SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Exercise Physiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1589200
This article is part of the Research TopicAcute and Chronic Physiological Adaptations to Resistance Exercises Across Various Populations: Mechanisms and Practical ApplicationsView all 12 articles
Optimization of High-Intensity Resistance Exercise Protocols for Improving Bone Mineral Density in the Elderly Without Chronic Diseases: A systematic review and network meta-Analysis
Provisionally accepted
- 1Beijing Institute of Technology, Beijing, Beijing Municipality, China
- 2Capital Institute of Physical Education and Sports, Beijing, Beijing, China
- 3Jiangsu University of Technology, Changzhou, Jiangsu, China
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Objective: This study aims to explore the effects of high-intensity resistance exercise (HIRE) protocols on improving bone mineral density (BMD) in the elderly without chronic diseases by using a forest plot and network meta-analysis.Methods: A systematic search was performed across seven databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wan Fang and VIP), to investigate the effects of HIRE on BMD in the elderly by December 9, 2024. The search strategy incorporated Boolean operators (AND, OR, NOT) to refine the selection of relevant studies. The methodological quality was assessed by using Risk of Bias tool 2 and Tool for the Assessment of Study Quality and Reporting in Exercise, and data analysis was performed using Stata 17.Results: A total of 13 RCTs involving 589 participants were included. Among the various HIRE protocols, two demonstrated positive effects on lumbar spine and whole-body BMD, while four were positive in improving femoral neck BMD compared to the control group. The network meta-analysis revealed that 2M(9-10) was more effective than 1M(6-8) in improving lumbar spine BMD (SMD = 1.16, 95% CI: 0.11 to 2.22) and also superior to 3M(6-8) in enhancing whole-body BMD (SMD = 0.86, 95% CI: 0.00 to 1.72). However, no significant differences were observed among the HIRE protocols for femoral neck BMD. According to the SUCRA rankings, 2M(9-10) was the most effective protocol for improving lumbar spine (93.6%) and whole-body BMD (94.9%), while 2M(6-8) ranked highest for femoral neck BMD improvement (74.8%).Conclusion: HIRE protocol is critical to ensure BMD improvement for elderly without chronic diseases, and not all HIRE protocols yield positive effects on BMD. A twice-weekly, multiple-set regimen may be more beneficial for improving lumbar spine, whole-body, and femoral neck BMD in the elderly, with the number of repetitions per set may vary depending on the targeted bone area.
Keywords: Resistance exercise, Resistance Training, strength, Elderly, bone mineral density, osteopenia, network, Meta-analysis
Received: 07 Mar 2025; Accepted: 07 May 2025.
Copyright: © 2025 Cheng, Yi, Bo, Mao and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yue Yi, Beijing Institute of Technology, Beijing, 100081, Beijing Municipality, China
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