Finding the Optimal Resistance Training Intensity for Your Bones: Protocol for a Randomized Controlled Trial

Objective. The purpose of this trial is to evaluate the effect of twice-weekly, moderate-to-high intensity progressive resistance training (PRT) for 1 year on lumbar spine bone mineral density (BMD) in individuals with low BMD, compared to attention control. Secondary analyses will examine if resistance training improves other health outcomes; if high intensity is more effective than moderate intensity resistance training for all outcomes; the cost of intervention versus benefit; the willingness to pay; and harms. Methods. For this study, 324 men or postmenopausal women aged >50 years with a femoral neck, total hip, or lumbar spine BMD T-score of [less than or equal to] -1, or a Fracture Risk Assessment Tool probability of >20% for major osteoporotic fracture or [greater than or equal to]3% for hip fracture are being recruited to participate in a randomized controlled trial with 1:1:1 randomization. Participants will be stratified by site (3 centers) to twice-weekly, supervised PRT at moderate intensity (about 10 repetitions maximum), to high intensity PRT ([less than or equal to]6 repetitions maximum), or to a home posture and balance exercise program (attention control) for 1 year (resistance training to comparator allocation ratio of 2:1). The primary outcome is lumbar spine BMD via dual-energy X-ray absorptiometry. Secondary outcomes include trabecular bone score, proximal femur and total hip BMD and structure, bone-free and appendicular lean mass, physical functioning, falls, fractures, glucose metabolism, cost per life-year gained, adverse events, and quality of life. Between-group differences will be tested in intention-to-treat and per-protocol analyses using analysis of covariance, chi-square tests, or negative binomial or logistic regression, adjusting for site and baseline values. Impact. The Finding the Optimal Resistance Training Intensity For Your Bones trial will support decision making on resistance training for people at risk of fracture. Keywords: Bone Mineral Density, Fracture, Intensity, Moderate, Osteoporosis, Progressive Resistance Training
Introduction Exercise is recommended for fall and fracture prevention. (1,2) Progressive resistance training (PRT) has the potential to be osteogenic, but concerns about safety in people with osteoporosis limit its [...]