight women. Acta Obstetricia et Gynecologica Scandinavica, 88(3), 308–313. https://doi.org/10.1080/00016340802695942
Borba-Pinheiro, C. J., Dantas, E. H. M., Vale, R. G. de S., Drigo, A. J., Carvalho, M. C. G. de A., Tonini, T., … Figueiredo, N. M. A. de. (2016). Resistance training programs on bone related variables and functional independ-ence of postmenopausal women in pharmacological treatment: A randomized controlled trial. Archives of Gerontol-ogy and Geriatrics, 65, 36–44. https://doi.org/10.1016/j.archger.2016.02.010
Cheng, C., Wentworth, K., & Shoback, D. M. (2020). New Frontiers in Osteoporosis Therapy. Annual Review of Medi-cine, 71(1), 277–288. https://doi.org/10.1146/annurev-med-052218-020620
Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009). Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & Exercise, 41(7), 1510–1530. https://doi.org/10.1249/MSS.0b013e3181a0c95c
Chow, R., Harrison, J. E., & Notarius, C. (1987). Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women. BMJ, 295(6611), 1441–1444. https://doi.org/10.1136/bmj.295.6611.1441
Cordeiro, L. D. S., Linhares, D. G., Barros Dos Santos, A. O., Lima Dos Santos, L., De Castro, J. B. P., & Vale, R. G. D. S. (2023). Influence of resistance training on muscle architecture in older adults: A systematic review and meta-analysis of randomized controlled trials. Archives of Gerontology and Geriatrics, 112, 105020. https://doi.org/10.1016/j.archger.2023.105020
Du, X., Zhang, C., Zhang, X., Qi, Z., Cheng, S., & Le, S. (2021). The Impact of Nordic Walking on Bone Properties in Postmenopausal Women with Pre-Diabetes and Non-Alcohol Fatty Liver Disease. International Journal of Environ-mental Research and Public Health, 18(14), 7570. https://doi.org/10.3390/ijerph18147570
García-Gomáriz, C., Blasco, J. M., Macián-Romero, C., Guillem-Hernández, E., & Igual-Camacho, C. (2018). Effect of 2 years of endurance and high-impact training on preventing osteoporosis in postmenopausal women: Random-ized clinical trial. Menopause (New York, N.Y.), 25(3), 301–306. https://doi.org/10.1097/GME.0000000000001005
Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., … Sterne, J. A. C. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical Research Ed.), 343, d5928. https://doi.org/10.1136/bmj.d5928
Iwamoto, J., Takeda, T., & Ichimura, S. (2001). Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis. Journal of Orthopaedic Science, 6(2), 128–132. https://doi.org/10.1007/s007760100059
Iwamoto, J., Takeda, T., Sato, Y., & Uzawa, M. (2005). RETRACTED ARTICLE: Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clinical and Experimental Research, 17(2), 157–163. https://doi.org/10.1007/BF03324589
Jepsen, D. B., Ryg, J., Hansen, S., Jørgensen, N. R., Gram, J., & Masud, T. (2019). The combined effect of Parathy-roid hormone (1–34) and whole-body Vibration exercise in the treatment of postmenopausal OSteoporosis (Pa-VOS study): A randomized controlled trial. Osteoporosis International, 30(9), 1827–1836. https://doi.org/10.1007/s00198-019-05029-z
Kistler-Fischbacher, M., Weeks, B. K., & Beck, B. R. (2021). The effect of exercise intensity on bone in postmenopau-sal women (part 1): A systematic review. Bone, 143, 115696. https://doi.org/10.1016/j.bone.2020.115696
Krueger, D., Vallarta-Ast, N., Checovich, M., Gemar, D., & Binkley, N. (2012). BMD Measurement and Precision: A Comparison of GE Lunar Prodigy and iDXA Densitometers. Journal of Clinical Densitometry, 15(1), 21–25. https://doi.org/10.1016/j.jocd.2011.08.003
Laiz, A., Malouf, J., Marin, A., Longobardi, V., De Caso, J., Farrerons, J., & Casademont, J. (2017). Impact of 3-monthly vitamin D supplementation plus exercise on survival after surgery for osteoporotic hip fracture in adult pa-tients over 50 years: A pragmatic randomized, partially blinded, controlled trial. The Journal of Nutrition, Health & Aging, 21(4), 413–420. https://doi.org/10.1007/s12603-016-0773-3
Linhares, D.G., dos Santos, A. O. B., dos Santos, L. L., Marcos-Pardo, P. J., de Souza Cordeiro, L., de Castro, J. B. P., & de Souza Vale, R. G. (2022). Effects of taekwondo on health in older people: A systematic review. Retos, 46, 36–42. Scopus. Recuperado de Scopus.
