A network meta-analysis of the effects of different aerobic exercise prescriptions on bone density in osteoporosis patients.

OBJECTIVE

To compare the effects of different doses of aerobic exercise on bone mineral density in osteoporosis patients through a network meta-analysis.

METHODS

This study systematically retrieved and screened 7 databases (including PubMed, Web of Science, and Cochrane Library, etc.) for randomized controlled trials on aerobic exercise interventions for osteoporosis patients from database inception to June 2025. The study strictly followed the PRISMA guidelines, within the framework of frequency theory, we conducted a network meta-analysis using Stata 15.0 software, quality assessment of the literature using Cochrane bias risk assessment tool.

RESULTS

A total of 27 randomized controlled trials involving 2,183 participants were included in this study. The network meta-analysis revealed that aerobic exercise regimens with the following parameter: intensity (High, medium, low-to-medium and medium-to-high intensity progressive loads), training duration (24 weeks), single-session duration (30-59min), and intervention frequency (2-3, 4-5times a week) all significantly improved bone density in osteoporosis patients compared to the control group. Indirect comparison results revealed statistically significant advantages of high-intensity exercise over moderate and low-intensity exercise. The frequency of 4-5 times a week showed a significant advantage compared to 2-3 times and 6-7 times per week. No significant differences were observed between intervention frequency and duration. The Surface Under the Cumulative Ranking Curve (SUCRA) demonstrated the following rankings: the efficacy was highest at the high intensity level, followed by the medium to high intensity level, then the low to medium intensity, the medium intensity, the Low intensity level, and the control group. For exercise duration, a 24-week intervention achieved the best efficacy, followed by a 12-week intervention, then the 48 weeks or longer, and the control group. Regarding single session intervention time, sessions lasting 30 to 59 minutes produced superior efficacy, followed by 60 minutes or longer, then the control group. In terms of weekly exercise frequency, training 4 to 5 times per week ranked first in efficacy, followed by 2 to 3 times per week, then 6 to 7 times per week, and the control group.

CONCLUSION

The results showed that the optimal exercise dose for improving bone mineral density (BMD) in OP patients was aerobic exercise with high intensity, 30-59min per session, 4-5 times per week, and continue 24 weeks.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251155131, identifier CRD420251155131.