Sports Medicine ( IF 9.3 ) Pub Date : 2022-05-24 , DOI: 10.1007/s40279-022-01675-2 Steven J O'Bryan 1 , Catherine Giuliano 1 , Mary N Woessner 1 , Sara Vogrin 2, 3 , Cassandra Smith 1, 2, 4 , Gustavo Duque 2, 3 , Itamar Levinger 1, 2, 3
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Background
Older adults experience considerable muscle and bone loss that are closely interconnected. The efficacy of progressive resistance training programs to concurrently reverse/slow the age-related decline in muscle strength and bone mineral density (BMD) in older adults remains unclear.
Objectives
We aimed to quantify concomitant changes in lower-body muscle strength and BMD in older adults following a progressive resistance training program and to determine how these changes are influenced by mode (resistance only vs. combined resistance and weight-bearing exercises), frequency, volume, load, and program length.
Methods
MEDLINE/PubMed and Embase databases were searched for articles published in English before 1 June, 2021. Randomized controlled trials reporting changes in leg press or knee extension one repetition maximum and femur/hip or lumbar spine BMD following progressive resistance training in men and/or women ≥ 65 years of age were included. A random-effects meta-analysis and meta-regression determined the effects of resistance training and the individual training characteristics on the percent change (∆%) in muscle strength (standardized mean difference) and BMD (mean difference). The quality of the evidence was assessed using the Cochrane risk-of-bias tool (version 2.0) and Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria.
Results
Seven hundred and eighty studies were identified and 14 were included. Progressive resistance training increased muscle strength (∆ standardized mean difference = 1.1%; 95% confidence interval 0.73, 1.47; p ≤ 0.001) and femur/hip BMD (∆ mean difference = 2.77%; 95% confidence interval 0.44, 5.10; p = 0.02), but not BMD of the lumbar spine (∆ mean difference = 1.60%; 95% confidence interval − 1.44, 4.63; p = 0.30). The certainty for improvement was greater for muscle strength compared with BMD, evidenced by less heterogeneity (I2 = 78.1% vs 98.6%) and a higher overall quality of evidence. No training characteristic significantly affected both outcomes (p > 0.05), although concomitant increases in strength and BMD were favored by higher training frequencies, increases in strength were favored by resistance only and higher volumes, and increases in BMD were favored by combined resistance plus weight-bearing exercises, lower volumes, and higher loads.
Conclusions
Progressive resistance training programs concomitantly increase lower-limb muscle strength and femur/hip bone mineral density in older adults, with greater certainty for strength improvement. Thus, to maximize the efficacy of progressive resistance training programs to concurrently prevent muscle and bone loss in older adults, it is recommended to incorporate training characteristics more likely to improve BMD.
中文翻译：
渐进式抗阻训练可同时增加老年人的肌肉力量和骨矿物质密度：系统回顾和荟萃分析
背景
老年人经历大量密切相关的肌肉和骨质流失。渐进式阻力训练计划同时逆转/减缓老年人肌肉力量和骨矿物质密度 (BMD) 与年龄相关的下降的效果仍不清楚。
目标
我们的目的是量化老年人在进行渐进式阻力训练计划后下半身肌肉力量和 BMD 的伴随变化，并确定这些变化如何受到模式（仅阻力训练与组合阻力和负重训练）、频率、训练量的影响、负载和程序长度。
方法
检索了 MEDLINE/PubMed 和 Embase 数据库，查找 2021 年 6 月 1 日之前以英文发表的文章。随机对照试验报告了男性和/或男性进行渐进抗阻训练后腿部按压或膝关节伸展一次最大重复次数以及股骨/髋部或腰椎 BMD 的变化年龄≥ 65 岁的女性也被纳入其中。随机效应荟萃分析和荟萃回归确定了阻力训练和个人训练特征对肌肉力量（标准化平均差）和 BMD（平均差）百分比变化 (Δ%) 的影响。使用 Cochrane 偏倚风险工具（2.0 版）和推荐、评估、开发和评价（GRADE）标准的分级来评估证据的质量。
结果
共确定了 780 项研究，其中 14 项被纳入。渐进阻力训练增加了肌肉力量（Δ标准化平均差 = 1.1%；95%置信区间 0.73, 1.47； p ≤ 0.001）和股骨/髋部 BMD（Δ平均差 = 2.77%；95% 置信区间 0.44, 5.10； p = 0.02），但不是腰椎的 BMD（Δ 平均差 = 1.60%；95% 置信区间 − 1.44, 4.63； p = 0.30）。与 BMD 相比，肌肉力量改善的确定性更大，异质性较小（ I 2 = 78.1% vs 98.6%）和总体证据质量较高就证明了这一点。没有任何训练特征显着影响这两个结果 ( p > 0.05)，尽管较高的训练频率有利于力量和 BMD 的同时增加，仅阻力和更高训练量有利于力量的增加，而阻力加组合有利于 BMD 的增加负重练习、较低的训练量和较高的负荷。
结论
渐进式阻力训练计划可同时增加老年人的下肢肌肉力量和股骨/髋部骨矿物质密度，从而更确定地提高力量。因此，为了最大限度地发挥渐进式阻力训练计划的功效，同时防止老年人的肌肉和骨质流失，建议纳入更有可能改善骨密度的训练特征。
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