Treino físico e saúde pós-menopáusica para mulheres: revisão sistemática
DOI:
https://doi.org/10.47197/retos.v75.117282Palavras-chave:
Exercício, terapia com exercício, densidade óssea, osteoporose pós-menopáusica, pós-menopausaResumo
Introdução: A osteoporose é uma doença esquelética progressiva caracterizada pela redução da densidade mineral óssea (DMO), que aumenta o risco de fraturas, especialmente na coluna lombar e no osso femoral. Afeta principalmente as mulheres posmenopáusicas devido à descida do estrogénio, hormona essencial no metabolismo ósseo. A perda de massa óssea compromete a funcionalidade e a qualidade de vida, aumentando a morbilidad nesta população. O exercício físico foi proposto como uma estratégia não farmacológica para prevenir ou reverter a perda óssea, embora os seus efeitos específicos não estejam completamente diluídos.
Objectivo: Analisar os efeitos das especificidades das modalidades de exercício físico na densidade mineral óssea em mulheres pós-menopáusicas e identificar os intervalos de intensidade mais eficazes para a sua melhor.
Métodos: Foi realizada uma revisão sistemática seguindo as guidelines PRISMA 2020. Foram incluídos ensaios clínicos aleatorizados publicados entre 2016 e dezembro de 2023 que avaliaram o desempenho (força, impacto, aeróbio ou combinados). O risco de sessão foi avaliado com a ferramenta Rob 2 e a certeza da evidência com a abordagem GRADE.
Resultados: Se analisou 16 ensaios (n = 1.186; edad media = 63 anos). A maioria referiu incrementos modestos na DMO lombar (+1,4% a +2,9%) e femoral (+0,8% a +3,5%). Os programas de força e impacto foram mais eficazes no osso femoral, enquanto as intervenções combinadas mostram melhores consistências na coluna lombar.
Conclusões: O exercício físico, especialmente aquele que integra força e impacto, é uma intervenção eficaz para melhorar ou manter a DMO em mulheres pós-menopáusicas, contribuindo para a prevenção de fraturas e para a saúde óssea e funcional.
Referências
Barak, M. M. (2024). Cortical and Trabecular Bone Modeling and Implications for Bone Functional Adaptation in the Mammalian Tibia. Bioengineering, 11(5), 514. https://doi.org/10.3390/bioengineering11050514
Black, D. M., Cummings, S. R., Karpf, D. B., Cauley, J. A., Thompson, D. E., Nevitt, M. C., … Bauer, D. C. (1996). Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. The Lancet, 348(9041), 1535–1541. https://doi.org/10.1016/S0140-6736(96)09446-3
Black, D. M., Delmas, P. D., Eastell, R., Reid, I. R., Boonen, S., Cauley, J. A., … Cummings, S. R. (2007). Once yearly zoledronic acid for treatment of postmenopausal osteoporosis. New England Journal of Medicine, 356(18), 1809–1822. https://doi.org/10.1056/NEJMoa067312
Basat, H., Esmaeilzadeh, S., & Eskiyurt, N. (2013). The effects of strengthening and high-impact exercis-es on bone metabolism and quality of life in postmenopausal women: A randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation, 26(4), 427–435. https://doi.org/10.3233/BMR-13040
Bello, M., Sousa, M. C., Neto, G., Oliveira, L., Guerras, I., Mendes, R., & Sousa, N. (2014). The effect of a long-term, community-based exercise program on bone mineral density in postmenopausal women with pre-diabetes and type 2 diabetes. Journal of Human Kinetics, 43(1), 43–48. https://doi.org/10.2478/hukin-2014-0088
Beck, B. R., Daly, R. M., Singh, M. A. F., & Taaffe, D. R. (2015). High-impact exercise improves bone min-eral density and physical function in osteopenic postmenopausal women: A randomized con-trolled trial. Journal of Bone and Mineral Research, 30(10), 1703–1712. https://doi.org/10.1002/jbmr.2473
Borba-Pinheiro, C. J., Dantas, E. H. M., Vale, R. G. S., Drigo, A. J., Alencar, M. C. G., Tonini, T., ... & Figueire-do, N. M. A. (2016). Resistance training programs on bone related variables and functional inde-pendence of postmenopausal women in pharmacological treatment: A randomized controlled trial. Archives of Gerontology and Geriatrics, 65, 36–44. https://doi.org/10.1016/j.archger.2016.02.010
