BONE HEALTH, MUSCLE STRENGTH AND LEAN MASS: RELATIONSHIPS AND EXERCISE RECOMMENDATIONS

Pimenta, Luciana Duarte; Massini, Danilo Alexandre; Santos, Daniel dos; Vasconcelos, Camila Midori Takemoto; Simionato, Astor Reis; Gomes, Larissa Aparecida Takehana; Guimarães, Bianca Rosa; Neiva, Cassiano Merussi; Pessôa, Dalton Muller

doi:10.1590/1517-869220192503210258

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Revista Brasileira de Medicina do Esporte

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REVIEW ARTICLE, PHYSIOLOGY • Rev Bras Med Esporte 25 (3) • May-Jun 2019 • https://doi.org/10.1590/1517-869220192503210258 copy

BONE HEALTH, MUSCLE STRENGTH AND LEAN MASS: RELATIONSHIPS AND EXERCISE RECOMMENDATIONS

SAÚDE ÓSSEA, FORÇA MUSCULAR E MASSA MAGRA: RELAÇÕES E RECOMENDAÇÕES DE EXERCÍCIOS

SALUD ÓSEA, FUERZA MUSCULAR Y MASA MAGRA: RELACIONES Y RECOMENDACIONES DE EJERCICIOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Although muscle strength, lean mass and bone mineral content/density (BMC/BMD) are consistently reported as major outcomes of resistance training (RT), there is still no agreement on the RT regimen that is capable of achieving this result in men and women of different ages. This study describes the effects of RT on muscle strength, lean mass and bone mineralization, highlighting the relationships between them and analyzing the effectiveness of the RT protocol. Information searches were conducted in open access online academic libraries, using the BMC/BMD indices combined with muscle strength, body composition, and resistance exercises. The results showed changes in BMC/BMD in 72% of the studies published in the last decade. Among these, 77% recommended loads ≥ 80% 1-RM, 61% involved older individuals (> 60 years) and 61% had planning protocols of between 3 and 5 months (~12-20 weeks). The results also highlight muscle strength as a promising index of variations in BMC/BMD, with a moderate to high level of association (r²>0.5), which are specific for men and women in relation to the body region with best responsiveness. Among the studies published in last decade, about 61% had protocols involving only RT, and of these, 82% observed combined changes in BMC/BMD, body composition and muscle strength. This review therefore concludes that RT is important for improving muscle strength, increasing lean mass (whole-body and regional) and preventing risk factors that could impair the mineral integrity of the bone tissue, in individuals of all ages and sexes. Level of Evidence I; Systematic review of Level I RCTs (and study results were homogenous).

Bone density; Exercise; Body composition; Young adult; Aged; Sex factors

Study	Variables	RT Protocol	Participants	Results
Cunha et al. (2018)²⁰	Whole-body BMD	RT: 1 set vs. 3 sets, 10-15 RM, 1-2 min. rest between sets, 3 weekly sessions for 12 weeks. Progression: 2-5% and 5-10% for UL and LL*.	62 Women (osteosarcopenic) 68.0 ± 4.3 years	None of the ST protocols altered whole-body BMD.
Huovinen et al. (2016)²¹	Hip, femoral neck e trochanteric BMD	RT: 3 sets, 8-15 repetitions, 50-85% 1RM, 3 weekly sessions for 16 weeks	37 Women between 68-78 years (low strength fitness)	Alteration of 6% hip BMD, by the change 10.7% inter-trochanteric BMD.
Watson et al. (2015)²²	Whole-body, lumbar and femoral neck BMD	RT: 5 sets, 5 repetitions, 80-85% 1RM, 2 weekly sessions for ~32 weeks + impact exercises.	28 Womens > 60 years (T-score < -1,0 hip/vertebrae)	Alteration of 0.3% and 1.6% BMD femoral neck and hip in group ST.
Villareal et al. (2017)⁷	Whole-body, lumbar e hip BMD	RT in progression of 1-3 sets, 65-85% 1RM, 3 weekly sessions for 26 weeks.	141 (Men ~35%; and Women ~65%) > 65 years (~4% blacks e ~31% Hispanics)	Non-significant changes in BMD.
Beavers et al., (2017)²³	Lumbar, left hip, femoral neck, and trochanter BMD	RT: 3 sets, 70% 1RM, 10 repetitions, 3 weekly sessions for ~20 weeks.	123 (Men ~33%; and Women ~67%) 65-79 years (~81% white), osteopenia in ~53%	Alteration of hip and femoral neck BMD in ST group + Diet.
Petersen et al. (2017)²⁴	Arms, legs, vertebrae and pélvis BMD	RT: 1 set, ~100 repetitions (4-5 min. exercise), 20% 1RM, 2 weekly sessions for 12 week + 1 session for another 12 weeks.	20 (6 Men e 14 Women) between 28-63 years	Alteration of BMD: 4% arms, 8% legs, 6% pelvis e 4% vertebrae.
Stunes et al. (2017)²⁵	Whole-body, lumbar, hip and femoral neck BMD	RT: 2 weekly sessions with 8-10 RM (rest: 1 min.) + 1 session 3-5 RM (rest: 2 min.) ou 13-15 RM (rest: 45s), for 12 weeks.	35 Men > 60 years	Alterations in lumbar and hip BMD in the group without supplementation of vitamins C + E.
Bolam et al. (2015)²⁶	Lumbar, hip and femoral neck BMD	RT: 2 sets, 12 repetitions with 60% 1RM, 2 weekly sessions + 2 sessions of impact exercises (different volumes) for ~ 36 weeks.	42 Men ≥ 50 years	Non-significant BMD changes in relation to the control group.
Hinton et al. (2015)²⁷	Whole-body, lumbar and hip BMD	RT: 6-week cycles, progressing every two weeks: 3-5 sets, 3-10 repetitions, 50-90% 1RM, 2 weekly sessions, for 12 months.	38 Men between 25-60 years	Alteration in whole-body (0.6%), lumbar (1.3%) and hip (0.8%) BMD in 6 months.
Cunha et al. (2015)²⁸	Whole-body, arms, legs and trunk BMC	RT: 3 sets, 15 repetitions with 60% 1RM, 3 weekly sessions for 12 weeks. Load progression (70-80% 1RM, 6-12 repetitions), every 4 weeks.	18 Boys aged 10-12 years	Changes in whole-body, arms, legs and trunk BMC with greater effect in the ST group
Mosti et al. (2014)²⁹	Lumbar and hip BMD	RT: 4 sets, 3-5 repetitions with 85-90% 1RM (rest: 2-3 min.), 3 weekly sessions for 12 weeks.	29 Women 18 - 27 years	Alterations in lumbar and hip BMD of 2.2% and 1%.

