Strength Training Intensity for Osteoporosis
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Waterloo
Must not be taking: Bone medications
Disqualifiers: Cancer, Dementia, Surgery, others
No Placebo Group
Trial Summary
What is the purpose of this trial?
Osteoporosis is a bone disease that can result in fractures, disability and an increased risk of premature death. Exercise is recommended for fall and fracture prevention, but health care professionals often recommend walking or lower intensity community exercise classes, which may not be effective for building bone. Further, individuals with osteoporosis are often told to avoid lifting or moving in certain ways, which creates fear and activity avoidance. Conversely, research suggests that to stimulate bone, you need higher loads on bone, with either higher intensity resistance training or impact exercise - the types of things people with low bone mass are told to avoid. Our study will examine different types of exercise intensity and how they translate to building bone in people with low bone mineral density (BMD).
Will I have to stop taking my current medications?
The trial requires that participants have not taken medications affecting bone health in the last 12 months. If you are currently on such medications, you may need to stop taking them to participate.
What data supports the effectiveness of the treatment Strength Training Intensity for Osteoporosis?
Research shows that high-load resistance training and power-based resistance training can improve bone mineral density (BMD) and reduce fall risk in postmenopausal women with osteoporosis. Additionally, maximal strength training has been found to enhance skeletal health by increasing bone mineral content and stimulating bone formation.12345
Is strength training generally safe for humans?
How does supervised strength training differ from other treatments for osteoporosis?
Supervised strength training is unique because it involves high-intensity exercises specifically designed to improve bone density and muscle strength, which are crucial for reducing fracture risk in osteoporosis. Unlike other treatments that may focus on medication, this approach uses physical activity to directly target bone health and muscle function.111121314
Eligibility Criteria
This trial is for individuals over 50 with low bone density or high fracture risk who have declined osteoporosis medication. Participants must be postmenopausal, willing to exercise twice weekly, and fully vaccinated against COVID-19. Those already doing similar training or with conditions affecting bone health cannot join.Inclusion Criteria
I am a woman who has been postmenopausal for 2 years or more, or this has been confirmed by a blood test.
Willing to participate in 2x weekly exercise sessions
I am at high risk for bone fractures and have chosen not to take or stopped taking osteoporosis medication.
See 4 more
Exclusion Criteria
I have a condition that affects my bone health.
I cannot communicate in English.
I have had cancer other than non-melanoma skin cancer in the last 2 years.
See 10 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants engage in supervised twice-weekly progressive resistance training at moderate or high intensity, or a home posture and balance exercise program for one year
52 weeks
104 visits (in-person for supervised groups), biweekly virtual classes for home exercise group
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Treatment Details
Interventions
- Home exercise (Exercise)
- Supervised strength training (group 1) (Behavioural Intervention)
- Supervised strength training (group 2) (Behavioural Intervention)
Trial OverviewThe study tests the effects of different exercise intensities on bone strength in people at risk for fractures due to low bone mineral density. It compares supervised strength training at two intensity levels versus home exercises.
Participant Groups
3Treatment groups
Experimental Treatment
Active Control
Group I: Supervised strength training (group 2)Experimental Treatment1 Intervention
In-person, supervised muscle strengthening exercises twice weekly at a specific intensity.
Group II: Supervised strength training (group 1)Experimental Treatment1 Intervention
In-person, supervised muscle strengthening exercises twice weekly at a specific intensity.
Group III: Home exerciseActive Control1 Intervention
Home exercise program, with biweekly group virtual education and exercise classes.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of WaterlooWaterloo, Canada
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Who Is Running the Clinical Trial?
University of WaterlooLead Sponsor
University of SaskatchewanCollaborator
University Health Network, TorontoCollaborator
Canadian Institutes of Health Research (CIHR)Collaborator
References
Impact of high-load resistance training on bone mineral density in osteoporosis and osteopenia: a meta-analysis. [2021]This study aimed to examine the effect of high-load resistance training (HLRT) on bone mineral density (BMD) in patients with osteoporosis and osteopenia using a meta-analysis.
A Randomized Clinical Trial to Evaluate the Efficacy and Safety of the ACTLIFE Exercise Program for Women with Post-menopausal Osteoporosis: Study Protocol. [2020]Osteoporosis (OP) is a systemic disease of the skeleton characterized by increased risk of fracture. There is a general consensus on the efficacy of physical activity in the prevention of bone loss, falls and fractures, but there is no agreement on the best setting to exercise. The aim of the study is to evaluate the efficacy of a 12-months exercise protocol for women with post-menopausal OP when administered as individual home training (IHT) versus gym group training (GGT). The study is a randomized trial with two parallel groups. Sedentary patients with primary post-menopausal osteoporosis are recruited at the Istituto Ortopedico Rizzoli of Bologna. In the first group, the 12-month ACTLIFE program is performed as IHT, while in the second as GGT. The program is aimed at improving joint mobility, muscle force, balance, motor coordination and endurance. The study is single blinded. Patients are assessed at baseline and after 6 and 12 months. The primary outcome is the modification of quality of life measured with the Short Osteoporosis Quality of Life Questionnaire (ECOS-16). The findings of this study will highlight advantages and disadvantages of exercising in the two different settings and provide evidence on how to increase physical activity in osteoporotic women.