Bucci, M., Marcocci, C., & Iantomasi, T. (2016). Effect of antioxidant supplementation on bone mineral density in postmenopausal women: A systematic review. Calcified Tissue International, 98(5), 430–446. https://doi.org/10.1007/s00223-015-9976-6
Cooper, C., Cole, Z. A., Holroyd, C. R., Dennison, E., & Kanis, J. A. (2022). Global hip fracture projections 2022–2050. The Lancet Healthy Longevity, 3(7), e456–e465. https://doi.org/10.1016/S2666-7568(22)00102-3
Compston, J. E., McClung, M. R., & Leslie, W. D. (2019). Osteoporosis. The Lancet, 393(10169), 364–376. https://doi.org/10.1016/S0140-6736(18)32112-3
de Oliveira Silva, F., Ferreira, L. L., Pegorari, M. S., & Tavares, D. M. S. (2013). Resistance exercise im-proves physical performance and health related quality of life in older women with sarcopenia: a randomized controlled trial. Archives of Gerontology and Geriatrics, 59(2), 331–337. https://doi.org/10.1016/j.archger.2013.05.004
Dieli-Conwright, C. M., Courneya, K. S., Demark-Wahnefried, W., Sami, N., Lee, K., Sweeney, F. C., Buchholz, S., & Spicer, D. (2018). Effects of aerobic and resistance exercise on markers of systemic inflammation and oxidative stress in women: A randomized controlled trial. Journal of Applied Physiology, 125(1), 182–190. https://doi.org/10.1152/japplphysiol.00997.2017
Frost, H. M. (2003). Bone’s mechanostat: A 2003 update. The Anatomical Record Part A: Discoveries in Molecular, Cellular, and Evolutionary Biology, 275A(2), 1081–1101. https://doi.org/10.1002/ar.a.10119
Granacher, U., Gollhofer, A., Hortobágyi, T., Kressig, R. W., & Muehlbauer, T. (2011). The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: A systematic review. Sports Medicine, 43(7), 627–641. https://doi.org/10.1007/s40279-013-0041-1
Giangregorio, L. M., Papaioannou, A., MacIntyre, N. J., et al. (2014). Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporosis International, 25(3), 821–835. https://doi.org/10.1007/s00198-013-2523-2
Gourlay, M. L., Fine, J. P., Preisser, J. S., May, R. C., Li, C., Lui, L. Y., & Ensrud, K. E. (2012). Bone-density testing interval and transition to osteoporosis in older women. New England Journal of Medi-cine, 366(3), 225–233. https://doi.org/10.1056/NEJMoa1107142 Granacher, U., Muehlbauer, T., Zahner, L., Gollhofer, A., & Kressig, R. W. (2011). Comparison of traditional and recent ap-proaches in the promotion of balance and strength in older adults. Sports Medicine, 41(5), 377–400. https://doi.org/10.2165/11538570-000000000-00000
Gugliucci, A., & Menini, T. (2002). The role of advanced glycation end products in aging and metabolic diseases. Journal of Biomedical Science, 9(3), 232–240. https://doi.org/10.1007/BF02296260
Hernlund, E., Svedbom, A., Kanis, J. A., & Borgström, F. (2023). Osteoporosis burden in 2023: Updated epidemiology and global projections. Osteoporosis International, 34, 1123–1135. https://doi.org/10.1007/s00198-023-06789-4
Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., … Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, (7), CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
Holubiac, I. S., Leuciuc, F. V., Crăciun, D. M., & Dobrescu, T. (2022). Effect of strength training protocol on bone mineral density for postmenopausal women with osteopenia/osteoporosis assessed by dual-energy X-ray absorptiometry (DEXA). Sensors, 22(5), 1904. https://doi.org/10.3390/s22051904
Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., Harbour, R. T., Caldwell, L. M., & Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, 2011(7), CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
Kanis, J. A., Harvey, N. C., McCloskey, E., Bruyère, O., Veronese, N., Lorentzon, M., Cooper, C., Rizzoli, R., & Reginster, J. Y. (2021). Algorithm for the management of postmenopausal osteoporosis. Osteoporosis International, 32(12), 2519–2544. https://doi.org/10.1007/s00198-021-06019-0
