Section 4: What about walking? Copy

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Conflicting reviews on walking benefits

Cochrane Review: Exercise for preventing and treating osteoporosis in postmenopausal women (Bonaiuti et al., 2002; Bonaiuiti et al., 2009)

3 studies utilizing walking programs
comparison to control groups
walking program: high intensity, 3x/wk, 30-45 minutes
analyzed results showed walking to have a positive effect on the BMD of spine 1.31[95%CI (-0.03 to 2.65)] and the hip 0.92 [95%CI(0.21 to1.64)]

Author’s conclusion: Walking resulted in statistically significant improvements of BMD in lumbar spine and hip. The authors suggest that this program may be easiest, simplest and best program for implementation long-term.

Meta-analysis of walking for preservation of bone mineral density in postmenopausal women (Martyn-St James et al., 2008)

Meta-analysis carried out in line with Cochrane Collaboration guidelines
8 walking studies reviewed – 5 RCT studies and 3 non-randomized trials
All utilized control groups
Walking program amongst 8 studies varied (self-paced, brisk pace, pace based on heart rate, treadmill walking & outdoor walking)
8 showed relative change in lumbar spine BMD of 0.39%
5 studies examined femoral neck BMD – a relative change of 0.35%

Author’s conclusions: walking as a singular exercise intervention is not sufficient to preserve BMD at the spine or hip in post-menopausal women. The effects on BMD may be clinically too small to impact reduction of fractures.

Points to Ponder

Is improving BMD the only reason you would consider prescribing walking for your client? If you review research of the effect of prescription medications on BMD, the reports often demonstrate small changes in BMD but large increases in fracture risk reduction percentage. What does this suggest about focusing on BMD changes as the ultimate indicator of an intervention’s success?

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References

Bonaiuti, D., Shea, B., Iovine, R., Negrini, S., Robinson, V., Kemper, H. C., et al. (2002). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev(3), CD000333.

Bonaiuti, D., Shea, B., Iovine, R., Negrini, S., Welch, V., Kemper, H.H.C.G., Wells, G.A., Tugwell, P., Cranney, A. (2009). Exercise for preventing and treating osteoporosis in postmenopausal women (Review). Cochrane Database Syst Rev, 1, 1-40.

Martyn-St James, M., & Carroll, S. (2008). Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone, 43(3), 521-531.