Power training improves bone mineral density and fall risk for a postmenopausal woman with a history of osteoporosis and increased risk of falling: A case report. [2021]The purpose of this case study was to assess the degree to which a 12-month power-based resistance-training program improved bone mineral density (BMD) and fall risk for a 70-year-old postmenopausal woman with osteoporosis and increased risk of falling. After an eight-week strength-development phase, we had the patient perform 44 weeks of resistance training with maximal force mobilization by instructing her to complete as many repetitions as possible during each 60-s set. We used dual-energy X-ray absorptiometry (DEXA) to assess BMD and Dynamic Gait Index (DGI) to assess fall risk before and after the intervention. Post compared to pre-training testing indicated an increase in BMD in the lumbar spine (24%) and femoral neck (29%) resulting in changes in T-score of 0.7 and 0.4 SD, respectively. Testing also revealed a seven-point change in DGI which improved her status to "safe ambulator." After a 12-month period of power training, BMD was increased and fall risk was reduced for a postmenopausal woman with osteoporosis and increased risk of falling.
Maximal strength training in postmenopausal women with osteoporosis or osteopenia. [2016]Current guidelines recommend weight-bearing activities, preferably strength training for improving skeletal health in patients with osteoporosis. What type of strength training that is most beneficial for these patients is not established. Maximal strength training (MST) is known to improve 1-repetition maximum (1RM) and rate of force development (RFD), which are considered as important covariables for skeletal health. Squat exercise MST might serve as an effective intervention for patients with low bone mass. We hypothesized that 12 weeks of squat exercise MST would improve 1RM and RFD in postmenopausal women with osteoporosis or osteopenia and that these changes would coincide with improved bone mineral density (BMD) and bone mineral content (BMC), and serum markers of bone metabolism. The participants were randomized to a training group (TG, n = 10) or control group (CG, n = 11). The TG underwent 12 weeks of supervised squat exercise MST, 3 times a week, with emphasis on rapid initiation of the concentric part of the movement. The CG was encouraged to follow current exercise guidelines. Measurements included 1RM, RFD, BMD, BMC, and serum bone metabolism markers; type 1 collagen amino-terminal propeptide (P1NP) and type 1 collagen C breakdown products (CTX). At posttest, 8 participants remained in each group for statistical analyses. The TG improved the 1RM and RFD by 154 and 52%, respectively. Lumbar spine and femoral neck BMC increased by 2.9 and 4.9%. The ratio of serum P1NP/CTX tended to increase (p = 0.09), indicating stimulation of bone formation. In conclusion, squat exercise MST improved 1RM, RFD, and skeletal properties in postmenopausal women with osteopenia or osteoporosis. The MST can be implemented as a simple and effective training method for patients with reduced bone mass.
Effect of specific exercise training on bone mineral density in women with postmenopausal osteopenia or osteoporosis. [2009]To analyse the effect of a specific program of weight training exercise with closed kinetic chain in bone mineral density in postmenopausal women with osteopenia or osteoporosis.
Weightlifting, weight training and injuries. [2022]Although millions of men and women in the United States are regularly involved in some form of weightlifting, the average physician knows, and frequently cares, little about the sports involved. As a result, his or her knowledge of the medical and physiological issues involved is limited This article attempts to address this lack by beginning with a brief introductory section outlining some of the similarities differences between the major weight lifting approaches (power lifting, olympic lifting, weight training and body building). Next it reviews major issues and controversies such as age restrictions for lifters, physiological effects, drug use, potential strength gains and hypertrophy. Finally, it discusses some of the more frequent and unique injuries that can occur in lifters.
Effects of high-intensity resistance training on bone mineral density in young male powerlifters. [2019]The effects of high-intensity resistance training on bone mineral density (BMD) and its relationship to strength were investigated. Lumbar spine (L2-L4), proximal femur, and whole body BMD were measured in 10 male powerlifters and 11 controls using dual-energy X-ray absorptiometry (DXA). There were significant differences in lumbar spine and whole body BMD between powerlifters and controls, but not in proximal femur BMD. A significant correlation was found between lumbar spine BMD and powerlifting performance. These results suggest that high-intensity resistance training is effective in increasing the lumbar spine and whole body BMD.
