Vitamin D supplementation associated with 12-weeks multimodal training in older women with low bone mineral density: A randomized double-blind placebo-controlled trial
Introduction
Vitamin D is essential for calcium absorption in the intestine (Ba̧czyk et al., 2012; El Maghraoui et al., 2012), as well as for maintaining muscle strength and postural balance (Ba̧czyk et al., 2012; El Maghraoui et al., 2012; O'Donnell et al., 2008), and is associated with lower limb function (Bischoff-Ferrari et al., 2004). Insufficiency or deficiency of vitamin D can be associated with muscle hypotrophy and may increase the risk of falls (Glerup et al., 2000), affecting one billion people worldwide (Shinchuk and Holick, 2007). Osteoporosis and osteopenia are determined by lower bone mineral densities (BMD) (Ba̧czyk et al., 2012). Osteoporosis is considered a public health burden that is responsible for the expenditure of USD$ 73 million from 2008 to 2010 by the Brazilian Unified Health System (Moraes et al., 2014).
Falls are the main causes of unintentional injuries (Edgren et al., 2019), and a major risk factor for fractures in older women with bone loss (El Maghraoui et al., 2012). Predisposing factors for falls are muscle weakness and increased center of gravity oscillation due to loss of sensorimotor control (Nikander et al., 2010). Falls in the older adults are associated with higher morbidity and mortality, disability, hospitalization, institutionalization and excessive utilization of social and health services (Mishra et al., 2011).
Resistance exercise is considered one of the best non-pharmacological interventions to stimulate bone formation and muscle strength (Karinkanta et al., 2007; Young et al., 2007). However, it is not known if individuals with vitamin D insufficiency have the same capacity to benefit from resistance exercise as compared to subjects with normal vitamin D levels. Regarding postural balance, sensory motor training is the best exercise modality for reducing the risk of falls.
Uusi-Rasi et al. (2015b) raises important considerations in the study design of randomized clinical trials on the effect of vitamin D on falling. In a 2-year randomized, double-blind, placebo-controlled vitamin D and open exercise trial (Uusi-Rasi et al., 2015a), they found that the rate of injurious falls and injured fallers more than halved with strength and balance training in home-dwelling older women, while neither exercise nor vitamin D affected the rate of falls and describe the importance of future research to determine the role of vitamin D in the enhancement of strength, balance, and mobility. Multimodal training program associated with Vitamin D among older women has been used in many study's in a Finland group (Karinkanta et al., 2007; Uusi-Rasi et al., 2012, Uusi-Rasi et al., 2015a, Uusi-Rasi et al., 2017). Also in a recent study (Daly et al., 2020) with 12-month supervised multimodal training program for older adults they found that the multimodal training program can effectively improve multiple musculoskeletal and functional outcomes in older adults and that these benefits can be sustained over a 6-month. Multimodal exercise programs (i.e., including both resistance and sensory-motor exercise) has become important for this population. Since there is no consensus regarding vitamin D supplementation association for muscle strength preservation/gain and postural balance, there is need for research to better understand the role of vitamin D in muscle performance and postural balance that would help in prevention strategies.
This study aimed to evaluate the influence of vitamin D supplementation associated with a multimodal exercise program on postural balance and muscle strength in older women with both low bone mineral density and vitamin D insufficiency.
Section snippets
Experimental design, local and ethics
A 12-week double-blind, randomized, parallel-group, placebo-controlled trial was conducted between December 2017 and February 2019 in XXXX, according to the guidelines of the Consolidated Standards of Reporting Trials (CONSORT).
The study was performed at the Motion Study Laboratory of the Institute of Orthopedics and Traumatology, XXXX School of Medicine and was approved by the Local Ethics Committee of the University XXX (number 306/15) (registered at clinicaltrials.gov as NCT XXXX) and all of
Results
The flowchart of participants is shown in Fig. 1. A total of 422 subjects were screened for participation and 46 met the inclusion criteria.
No differences between the two groups were detected in any of the main characteristics of the participants at baseline (Table 1).
During the intervention, the vitamin D levels increased from 22.9 (±5.6; CV = 24.3) ng/mL from baseline to 63.9 (±19.1) (min 29.8; CV = 82.7) ng/mL post-treatment at in the EG (P < 0.001). In the CG, the baseline vitamin D level
Discussion
The main findings of the present study are that there was an improvement in postural balance and muscle strength with a multimodal exercise program, independent of vitamin D supplementation.
The hypothesis of this study was not confirmed. We were expecting that vitamin D supplementation combined with exercise would improve muscle strength and postural balance to a greater extent than the CG. Thus, it could be expected in EG, a gain in muscle strength and maintenance of muscle function, by the
Conclusion
Vitamin D supplementation combined with multimodal exercise program did not improve muscle strength and postural balance in older women with low bone mineral density and insufficiency vitamin D to a greater extent than multimodal exercise alone.
Declaration of competing interest
The authors have nothing to declare.
Acknowledgments
We would like to thank the Anima Institute, Brazil. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.
References (41)
- et al.
Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged ≥60 y
Am. J. Clin. Nutr.
(2004) - et al.
The effects of motor learning on clinical isokinetic performance of postmenopausal women
Maturitas
(2011) - et al.
Evaluation of the association between osteoporosis and postural balance in postmenopausal women
Gait Posture
(2013) - et al.
Serum 25-hydroxyvitamin D levels are associated with functional capacity but not with postural balance in osteoporotic postmenopausal women
Clinics
(2017) - et al.
Efficacy of food fortification on serum 25-hydroxyvitamin D concentrations: systematic review
Am. J. Clin. Nutr.
(2008) - et al.
Multifactorial analysis of risk factors for reduced bone mineral density among postmenopausal women
Arch. Med. Sci.
(2012) - et al.
Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial
J. Bone Miner. Res.
(2003) - et al.
Is fall prevention by vitamin D mediated by a change in postural or dynamic balance?
Osteoporos. Int.
(2006) - et al.
Effects of vitamin D3 supplementation on muscle strength, mass, and physical performance in women with vitamin D insufficiency: a randomized placebo-controlled trial
Calcif. Tissue Int.
(2018) - et al.
Correlation of postural balance and knee muscle strength in the sit-to-stand test among women with and without postmenopausal osteoporosis
Osteoporos. Int.
(2013)
Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects
Exp. Gerontol.
Effect of isolated vitamin D supplementation on the rate of falls and postural balance in postmenopausal women fallers: a randomized, double-blind, placebo-controlled trial
Menopause
1,25(OH)2-vitamin D3 induces translocation of the vitamin D receptor (VDR) to the plasma membrane in skeletal muscle cells
J. Cell. Biochem.
Exercise and physical activity for older adults
Med. Sci. Sports Exerc.
Calcium uptake by sarcoplasmic reticulum of muscle from vitamin D-deficient rabbits
Nature
Effects of a 12-month supervised, community-based, multimodal exercise program followed by a 6-month research-to-practice transition on bone mineral density, trabecular microarchitecture, and physical function in older adults: a randomized controlled trial
J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res.
Counselling for physical activity, life-space mobility and falls prevention in old age (COSMOS): protocol of a randomised controlled trial
BMJ Open
Hypovitaminosis D and prevalent asymptomatic vertebral fractures in Moroccan postmenopausal women
BMC Womens Health
Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement
Calcif. Tissue Int.
A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial
Osteoporos. Int.
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