Kemmler, W., Häberle, L., Von Stengel, S., & Kalender, W. A. (2015). Changes in menopausal risk factors in early postmenopausal osteopenic women: 3-year exercise study. Clinical Interventions in Ag-ing, 10, 117–129. https://doi.org/10.2147/CIA.S283177
Kistler-Fischbacher, M., Yong, J. S., Weeks, B. K., & Beck, B. R. (2021). A comparison of bone‐targeted exercise with and without antiresorptive bone medication to reduce indices of fracture risk in postmenopausal women with low bone mass: The MEDEX‐OP randomized controlled trial. Journal of Bone and Mineral Research, 36(10), 1825–1838. https://doi.org/10.1002/jbmr.4334
Kemmler, W., Hettchen, M., Kohl, M., Murphy, M., Bragonzoni, L., Julin, M., Risto, T., & von Stengel, S. (2021). Detraining effects on musculoskeletal parameters in early postmenopausal osteopenic women: 3-month follow-up of the randomized controlled ACTLIFE study. Calcified Tissue In-ternational. https://doi.org/10.1007/s00223-021-00829-0
Khosla, S., & Monroe, D. G. (2018). Regulation of bone metabolism by sex steroids. Cold Spring Harbor Perspectives in Medicine, 8(1), a031211. https://doi.org/10.1101/cshperspect.a031211 Liu Ambrose, T., Khan, K. M., Eng, J. J., Janssen, P. A., Lord, S. R., & McKay, H. A. (2004). Resistan-ce and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6 month randomized, controlled trial. Journal of the American Geriatrics Society, 52(5), 657–665. https://doi.org/10.1111/j.1532-5415.2004.52210.x
Kohrt, W. M., Bloomfield, S. A., Little, K. D., Nelson, M. E., & Yingling, V. R. (2004). Physical activity and bone health. Medicine & Science in Sports & Exercise, 36(11), 1985–1996. https://doi.org/10.1249/01.MSS.0000142662.21767.58
Liu-Ambrose, T., Donaldson, M. G., Ahamed, Y., Graf, P., Cook, W. L., Close, J., & Khan, K. M. (2008). Otago home-based strength and balance retraining improves executive functioning in older fallers: A randomized controlled trial. Journal of the American Geriatrics Society, 56(10), 1821–1830. https://doi.org/10.1111/j.1532-5415.2008.01931.x
Marini, H., Minutoli, L., Polito, F., Bitto, A., Altavilla, D., Atteritano, M., … Squadrito, F. (2007). Effects of the phytoestrogen genistein on bone metabolism in osteopenic postmenopausal women: A ran-domized trial. Annals of Internal Medicine, 146(12), 839–849. https://doi.org/10.7326/0003-4819-146-12-200706190-00004
Marques, E. A., Mota, J., Carvalho, J., & Vale, S. (2011). Effects of resistance and multicomponent exercise on bone mineral density in older women: A randomized controlled trial. Journal of Bone and Mineral Metabolism, 30(5), 561–569. https://doi.org/10.1007/s00774-011-0344-7
Maddalozzo, G. F., Iwaniec, U. T., Turner, R. T., Rosen, C. J., & Widrick, J. J. (2015). Whole-body vibration slows the acquisition of fat in mature female rats. Journal of Strength and Conditioning Re-search, 29(4), 955–963. https://doi.org/10.1519/JSC.0000000000000714
Marques, E. A., Mota, J., & Carvalho, J. (2011). Exercise effects on bone mineral density in older adults: a meta analysis of randomized controlled trials. Age, 34(6), 1493–1515. https://doi.org/10.1007/s11357-011-9260-0
Miszko, T. A., Cress, M. E., Slade, J. M., Covey, C. J., Agrawal, S. K., & Doerr, C. E. (2003). Effect of strength and power training on physical function in community-dwelling older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(2), M171–M175. https://doi.org/10.1093/gerona/58.2.M171
Miszko, T. A., Cress, M. E., Slade, J. M., Covey, C. J., Agrawal, S. K., & Doerr, C. E. (2003). Effect of strength and power training on physical function in community dwelling older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(2), M171–M175. https://doi.org/10.1093/gerona/58.2.M17
