The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis
- 688 Downloads
Certain cancer treatments are associated with bone loss and increased fracture risk. Weight-bearing impact exercise, resistance training or the combination, are recommended to preserve or improve bone mineral density (BMD) inhealthy older adults, but their efficacy in cancer survivors is less well understood. The aim of this systematic review with meta-analysis of randomised control trials (RCT) was to review the evidence regarding the role of exercise to counteract cancer treatment-induced bone loss.
Four databases were searched systematically with 12 RCTs of at least 6-month duration investigating the effects of exercise on BMD compared to a control group in adult cancer survivors identified.
Meta-analysis was completed using available data from six studies enrolling 814 participants, with lumbar spine, femoral neck and/or total hip BMD as the primary outcome measures. Overall, there was no significant benefit of exercise compared to controls on BMD at the lumbar spine (0.0071 g/cm , 95% CI −0.0002 to 0.0145, p = 0.057), femoral neck (0.0044 g/cm , 95% CI −0.0005 to 0.0093, p = 0.077), or total hip (0.0024 g/cm , 95% CI −0.0038 to 0.0086, p = 0.443). Subgroup analysis revealed a positive effect on lumbar spine BMD in three studies implementing a combined resistance and impact exercise intervention (0.015 g/cm , 95% CI 0.003 to 0.028, p = 0.019).
From the evidence available, exercise may not be sufficient to improve bone health in cancer survivors, but given the heterogeneity in the participant characteristics and several exercise programs which may not have been designed to specifically optimise bone health, these findings should be interpreted with caution.
KeywordsBone mineral density Cancer Exercise Meta-analysis
Compliance with ethical standards
Conflicts of interest
- 4.Gardner JR, Livingston PM, Fraser SF (2014) Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol Off J Am Soc Clin Oncol 32(4):335–346. https://doi.org/10.1200/JCO.2013.49.5523 CrossRefGoogle Scholar
- 13.Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097Google Scholar
- 14.Higgins JPT, Green S (editors) The Cochrane Collaboration (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. Available from www.cochrane-handbook.org.Google Scholar
- 17.Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, Chung GG, Jones B, Knobf MT, DiPietro L (2009) Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring, Md) 17(8):1534–1541. https://doi.org/10.1038/oby.2009.18 CrossRefGoogle Scholar
- 18.Waltman NL, Twiss JJ, Ott CD, Gross GJ, Lindsey AM, Moore TE, Berg K, Kupzyk K (2010) The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial. Osteoporos Int 21(8):1361–1369. https://doi.org/10.1007/s00198-009-1083-y CrossRefPubMedGoogle Scholar
- 19.Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, Schwartz A (2011) Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat 127(2):447–456. https://doi.org/10.1007/s10549-011-1444-z CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Saarto T, Sievänen H, Kellokumpu-Lehtinen P, Nikander R, Vehmanen L, Huovinen R, Kautiainen H, Järvenpää S, Penttinen HM, Utriainen M, Jääskeläinen AS, Elme A, Ruohola J, Palva T, Vertio H, Rautalahti M, Fogelholm M, Luoto R, Blomqvist C (2012) Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial. Osteoporos Int 23(5):1601–1612CrossRefGoogle Scholar
- 21.Winters-Stone KM, Dobek J, Nail LM, Bennett JA, Leo MC, Torgrimson-Ojerio B, Luoh SW, Schwartz A (2013) Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial. Osteoporos Int 24(5):1637–1646. https://doi.org/10.1007/s00198-012-2143-2 CrossRefPubMedGoogle Scholar
- 23.Winters-Stone KM, Laudermilk M, Woo K, Brown JC, Schmitz KH (2014) Influence of weight training on skeletal health of breast cancer survivors with or at risk for breast cancer-related lymphedema. J Cancer Surviv 8(2):260–268. https://doi.org/10.1007/s11764-013-0337-z CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Uth J, Hornstrup T, Christensen JF, Christensen KB, Jørgensen NR, Schmidt JF, Brasso K, Jakobsen MD, Sundstrup E, Andersen LL, Rørth M, Midtgaard J, Krustrup P, Helge EW (2016) Efficacy of recreational football on bone health, body composition, and physical functioning in men with prostate cancer undergoing androgen deprivation therapy: 32-week follow-up of the FC prostate randomised controlled trial. Osteoporos Int 27(4):1507–1518CrossRefGoogle Scholar
- 27.Thomas GA, Cartmel B, Harrigan M, Fiellin M, Capozza S, Zhou Y, Ercolano E, Gross CP, Hershman D, Ligibel J, Schmitz K, Li F-Y, Sanft T, Irwin ML (2017) The effect of exercise on body composition and bone mineral density in breast cancer survivors taking aromatase inhibitors. Obesity 25(2):346–351. https://doi.org/10.1002/oby.21729 CrossRefPubMedGoogle Scholar