A Systematic Review and Meta-Analysis to Examine the Effectiveness of Exercise Training in People With Osteoporosis or Osteopenia Compared to Other Rehabilitation Interventions on Fear of Falling and the Number of Falls.

Background and purpose: Fear of falling (FoF) and falls are significant concerns for community-dwelling older adults with osteoporosis or osteopenia, leading to decreased mobility and quality of life. Despite evidence suggesting the benefits of exercise training, its specific effects on the FoF and number of falls (NoF) in this population are not well-documented. This study aims to appraise research evidence on the effects of exercise training, including balance, resistance, and aerobic exercises, on the FoF and NoF in community-dwelling older adults with osteoporosis or osteopenia.

Methods: A comprehensive search was conducted on scientific databases, including EMBASE, MEDLINE, PEDRO, the Cochrane Library, Psych INFO, CINHAL, and Google Scholar, to identify relevant articles. Randomized controlled trials written in English and focusing on exercise training in older adults with osteoporosis or osteopenia were considered for inclusion in this study. Two independent authors conducted screening and reviewed articles. They extracted pertinent information, including authors' names, publication year, sample characteristics, intervention and comparison groups details, the FoF and NoF outcomes, intervention duration and dosage, and follow-up periods. We used the Cochrane Risk of Bias tool (RoB2) for the risk of bias assessment and the GRADE approach to evaluate the quality of evidence for each outcome. We calculated standardized mean difference, Incidence Rate Ratio, and 95% confidence intervals for the quantitative synthesis of the FoF and NoF.

Results and discussion: We included 14 randomized controlled trials (8 for FoF, 5 for the NoF, and 1 with both outcomes) with 2797 participants. All studies but one (with some risk) had a high risk of bias. The primary sources of bias in the included studies were the measurement of outcomes and selective reporting of results. Meta-analyses demonstrated that exercise training including balance, resistance, and aerobic exercises reduced FoF measured using the Fall Efficacy Scale International (overall effect size: -2.15, 95% CI = -3.16 to -1.15, Z = -4.2, P = .001, and I2 = 0.97) and NoF (IRR = 0.46, 95% CI: 0.14 to 0.78, Z = 2.79, P = .012, and I2 = 96%) significantly. Exercise training may effectively reduce the FoF and fall incidence in patients with osteoporosis or osteopenia. However, the considerable variability, high risk of bias, and methodological limitations in most studies underscored the critical need for high-quality studies to inform evidence-based guidelines, optimize intervention protocols, and establish these programs' long-term effects and sustainability.

Conclusion: Our study highlighted that exercise training including balance, resistance, and aerobic exercises can significantly decrease the FoF and NoF in older adults with osteoporosis or osteopenia. This issue supports the inclusion of tailored exercise prescriptions within fall prevention strategies for this group. Future research should aim to standardize these exercise interventions to enhance their effectiveness.