McClung, M. R., Geusens, P., Miller, P. D., Zippel, H., Bensen, W. G., Roux, C., … Reginster, J. Y. (2001). Effect of risedronate on the risk of hip fracture in elderly women. New England Journal of Medicine, 344(5), 333–340. https://doi.org/10.1056/NEJM200102013440502
Montes Mata, K. J., Aguirre Chávez, J. F., Franco Gallegos, L. I., & Robles Hernández, G. S. I. (2025). Me-taanálisis del impacto de la actividad física en la salud ósea y muscular en mujeres postmeno-páusicas. Retos, 62, 777-786. https://doi.org/10.47197/retos.v62.109394
Moreira, L. D. F., Oliveira, M. L. D., Lirani-Galvão, A. P., Marin-Mio, R. V., dos Santos, R. N., & Lazaretti-Castro, M. (2013). Physical exercises in postmenopausal women with low bone mineral density and their effect on bone metabolism markers and quality of life: A randomized controlled trial. Clinics, 69(9), 561–568. https://doi.org/10.6061/clinics/2014(09)01
Neer, R. M., Arnaud, C. D., Zanchetta, J. R., Prince, R., Gaich, G. A., Reginster, J. Y., … Sawicki, A. Z. (2001). Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. New England Journal of Medicine, 344(19), 1434–1441. https://doi.org/10.1056/NEJM200105103441904
Posch, M., Schranz, A., Lener, M., Tecklenburg, K., Burtscher, M., Ruedl, G., Niedermeier, M., & Wlaschek, W. (2019). Effectiveness of a mini-trampoline training program on balance and functional mobility, gait performance, strength, fear of falling and bone mineral density in older women with osteopenia. Clinical Interventions in Aging, 14, 2281–2293. https://doi.org/10.2147/CIA.S230008
Rajapakse, C. S., Johncola, A. J., Batzdorf, A. S., Jones, B. C., Al Mukaddam, M., Sexton, K., Shults, J., Leonard, M. B., Snyder, P. J., & Wehrli, F. W. (2020). Effect of low intensity vibration on bone strength, microstructure, and adiposity in pre‐osteoporotic postmenopausal women: A randomized placebo‐controlled trial. Journal of Bone and Mineral Research. https://doi.org/10.1002/jbmr.4229
Reginster, J. Y., Minne, H. W., Sorensen, O. H., Hooper, M., Roux, C., Brandi, M. L., … Eastell, R. (2000). Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporosis International, 11(1), 83–91. https://doi.org/10.1007/s001980050010
Robling, A. G., Niziolek, P. J., Baldridge, L. A., Condon, K. W., Allen, M. R., Alam, I., Mantila, S. M., Gluhak-Heinrich, J., Bellido, T., Harris, S. E., & Turner, C. H. (2008). Mechanical stimulation of bone in vi-vo reduces osteocyte expression of Sost/sclerostin. Journal of Biological Chemistry, 283(9), 5866–5875. https://doi.org/10.1074/jbc.M705092200
Svedbom, A., Hernlund, E., & Borgström, F. (2023). Global prevalence of osteoporosis and low bone mass: 2023 update. Archives of Osteoporosis, 18(1), 45–57. https://doi.org/10.1007/s11657-023-01209-7
Shojaa, M., von Stengel, S., & Kohl, M. (2020). Effects of exercise training on bone mineral density in postmenopausal women: A systematic review and meta analysis of randomized controlled tri-als. Journal of Musculoskeletal and Neuronal Interactions, 20(3), 327–338. PubMed PMID: 32598251
Shojaa, M., von Stengel, S., & Kohl, M. (2021). Exercise and bone mineral density in postmenopausal women: A systematic review and meta analysis of training modes. Journal of Aging and Physi-cal Activity, 29(1), 10–25. https://doi.org/10.1123/japa.2020-0050
Shojaa, M., von Stengel, S., Schoene, D., Kohl, M., & Kemmler, W. (2021). Effect of exercise training on bone mineral density in postmenopausal women: A systematic review and meta-analysis. Bone, 143, 115770. https://doi.org/10.1016/j.bone.2020.115770
Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. (2017). Exercise for preventing falls in older people living in the com-munity. Cochrane Database of Systematic Reviews, 1, CD012424. https://doi.org/10.1002/14651858.CD012424
Oliveira, M. L. A. D., Albuquerque, A. P. A., Silva, A. F., & Sá, C. K. C. D. (2016). The effects of different physical exercise programs on body composition and functional capacity in postmenopausal women. Archives of Gerontology and Geriatrics, 65, 130–135. https://doi.org/10.1016/j.archger.2016.02.010