Linhares, Diego Gama, Borba-Pinheiro, C. J., Castro, J. B. P. D., Santos, A. O. B. D., Santos, L. L. D., Cordeiro, L. D. S., … Vale, R. G. D. S. (2022). Effects of Multicomponent Exercise Training on the Health of Older Women with Osteoporosis: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19(21), 14195. https://doi.org/10.3390/ijerph192114195
Linhares, Diego Gama, Brandão Pinto De Castro, J., Borba-Pinheiro, C. J., Linhares, B. G., Dos Santos, L. L., Marcos-Pardo, P. J., & De Souza Vale, R. G. (2023). Effect of combat sports on physical fitness and activities of daily living of older adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Geron-tology and Geriatrics, 1–12. https://doi.org/10.36150/2499-6564-N613
Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPI-DER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Services Research, 14(1), 579. https://doi.org/10.1186/s12913-014-0579-0
Mofid, M., Mohebi, S., Darbani, M., Basiri, Z., Naderifar, H., & Torkaman, G. (2022). Fat Mass as an Independent Variable to Assess the Possibility of Predicting the Stability in Postmenopausal Women with and Without Osteopo-rosis. Muscle Ligaments and Tendons Journal, 12(03), 352. https://doi.org/10.32098/mltj.03.2022.10
Pernambuco, C. S., Borba-Pinheiro, C. J., Vale, R. G. D. S., Di Masi, F., Monteiro, P. K. P., & Dantas, E. H. M. (2013). Functional autonomy, bone mineral density (BMD) and serum osteocalcin levels in older female partici-pants of an aquatic exercise program (AAG). Archives of Gerontology and Geriatrics, 56(3), 466–471. https://doi.org/10.1016/j.archger.2012.12.012
Radominski, S. C., Bernardo, W., Paula, A. P. D., Albergaria, B.-H., Moreira, C., Fernandes, C. E., … Borba, V. Z. C. (2017). Brazilian guidelines for the diagnosis and treatment of postmenopausal osteoporosis. Revista Brasileira de Reumatologia (English Edition), 57, 452–466. https://doi.org/10.1016/j.rbre.2017.07.001
Razzak, Z. A., Khan, A. A., & Farooqui, S. I. (2019). Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females. International Journal of Health Sciences, 13(4), 10–16.
Smart, N. A., Waldron, M., Ismail, H., Giallauria, F., Vigorito, C., Cornelissen, V., & Dieberg, G. (2015). Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. International Journal of Evidence-Based Healthcare, 13(1), 9–18. https://doi.org/10.1097/XEB.0000000000000020
Smidt, G. L., Lin, S.-Y., Oʼdwyer, K. D., & Blanpied, P. R. (1992). The Effect of High-Intensity Trunk Exercise on Bone Mineral Density of Postmenopausal Women: Spine, 17(3), 280–285. https://doi.org/10.1097/00007632-199203000-00007
Souza, J. M., Almeida, M. T. de, Vale, R. G. de S., Bello, M. de N. D., & Borba Pinheiro, C. J. (2021). EFEITOS DOS EXERCÍCIOS FÍSICOS NA DENSIDADE MINERAL ÓSSEA DE MULHERES ACIMA DE 50 ANOS: REVISÃO INTEGRATIVA. Biológicas & Saúde, 11(40), 11–28. https://doi.org/10.25242/8868114020212468
Swain, D. (2014). ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (7a).
Tanaka, H. (2009). Habitual Exercise for the Elderly. Family & Community Health, 32(1), S57–S65. https://doi.org/10.1097/01.FCH.0000342840.43724.ce
Ura C., Taga T., Yamazaki S., & Yatomi N. (2011). The factors influencing motivation to start exercise among elderly people in an urban area. Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics, 48(4), 345–351. https://doi.org/10.3143/geriatrics.48.345
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., … Murray, C. J. (2015). Global, region-al, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743–800. https://doi.org/10.1016/S0140-6736(15)60692-4
Wang, Z., Zan, X., Li, Y., Lu, Y., Xia, Y., & Pan, X. (2023). Comparative efficacy different resistance training proto-cols on bone mineral density in postmenopausal women: A systematic review and network meta-analysis. Frontiers in Physiology, 14, 1105303. https://doi.org/10.3389/fphys.2023.1105303
Weeks, B. K., Purvis, M., & Beck, B. R. (2016). Physical activity estimated by the bone-specific physical activity ques-tionnaire is also associated with cardiovascular risk. European Journal of Sport Science, 16(8), 1204–1211. https://doi.org/10.1080/17461391.2016.1153726
Xu, F., Letendre, J., Bekke, J., Beebe, N., Mahler, L., Lofgren, I. E., & Delmonico, M. J. (2015). Impact of a Pro-gram of Tai Chi Plus Behaviorally Based Dietary Weight Loss on Physical Functioning and Coronary Heart Disease Risk Factors: A Community-Based Study in Obese Older Women. Journal of Nutrition in Gerontology and Geriatrics, 34(1), 50–65. https://doi.org/10.1080/21551197.2014.1003672
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Retos
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Los autores que publican en esta revista están de acuerdo con los siguientes términos:
- Los autores conservan los derechos de autor y garantizan a la revista el derecho de ser la primera publicación de su obra, el cuál estará simultáneamente sujeto a la licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores pueden establecer por separado acuerdos adicionales para la distribución no exclusiva de la versión de la obra publicada en la revista (por ejemplo, situarlo en un repositorio institucional o publicarlo en un libro), con un reconocimiento de su publicación inicial en esta revista.
- Se permite y se anima a los autores a difundir sus trabajos electrónicamente (por ejemplo, en repositorios institucionales o en su propio sitio web) antes y durante el proceso de envío, ya que puede dar lugar a intercambios productivos, así como a una citación más temprana y mayor de los trabajos publicados (Véase The Effect of Open Access) (en inglés).
Esta revista sigue la "open access policy" de BOAI (1), apoyando los derechos de los usuarios a "leer, descargar, copiar, distribuir, imprimir, buscar o enlazar los textos completos de los artículos".
(1) http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess
