Strength Training Intensity for Osteoporosis

Not currently recruiting at 2 trial locations

Overseen By Dave Varandas, BSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Waterloo

Must not be taking: Bone medications

Disqualifiers: Cancer, Dementia, Surgery, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 104

Duration: 52 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine how varying exercise intensities impact bone health in individuals with low bone mineral density, a condition that weakens bones and increases fracture risk. Participants will engage in different types of strength training, including supervised sessions, to identify the most effective method for strengthening bones. The trial seeks individuals with low bone mineral density who have been postmenopausal for at least two years and are willing to exercise twice a week. As an unphased trial, it provides participants the chance to contribute to valuable research that could enhance bone health strategies for many.

Will I have to stop taking my current medications?

The trial requires that participants have not taken medications affecting bone health in the last 12 months. If you are currently on such medications, you may need to stop taking them to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that supervised high-intensity resistance training, which involves lifting heavy weights, is generally safe for individuals with low bone density. This exercise can strengthen bones. For instance, one study found that this training improved bone density in key areas like the hip. Another study demonstrated that it also reduces factors that increase fracture risk, benefiting bone health.

Participants in these studies typically managed the exercises well, with no major safety issues reported. This suggests that supervised strength training is a safe method to strengthen bones. However, following advice from trained professionals is crucial to ensure exercises are performed safely and correctly. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the strength training approach for osteoporosis because it focuses on the intensity of the exercises, which could be key in improving bone health. Traditional treatments often rely on medications like bisphosphonates or lifestyle changes such as diet and basic exercise. However, this approach highlights supervised, specific-intensity strength training, which might directly enhance bone density and muscle strength more effectively. Additionally, the comparison between in-person supervised sessions and home-based exercises with virtual support could reveal valuable insights into the best ways to manage osteoporosis. This trial aims to uncover how different exercise intensities impact bone health, potentially paving the way for more personalized and effective treatment strategies.

What evidence suggests that this trial's treatments could be effective for osteoporosis?

Research has shown that high-intensity strength training effectively increases bone mass, particularly in the spine and hips. This exercise involves lifting heavier weights, which puts more pressure on the bones and promotes growth. One study found that resistance training significantly improved bone strength in key areas like the lower spine and the top of the thigh bone. Another study demonstrated that a year of heavy resistance training led to short-term bone growth benefits in older adults. In this trial, participants will join different treatment arms, including supervised strength training (group 1 and group 2) and a home exercise program. Overall, these findings suggest that supervised strength training can be a promising way to combat bone loss in people with osteoporosis. ^{3 6 7 8 9}

Who Is on the Research Team?

Lora Giangregorio, PhD

Principal Investigator

University of Waterloo

Are You a Good Fit for This Trial?

This trial is for individuals over 50 with low bone density or high fracture risk who have declined osteoporosis medication. Participants must be postmenopausal, willing to exercise twice weekly, and fully vaccinated against COVID-19. Those already doing similar training or with conditions affecting bone health cannot join.

Inclusion Criteria

I am a woman who has been postmenopausal for 2 years or more, or this has been confirmed by a blood test.

Willing to participate in 2x weekly exercise sessions

I am at high risk for bone fractures and have chosen not to take or stopped taking osteoporosis medication.

Exclusion Criteria

I have a condition that affects my bone health.

I cannot communicate in English.

I have had cancer other than non-melanoma skin cancer in the last 2 years.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in supervised twice-weekly progressive resistance training at moderate or high intensity, or a home posture and balance exercise program for one year

52 weeks

104 visits (in-person for supervised groups), biweekly virtual classes for home exercise group

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Home exercise
• Supervised strength training (group 1)
• Supervised strength training (group 2)

Trial Overview The study tests the effects of different exercise intensities on bone strength in people at risk for fractures due to low bone mineral density. It compares supervised strength training at two intensity levels versus home exercises.

How Is the Trial Designed?

Group I: Supervised strength training (group 2) Experimental Treatment 1 Intervention

In-person, supervised muscle strengthening exercises twice weekly at a specific intensity.

Group II: Supervised strength training (group 1) Experimental Treatment 1 Intervention

In-person, supervised muscle strengthening exercises twice weekly at a specific intensity.

Group III: Home exercise Active Control 1 Intervention

Home exercise program, with biweekly group virtual education and exercise classes.

Who Is Running the Clinical Trial?

University of Waterloo

Lead Sponsor

Trials

132

Recruited

221,000+

University of Saskatchewan

Collaborator

Trials

261

Recruited

156,000+

University Health Network, Toronto

Collaborator

Trials

1,555

Recruited

526,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Published Research Related to This Trial

High-load resistance training (HLRT) significantly increases bone mineral density (BMD) in patients with osteoporosis and osteopenia, particularly in the lumbar spine, as shown by a meta-analysis of nine randomized controlled trials involving 495 patients.

While HLRT is effective for improving BMD, the study noted high heterogeneity and publication bias, indicating the need for further research with lower risk of bias to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of high-load resistance training on bone mineral density in osteoporosis and osteopenia: a meta-analysis. Kitsuda, Y., Wada, T., Noma, H., et al.[2021]

The study evaluates the effectiveness of a 12-month exercise program for women with post-menopausal osteoporosis, comparing individual home training (IHT) to gym group training (GGT) in a randomized trial involving sedentary patients.

The primary outcome is the improvement in quality of life, measured by the Short Osteoporosis Quality of Life Questionnaire, which will help determine the best exercise setting for enhancing physical activity in osteoporotic women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Clinical Trial to Evaluate the Efficacy and Safety of the ACTLIFE Exercise Program for Women with Post-menopausal Osteoporosis: Study Protocol. Bragonzoni, L., Barone, G., Benvenuti, F., et al.[2020]

A 12-month power-based resistance training program significantly improved bone mineral density (BMD) in a 70-year-old postmenopausal woman with osteoporosis, with increases of 24% in the lumbar spine and 29% in the femoral neck.

The training also reduced her fall risk, as indicated by a seven-point improvement in the Dynamic Gait Index, allowing her to be classified as a 'safe ambulator' after the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Power training improves bone mineral density and fall risk for a postmenopausal woman with a history of osteoporosis and increased risk of falling: A case report. Aquino, M., DiMenna, FJ., Petrizzo, J., et al.[2021]

A 12-week program of maximal strength training (MST) using squat exercises significantly improved strength measures (1-repetition maximum and rate of force development) in postmenopausal women with osteoporosis or osteopenia, indicating enhanced skeletal health.

The training also led to increases in bone mineral content at the lumbar spine and femoral neck, suggesting that MST can be an effective intervention for improving bone density and overall skeletal properties in patients with low bone mass.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Maximal strength training in postmenopausal women with osteoporosis or osteopenia. Mosti, MP., Kaehler, N., Stunes, AK., et al.[2016]

A six-month high-intensity strength-training program significantly increased trunk strength by 19.3% and lower limb strength (1RM squat) by 34.4% in women aged 50 and over, compared to an active control group.

While the strength training did not show a significant increase in lumbar bone mineral density (BMD), the control group experienced a decrease of 1.7%, suggesting that strength training may help maintain BMD in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying bone mass and muscular changes. Humphries, B., Mummery, K., Newton, RU., et al.[2016]

The LIFTMOR trial demonstrated that high-intensity progressive resistance training (HiPRT) with impact loading is safe and effective for improving bone health in postmenopausal women with low bone mass, with no reported injuries during the study.

Participants in the HiPRT group showed significant improvements in bone mineral density and functional performance compared to those in a low-intensity exercise group, indicating that high-intensity training can be beneficial for osteoporosis rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial. Watson, SL., Weeks, BK., Weis, LJ., et al.[2018]

High-intensity resistance training significantly increases bone mineral density (BMD) in the lumbar spine and whole body, as shown in a study of 10 male powerlifters compared to 11 control subjects.

There is a strong correlation between lumbar spine BMD and powerlifting performance, indicating that improved bone density may enhance strength in powerlifters.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of high-intensity resistance training on bone mineral density in young male powerlifters. Tsuzuku, S., Ikegami, Y., Yabe, K.[2019]

The article highlights the need for physicians to better understand the various forms of weightlifting, including powerlifting, Olympic lifting, weight training, and bodybuilding, to address the specific medical and physiological issues associated with these sports.

It also reviews important topics such as age restrictions for lifters, the effects of drug use, potential strength gains, hypertrophy, and common injuries, emphasizing the unique health considerations for weightlifters.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weightlifting, weight training and injuries. Basford, JR.[2022]

Strength training significantly benefits adults by reducing the risk of muscle mass loss, functional decline, and fall-related injuries, especially in older adults who can achieve notable strength gains within a few months of starting a program.

Despite the health benefits, only 21.9% of men and 17.5% of women reported engaging in strength training two or more times per week in 2004, which is below the national health objective of 30% set for 2010, highlighting the need for more initiatives to promote strength training among adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trends in strength training--United States, 1998-2004. [2022]

Both high-load and high-repetition resistance training protocols significantly improved muscular strength and muscle size in early postmenopausal women, with lower body strength increasing by approximately 30% and hip strength by 37-40%.

Neither training protocol resulted in significant increases in bone mineral density (BMD) at the spine or hip, suggesting that while these exercises enhance muscular fitness, they may not be sufficient for improving bone density in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Musculoskeletal responses to high- and low-intensity resistance training in early postmenopausal women. Bemben, DA., Fetters, NL., Bemben, MG., et al.[2019]

In a study of 59 postmenopausal women with osteopenia or osteoporosis, a 12-month weight training program showed a slight increase in bone mineral density (BMD) in the lumbar spine by 1.17%, while the control group experienced a decrease of 2.26%.

Although the weight training did not lead to significant improvements in BMD, it highlighted the importance of exercise in maintaining bone health compared to no exercise, suggesting that such programs may help prevent further bone loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of specific exercise training on bone mineral density in women with postmenopausal osteopenia or osteoporosis. de Matos, O., Lopes da Silva, DJ., Martinez de Oliveira, J., et al.[2009]

High-intensity strength training significantly improved bone mineral density in postmenopausal women, with increases in femoral neck and lumbar spine bone density, while control subjects experienced declines in bone density.

The strength training program also enhanced muscle mass, strength, and dynamic balance, demonstrating its effectiveness in reducing multiple risk factors for osteoporotic fractures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. Nelson, ME., Fiatarone, MA., Morganti, CM., et al.[2019]

A new evaluation protocol for lifting techniques in powerlifting squats and deadlifts was developed, focusing on aspects associated with injury risk, and was validated by a consensus of experts and physiotherapists.

The final protocols included 17 aspects for squats and 10 for deadlifts, demonstrating good to excellent content validity and reliability, which can help coaches and practitioners provide evidence-based recommendations for safe lifting techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Content Validity Index and Reliability of a New Protocol for Evaluation of Lifting Technique in the Powerlifting Squat and Deadlift. Sjöberg, H., Aasa, U., Rosengren, M., et al.[2021]

A review of 17 studies found that while strength training has well-documented benefits for physical health in overweight or obese individuals, its psychological effects are unclear and not convincingly supported by current evidence.

Some weak positive effects on psychological outcomes like self-efficacy and self-esteem were noted, but overall, the research indicates a significant gap in understanding the psychological benefits of strength training, highlighting the need for more comprehensive studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Psychological Effects of Strength Exercises in People who are Overweight or Obese: A Systematic Review. Ten Hoor, GA., Kok, G., Peters, GY., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6279907/

Effects of Resistance Exercise on Bone Health - PMC Exercise training has been recommended as a promising therapeutic strategy to encounter the loss of bone and muscle mass due to osteosarcopenia.

2. nature.com nature.com/articles/s41598-025-94510-3

Effect of different types of exercise on bone mineral density ... Notably, high-intensity strength training is more effective at increasing bone mass in the spine and hips than low-intensity or moderate- ...

3. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-025-05890-1

Optimal resistance training parameters for improving bone ... The results indicate that resistance training significantly improves BMD at the LS (SMD = 0.88, 95% CI [0.21, 1.56], P = 0.01, I2 = 91%), FN ( ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S8756328225000055

Heavy resistance training provides short-term benefits on ... We demonstrated that 1 year of heavy resistance training positively influenced short-term bone formation in well-functioning older adults, although the effect ...

5. frontiersin.org frontiersin.org/journals/physiology/articles/10.3389/fphys.2023.1105303/full

Comparative efficacy different resistance training protocols ... The results of the network Meta-analysis showed that moderate intensity resistance training was superior in improving lumbar spine bone mineral ...

6. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/32289518/

The LIFTMOR-M semi-randomised controlled trial Findings indicate that supervised HiRIT provides a positive stimulus to cortical bone at the medial FN compared with supervised IAC exercise.

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S8756328220301423

Effects of supervised high-intensity resistance and impact ... High-intensity resistance and impact training improves fracture risk factors in men. Abstract. Introduction. Few data exist on the effects of bone-targeted ...

8. melioguide.com melioguide.com/osteoporosis-exercises/liftmor-osteoporosis-osteopenia/

LIFTMOR Controlled Trial for Osteoporosis and Low Bone ... This study revealed something exciting: postmenopausal women who followed the LIFTMOR exercise program showed significantly greater improvements ...

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10345999/

Position Statement: Exercise Guidelines for Osteoporosis ... The 50 RCTs reported that even with osteoporosis and osteopenia, resistance and impact training consistently maximized bone strength, improved body strength and ...