Content Validity Index and Reliability of a New Protocol for Evaluation of Lifting Technique in the Powerlifting Squat and Deadlift. [2021]Sjöberg, H, Aasa, U, Rosengren, M, and Berglund, L. Content validity index and reliability of a new protocol for evaluation of lifting technique in the powerlifting squat and deadlift. J Strength Cond Res 34(9): 2528-2536, 2020-The aim of the study was to create a protocol to cover aspects of technique considered to be associated with risk of injury in the powerlifting squat and deadlift and to examine the content validity and reliability of the aspects included in the protocols. For the content validity investigation, a consensus group of 3 powerlifting physiotherapists identified the domains of content (risk of injury) for 2 protocols (1 for squat and 1 for deadlift) of essential aspects of lifting technique through discussions and a review of the literature. Eight selected powerlifting experts rated the relevance of each aspect in relation to risk of injury (acute or by overuse), and a quantitative estimate of the content validity of each aspect was measured through calculations of a Content Validity Index (CVI). Aspects of low content validity were discarded, and the remainders were evaluated for their inter-rater and intra-rater reliability among 4 experienced powerlifters used to coaching and evaluating powerlifting technique. The reliability was calculated and analyzed with kappa and percentage of agreement. The final protocols included 17 aspects of squat technique and 10 aspects of deadlift technique that showed good to excellent CVI and percentage of agreement between 64 and 100%. The protocols, formed in this study, will provide evidence-based recommendations on safe lifting technique for coaches and strength practitioners' to use to make relevant assessments and instructions.
Trends in strength training--United States, 1998-2004. [2022]Strength training is physical activity intended to increase muscle strength and mass. Adults who engage in strength training are less likely to experience loss of muscle mass, functional decline, and fall-related injuries than adults who do not strength train. Studies on strength-training interventions have indicated that inactive older adults who begin regular strength training achieve substantial strength gains within a few months. Because certain health benefits are linked to strength training, a national health objective for 2010 is to increase to 30% the proportion of adults who perform physical activities that enhance and maintain muscular strength and endurance on > or =2 days per week (objective 22-4). This objective is also recommended by the American College of Sports Medicine. CDC analyzed 1998-2004 data from the National Health Interview Survey (NHIS) to determine the annual prevalence of strength training among U.S. adults by age group and race/ethnicity. This report describes the results of that analysis, which demonstrated that although the national prevalence of strength training for U.S. adults increased slightly during 1998-2004, only 21.9% of men and 17.5% of women (age adjusted) in 2004 reported strength training two or more times per week. This is substantially lower than the national 2010 objective of 30% and underscores the need for additional programs to increase strength training among adults.
The Psychological Effects of Strength Exercises in People who are Overweight or Obese: A Systematic Review. [2019]Overweightness and obesity represent a high burden on well-being and society. Strength training has positive effects on body composition and metabolic health for people who are overweight or obese. The evidence for psychological effects of strength exercises is unclear.
Identifying bone mass and muscular changes. [2016]The aim of this investigation was to examine the impact of a six-month high intensity strength-training program on lumbar bone mineral density (BMD), trunk and lower limb strength in a population of Australian women aged 50 years and over. A subject pool of 44 women were recruited and randomly allocated into either strength training (n = 19) or active control (n = 25) groups. All subjects trained twice weekly in either a 50 minute supervised strength training session that progressed from 60% one repetition maximum (1RM) to 90% 1RM or a 50 minute group walk session. Measurements included a lumbar (L2-L4) BMD scan: peak isokinetic trunk strength and a dynamic 1RM squat as a measure of lower body strength. No significant group differences in lumbar BMD were evident at the completion of training. However, a significant (p
Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. [2019]To determine how multiple risk factors for osteoporotic fractures could be modified by high-intensity strength training exercises in postmenopausal women.
Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial. [2018]The aim of the LIFTMOR (Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation) trial is to determine the safety and efficacy of brief, bone-targeted, high-intensity progressive resistance training (HiPRT) with impact loading for postmenopausal women with low bone mass. Preliminary findings indicate the LIFTMOR program is safe and effective.
Musculoskeletal responses to high- and low-intensity resistance training in early postmenopausal women. [2019]The purpose of this study was to compare the effects of a high-load (80%, 1-repetition maximum (RM), 8 reps) and a high-repetition (40%, 1-RM, 16 reps) resistance training protocol on muscular strength and bone mineral density (BMD) in early postmenopausal, estrogen-deficient women. The 6-month programs were matched initially for training volume (3 sets, 3 d x wk(-1)) for 12 exercises selected to specifically load the spine and hip.