Mind–Body Exercise Helps Bone Mineral Density in Lumbar Spine and Femoral Neck

Exercise slows bone loss and increases bone density in people at risk for osteoporosis, but which exercises are most effective are unclear. Investigators sought the answer.

Mind–body exercise may be the most effective exercise to increase bone mineral density (BMD) of the lumbar spine and femoral neck, while resistance training may be the best type for total hip BMD among patients with osteoporosis and osteopenia. These findings were published in the Journal of Clinical Nursing.

Researchers conducted a systematic review and network meta-analysis (NMA) after searching English and Chinese databases from inception to February 2020 for exercise treatments for osteoporosis and osteopenia. English databases included PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL, Rehabilitation & Sports Medicine Source, and SCOPUS. Chinese databases included CNKI, Wanfang, and VIP.

A total of 97 studies were included in the network analysis, of which 32 were in  English and 65 were in Chinese.

Analysis of BMD  of the lumbar spine included 79 studies with 6912 participants. The NMA indicated that aerobic exercise (mean difference [MD] = 0.05; 95% CI, 0.02-0.07), resistance exercise (MD = 0.07; 95% CI, 0.03-0.11), combined exercise (MD = 0.04; 95% CI, 0.01-0.07), and mind–body exercise (MD = 0.12; 95% CI, 0.08-0.16), but not whole-body vibration, were effective for increasing lumbar spine BMD vs no exercise. According to the surface under the cumulative ranking curve score (SUCRA), mind–body exercise was the most effective type for improving BMD of the lumbar spine (SUCRA = 98.9)

“Mind-body exercise requires the body to take a half-squatting posture for practice, and constantly control the stability of the body posture,” the researchers explained, citing traditional Chinese sports such as Tai Chi, Wuqinxi, and Qigong as examples. “Therefore, long-term exercises will cause stress changes on the subjects’ lumbar spine and proximal femur, increase bone mass, and then have an impact on bone density.” Mind-body exercises also focus on “interactions among the brain, body, mind, and behavior”, the researchers added.

For BMD of the femoral neck, 49 studies with 4768 participants were included in the NMA, which found that all exercise interventions included in the analysis were effective vs no exercise. Mind–body exercise (SUCRA = 99.0) had the highest probability of being the most effective exercise for improving femoral neck BMD.

The NMA also included 22 studies with 1793 participants to measure BMD of the total hip. Interval plots suggested resistance exercise (MD = 0.08; 95% CI, 0.03-0.12) and aerobic exercise (MD = 0.03; 95% CI, 0.00-0.07) were effective for increasing total hip BMD vs no exercise. Resistance exercise (SUCRA = 95.2) was the optimal intervention, followed by aerobic exercise (SUCRA = 58.6).

The researchers noted several limitations to their results, as the ratio of men (n = 1174) and women (n = 7328) in all the included studies was unbalanced and most involved postmenopausal women. In addition, a majority of studies had an unclear risk of bias owing to under-reporting of randomized controlled trial methodologies Researchers also noted about two-thirds of the studies were conducted in China, which they said “might cause bias due to the difference of region and culture”

“This systematic review will contribute towards patients with osteoporosis to prevent and treat osteoporosis in a targeted manner, prevent the occurrence of serious complications such as fractures, and improve the quality of life,” the investigators concluded. “Additionally, the results might provide evidence-based information to inform medical decision-making.”


Zhang S, Huang X, Zhao X, et al. Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: a systematic review and network meta-analysis. J Clin Nurs. Published online November 1, 2021. doi:10.1111/jocn.16101