Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies

Setor K Kunutsor; Sarah Leyland; Dawn A Skelton; Laura James; Matthew Cox; Nicola Gibbons; Julie Whitney; Emma M Clark

doi:10.22540/JFSF-03-155

Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies

J Frailty Sarcopenia Falls. 2018 Dec 1;3(4):155-178. doi: 10.22540/JFSF-03-155. eCollection 2018 Dec.

Authors

Setor K Kunutsor^{1

2}, Sarah Leyland³, Dawn A Skelton⁴, Laura James⁵, Matthew Cox⁵, Nicola Gibbons⁵, Julie Whitney⁵, Emma M Clark⁶

Affiliations

¹ National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, UK.
² Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK.
³ National Osteoporosis Society, Camerton, Bath, UK.
⁴ School of Health & Life Sciences, Centre for Living, Glasgow Caledonian University, Glasgow.
⁵ Department of Academic Physiotherapy, King's College London, London, UK.
⁶ Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK.

Abstract

Objectives: We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews.

Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates.

Results: For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention.

Conclusion: Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551.

Keywords: Adverse events; Exercise; Osteoporosis; Physical activity; Systematic review.

Publication types

Review