Tagliaferri, C., Wittrant, Y., Davicco, M.-J., Walrand, S., & Coxam, V. (2015). Muscle and bone, two interconnected tissues. Ageing Research Reviews, 21, 55–70. https://doi.org/10.1016/j.arr.2015.03.002
Tsai, J. N., Uihlein, A. V., Burnett-Bowie, S. A., Neer, R. M., & Leder, B. Z. (2011). Comparative effects of teriparatide, denosumab, and combination therapy on vertebral trabecular microarchitecture in women with osteoporosis. The Journal of Clinical Endocrinology & Metabolism, 96(10), 3775–3782. https://doi.org/10.1210/jc.2011-1333
Tang, B. M., Eslick, G. D., Nowson, C., Smith, C., & Bensoussan, A. (2007). Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: A meta-analysis. The Lancet, 370(9588), 657–666. https://doi.org/10.1016/S0140-6736(07)61242-7
Taku, K., Melby, M. K., Kronenberg, F., Kurzer, M. S., & Messina, M. (2010). Extracted or synthesized soy-bean isoflavones reduce bone loss in menopausal women: A meta-analysis of randomized con-trolled trials. The Journal of Nutrition, 140(3), 576–583. https://doi.org/10.3945/jn.109.115618
Uesugi, T., Fukui, Y., & Yamori, Y. (2004). Beneficial effects of soybean isoflavone supplement on bone metabolism and serum lipids in postmenopausal Japanese women: A randomized double blind placebo controlled study. European Journal of Clinical Nutrition, 58(9), 1047–1053. https://doi.org/10.1038/sj.ejcn.1601949
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High intensity ex-ercise may protect against bone loss and sarcopenia in older men: A randomized controlled tri-al. Journal of Bone and Mineral Research, 33(6), 1015–1026. https://doi.org/10.1002/jbmr.3394
Weaver, C. M., Gordon, C. M., Janz, K. F., et al. (2016). The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors. Osteoporosis International, 27(4), 1281–1386. https://doi.org/10.1007/s00198-015-3440-3
Villareal, D. T., Chode, S., Parimi, N., Sinacore, D. R., Hilton, T., Armamento-Villareal, R., … Shah, K. (2011). Weight loss, exercise, or both and physical function in obese older adults. New England Journal of Medicine, 364(13), 1218–1229. https://doi.org/10.1056/NEJMoa1008234
Villareal, D. T., Aguirre, L., Gurney, A. B., Waters, D. L., Sinacore, D. R., Colombo, E., Armamento-Villareal, R., Qualls, C., & Shah, K. (2018). Weight loss and exercise for obese older adults: A randomized controlled trial. Rejuvenation Research, 21(5), 385–394. https://doi.org/10.1089/rej.2018.2069
Yu, X., Li, H., Wang, J., Zhang, L., Liu, Y., & Li, Y. (2019). Effects of combined exercise on bone mineral density and balance ability in postmenopausal women with osteoporosis: A randomized controlled trial. BioMed Research International, 2019, Article 9206075. https://doi.org/10.1155/2019/9206075
Yamazaki, S., Ichimura, S., Iwamoto, J., & Takeda, T. (2020). Effects of low-repetition, high-impact jump training on bone mineral density and physical function in postmenopausal women: A ran-domized controlled trial. Journal of Bone and Mineral Metabolism, 38, 558–566. https://doi.org/10.1007/s00774-019-01072-2
Zhao, R., & Zhao, M. (2015). The impact of high-intensity progressive resistance training on bone mineral density and bone turnover in postmenopausal women: A systematic review and meta-analysis. Osteoporosis International, 26(2), 639–649. https://doi.org/10.1007/s00198-014-2934-6
Zhao, R., & Zhao, M. (2015). Safety and efficacy of whole body vibration in attenuating bone loss in postmenopausal women: A meta-analysis. Clinical Interventions in Aging, 10, 859–874. https://doi.org/10.2147/CIA.S837
Zhao, R., Zhao, M., & Zhang, L. (2015). Efficiency of exercise interventions for improving bone mineral density in postmenopausal women: A network meta-analysis. Journal of Clinical Endocrinology & Metabolism, 100(5), 2212–2220. https://doi.org/10.1210/jc.2015-1062
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