Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity: A systematic review and meta-analysis

• 作者: Jakub Mesinovic Paul Jansons Ayse Zengin Barbora de Courten Alexander J.Rodriguez Robin M.Daly Peter R.Ebeling David Scott
• 来源期刊: 运动与健康科学（英文版）
• 年，卷（期）: 2021,（5）
• 所属期刊栏目: Reviews
• 页码范围: 550-559
• 页数: 10页
• 语种: 英文

摘要

Background:Weight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity;however, weight loss can also result in bone loss and increased fracture risk. Weight-loss-induced bone loss may be attenuated with exercise. Our aim was to compare changes in bone mineral density (BMD) in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise. Methods:We included randomized controlled trials (RCTs) in adults with overweight or obesity (aged≥18 years;body mass index≥25 kg/m2) that prescribed diet-induced weight loss alone or in combination with supervised exercise, and measured any bone structural parameters. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random-effects meta-analyses determined mean changes and net mean differences (95％confidence intervals (95％CIs)) in the percentage of areal BMD (aBMD) change between groups. Results: We included 9 RCTs. Diet-induced weight loss led to significant losses in femoral neck aBMD (mean change: -1.73％ (95％CI:-2.39％to-1.07％), p<0.001) and total hip aBMD (-2.19％(95％CI:-3.84％to-0.54％), p=0.009). Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group (net difference:-0.88％(95％CI: -1.73％ to -0.03％)); however, there were no differences in aBMD changes at any other skeletal site: total hip (-1.96％ (95％CI:-4.59％to 0.68％)) and lumbar spine (-0.48％(95％CI:-1.81％to 0.86％)). aBMD changes did not differ significantly according to exercise modality (resistance exercise, aerobic exercise, or a combination of the two) during diet-induced weight loss. Conclusion:Diet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise. Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss. The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions. Additional RCTs with appropriate, targeted exercise interventions should be conducted.