Study	Variables	RT Protocol	Participants	Results
Romero-Arenas et al. (2013)³⁰	Whole-body BMD	RT: 2 weekly sessions, 1-3 sets (rest: 3 min.), 12, 10 and 6 maximal repetitions (~ 50-75% 6RM and 85-90% 1RM), 2 blocks of 3 exercises (rest: 5 min pause), for 12 weeks. Traditional and Circuit-trainning.	35 Men and Women 55-75 years	Alteration of Whole-body BMD 1.1% and 1.2% for Traditional ST and Circuit-training.
Bemben & Bemben (2011)³¹	Whole-body, lumbar and hip BMD, femoral neck and trochanter BMD	RT: 2 and 3 weekly sessions, 3 sets, 8 repetitions with 80% 1RM and 3 sets, 16 repetitions with 40% 1RM, for 40 weeks.	45 Men e 79 Women betweens 55-74 years	Alterations in lumbar BMD 1.2% (2 sessions 80% 1RM) and trochanter BMD 1.5% (3 sessions 40% 1RM)
Almstedt et al. (2011)³²	Hip and lumbar BMD	RT: 3 weekly sessions with 67-95% 1RM (multi-joint exercises) combined with 67-80% 1RM (supplementary exercises), for 24 weeks.	29 Men and Women between 18-23 years	Alterations between 2.7% to 7.7% BMD in Men. In women, BMD changed -0.8 to 1.5%.
Marques et al. (2011)⁴	Hip, femoral neck, trochanter and inter-trochanteric BMD	RT: 3 weekly sessions, 2 sets with 50-60% 1RM (10-15 repetitions), progressing after 2 weeks 75-80% 1RM (6-8 repetitions), for 32 weeks.	71 Women between 60-95 years	Alterations of 2.9% and 1.5% BMD of the trochanter and hip for the ST group.
Liang at al. (2011)³³	Whole-body, lumbar, hip, femoral neck, trochanter, triangle Ward arms and legs BMD	RT: 3 weekly sessions, 1-3 sets, 8-15 repetitions, 65-80% 1 RM, for ~ 48 weeks (12 months).	51 Women between 20-35 years	Non-significant changes in the BMD sites of the ST group.
Vani et al. (2010)³⁴	Lumbar and right femoral neck BMD	RT: 3 weekly sessions, 3-4 series, 6-20 maximum repetitions, linear or wave progression, for 28 weeks.	30 Women between 35-44 years	Non-significant changes in the BMD sites of both ST groups.
Warren et al. (2008)³⁵	Lumbar, femoral neck, and trochanter BMD	RT: and weekly sessions, 3 sets of 8-10 repetitions, with intensity progression every 2 weeks, for ~ 96 weeks (2 years).	148 Women between 24-44 years	No effect on BMD, only on femoral neck BMC (+ 1.5%) throughout the intervention.

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[1] Correspondence: Dalton Muller Pessôa Filho Universidade Estadual Paulista - UNESP. Av. Engº Luiz Edmundo Carrijo Coube, s/n., Bauru, Sao Paulo, SP, Brazil.17033-360. dmpf@fc.unesp.br