Effect of exercise on bone health in middle aged and older adults: hierarchical network meta-analysis of randomised trials

Which exercise types and doses best preserve bone mineral density and lower fracture risk in adults aged 40 and over?

124 randomized — what this means trials with 18,429 participants aged 40+ (middle-aged and older adults); fracture analysis drew on 26 trials with 11,132 participants

Bayesian hierarchical network meta-analysis — what this means with dose-response modeling, comparing structured exercise modalities against non-exercise controls and each other; databases searched through January 2026

• Lumbar spine BMD: brisk walking/jogging +0.013 g/cm2 (95% CrI 0.006-0.021) and combined aerobic-resistance +0.013 g/cm2 (0.010-0.016) vs. control (low to moderate certainty — what this means)
• Femoral neck BMD: brisk walking/jogging +0.009 g/cm2 (0.001-0.018) and mind-body exercise +0.007 g/cm2 (0.002-0.013)
• Total hip BMD: only brisk walking/jogging showed benefit, +0.021 g/cm2 (0.005-0.038), low certainty — what this means
• Fractures: mixed aerobic exercise OR 0.29 (0.11-0.78) and mind-body exercise OR 0.58 (0.36-0.93); other modalities showed no effect
• Dose-response was inverted U-shaped, with meaningful thresholds near 400 METs-min/week for lumbar spine and ~600 METs-min/week for hip sites

Weight-bearing aerobic work and combined aerobic-resistance training appear to modestly slow age-related BMD loss at moderate weekly doses, though the certainty of evidence — what this means is only low to moderate and larger doses did not confer greater benefit.