One exercise for weight loss and fragile bones — is it really that simple?

Aim of the study: Type 2 diabetes mellitus (T2DM) is associated with an increased fracture risk. Weight loss in T2DM management may result in lowering of bone mass. In this systematic literature review, we aimed to investigate how exercise affects bone health in people with T2DM. Furthermore, we examined the types of exercise with the potential to prevent and treat bone fragility in people with T2DM.

Results: Exercise differs in type, mechanical load, and intensity, as does the osteogenic response to exercise. Aerobic exercise improves metabolic health in people with T2DM. However, the weight-bearing component of exercise is essential to bone health. Weight loss interventions in T2DM induce a loss of bone mass that may be attenuated if accompanied by resistance or weight-bearing exercise. Combination of weight-bearing aerobic and resistance exercise seems to be preventive against excessive bone loss in people with T2DM. However, evidence is sparse and clinical trials investigating the effects of exercise on bone health in people with T2DM are warranted.

Aim of the study: Osteoporosis is a major public health problem that is characterized by low bone mass and increased susceptibility to fractures, primarily of the hip, spine, and wrist. It is estimated to cause 1.5 million fractures annually in the United States in people aged 50 yr and older.

Results: Over the past 10 years, nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density. Conversely, a handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used. High-intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit of influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass.

Aim of the study: Atherosclerosis is a chronic inflammatory disease associated with an elevation of inflammatory markers such as CRP -- a robust predictor of cardiovascular events. Inflammation also plays a pivotal role in the pathogenesis of osteoporosis.

Results: The different components of the metabolic syndrome are at the same time well-established risk factors for osteoporosis. Physical training, weight loss, and a Mediterranean-style diet all have a proven cytokine-lowering effect. Contrary to muscle mass, adipose tissue if at all contributes only marginally to the preservation of bone. As a consequence, increasing lean body mass while reducing fat mass seems to be the most effective way to prevent both atherosclerosis and osteoporosis.

Aim of the study: The overall role of exercise as an integral part of osteoporosis prevention and treatment remains unclear and controversial.

Results: The overall role of exercise as an integral part of osteoporosis prevention and treatment remains unclear and controversial. Comparatively well accepted are the facts that disuse results in bone mass loss, that sedentary individuals in general have less bone mass than exercising individuals (from cross-sectional study data), that exercise may produce a modest increase in bone mass (from longitudinal study data), and that exercise cannot compensate for estrogen loss. However, numerous questions regarding exercise and the skeleton remain to be answered, such as how the apparent osteogenic effect of exercise is mediated, what is the relationship of exercise in reducing fractures, how to reconcile the discrepancy between exercise-induced bone mass gain (lesser) and disuse bone loss (greater).

Aim of the study: Physical activity is widely recognized as a fundamental component of health promotion and chronic disease prevention. Historically the focus has primarily been on aerobic exercise, while resistance training has received comparatively less attention.

Results: However, only approximately one-quarter of adults in the United States meet these recommendations, despite nearly half achieving recommended levels of aerobic activity alone. Although any form of physical activity can confer health benefits, participation in both aerobic exercise and muscle-strengthening, such as resistance training, produces more comprehensive and substantial health outcomes. As research on resistance training has evolved beyond its traditional focus on athletic performance, a growing body of evidence has demonstrated its effectiveness in the prevention and management of numerous chronic conditions. This narrative review summarizes the role of resistance training in the prevention and management of several prevalent lifestyle-related chronic conditions, including type 2 diabetes, obesity, hypertension, cardiovascular disease, dyslipidemia, and osteoporosis.