The Most Effective Exercise for Bone Health in Obese Adults

A new study compared the impact of resistance versus aerobic exercise regimens on bone health in obese adults and concluded that resistance exercise is effective alone and in combination with aerobic exercise, while aerobic exercise was not effective as a standalone option.

“Weight loss therapy of older adults with obesity is limited by weight loss–induced decrease in bone mineral density (BMD), which could exacerbate ongoing age‐related bone loss and increase the risk for fractures,” the study authors wrote in their abstract. “Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown.” Their findings were published in the Journal of Bone and Mineral Research.

The randomized controlled trial compared aerobic versus resistance exercise, alone and in combination, during matched ~10% weight loss in 160 obese adults. Changes in bone mineral density at the total hip, femoral neck, trochanter, intertrochanter, one-third radius, and lumbar spine, as well as bone markers, were all evaluated. Intensive lifestyle interventions were implemented for six months.

Bone mineral density decreases were lower in the resistance (−0.006 g/cm2 [−0.7%]) and combination groups (−0.012 g/cm2 [−1.1%]) compared to the aerobic group (−0.027 g/cm2 [−2.6%]) (P = 0.001 for between‐group comparisons). The aerobic group also presented greater increases in serum C‐telopeptide (33%), procollagen type 1 N‐propeptide (16%), and osteocalcin concentrations (16%) compared the resistance (7%, 2%, and 0%, respectively) and combination groups (11%, 2%, and 5%, respectively) (P = 0.004 to 0.048 for between‐group comparisons). In multiple regression analyses, independent predictors of declining hip BMD were declining whole body mass and serum leptin.

“It is never too late to practice a healthy lifestyle through diet and regular exercise, especially that which includes resistance exercise to improve physical function and preserve bone health during aging,” said senior study author Dennis T. Villareal, MD, of Baylor College of Medicine, in a press release.

The researchers concluded in their abstract, “These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss–induced decrease in hip BMD and less weight loss–induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity.”