+ Model ARTICLE IN PRESS FT-424; No. of Pages 10 Physiotherapy. 2016; xxx (xx): --- xxx xxx www.elsevier.es/ft REVISION Effects of physical activity on quality of life related to health in adults with osteopenia and osteoporosis: revision systematic and metaanalysis M. Prieto-Peralta to , C. Sandoval-Cuellar b Y EA Cobo-Mejia c , * to Service Social Mandatory Corps Group, Medicine Program, Faculty of Health Sciences, University of Boyacá , Tunja, Boyacá, Colombia b Intervention Integral Athlete, Group Corps, Physical Therapy Program, Faculty of Health Sciences, University of Boyacá, Tunja, Boyacá, Colombia c History, Corps group, Program of Physiotherapy, Faculty of Health Sciences, University of Boyacá , Tunja, Boyaca, Colombia Received 18 January 2016; accepted August 25, 2016 WORDS KEY Summary Activity physical; Objective: Identify the effect of physical activity on quality of life related to health in adults with osteopenia and osteoporosis. Osteoporosis; osteopenia; Revision systematic; Search strategy: the PubMed / MEDLINE, EMBASE, LILACS and the Cochrane Central Register of Controlled Trials meta-analysis (CENTRAL) data, and Scielo seekers were consulted, and Science Direct. These were identified randomized clinical trials. results: Six studies (n = 371) after evaluation had low risk of bias and methodological quality they were found. No differences between groups intervened with physical activity and usual care for both quality of life and for indicators observed bone densitometry, what is assumed it is given by the fact that the usual care includes regular exercise coupled with the clinical heterogeneity of the studies, including the type of participants and intervention times, which do not allow demonstrate the impact physical activity. conclusions: Physical activity is a safe no pharmacological strategy, with positive effects on adults with osteopenia and osteoporosis. © 2016 Asociaci' on Espa~ nola Physiotherapist. Published by Elsevier Espa~ na, SLU All all rights reserved. * author to correspondence. Mail electronic: elisaandrea88@hotmail.com (EA Cobo-Mejia). http://dx.doi.org/10.1016/j.ft.2016.08.002 0211-5638 / © 2016 Asociaci' on Espa~ NOLA Physiotherapists. Published by Elsevier Espa~ na, SLU All rights reserved. How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related health in adults with osteopenia and osteoporosis: systematic review and meta-analysis. Physiotherapy. 2016. + Model FT-424; No. of Pages 10 ARTICLE IN PRESS M. Prieto-Peralta et al. two KEYWORDS Physical activity; Osteoporosis; osteopenia; Systematic review; Meta-analysis Effects of physical activity on health-related quality of life in Adults with osteopenia and osteoporosis: systematic review and meta-analysis Abstract Objective: To Identify the effect of physical activity on quality of life related to health in Adults with osteopenia and osteoporosis. Search strategy: The PubMed / MEDLINE, EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) data, and Scielo seekers and Science Direct Were Consulted. In These randomized clinical trials They Were identified ed. results: Six studies (n = 371) That assessment after ADH low risk of bias and methodological quality were found. No Differences Between groups intervened With physical activity and usual care for Both quality of life as indicators of bone densitometry are Observed, Which is Assumed is Given by the fact That the usual care regularly includes practice of combined exercise the clinical heterogeneity of the studies, Including the type of participants and intervention times do not allow Demonstrate That the impact of physical activity. conclusions: Physical activity Represents a safe and positive effects in osteopenia and osteoporosis Adults with nonpharmacological strategy. © 2016 Asociaci' on Espa~ nola Physiotherapist. Published by Elsevier Espa~ na, SLU All rights reserved. Introduction the score of the T-score, which is the number of standard deviations above or below the average normal BMD of the young adult population of the same sex and race, The diseases bone demineralization constitute a health problem public, why they are thus compares different times are set in the progression of disease: osteopenia or subject to study, to better understand the different factors that lead to loss of bone low bone mineral density when the T-score is less than -1.0 and up -2.5, osteoporosis mass with increased risk of fractures, so that his approach has proposed several below -2.5 and severe osteoporosis: less than strategies prevention and treatment one . - 2.5 plus the presence of fracture 5 . In state States, it is estimated that more than 9.9 million Americans have osteoporosis and other 43.1 million They have low bone mineral density, addition of every two women The main impact of this condition is the increased risk of fractures that occur most frequently at the level of the hip, spine and mu~ neca because and one in five white men have a fracture at some point in life two . To date Colombia does a lower BMD increased risk of fracture 6 . After a fracture can give a complete recovery not have direct statistics, however, Latin study American Vertebral Osteoporosis Study 2012, or else stay with pain, disability or even cause death, which varies according to the He calculated that 2,609,858 and 1,423,559 women 50 å~ affected segment, eg hip is associated with increased mortality to å~ not among the 8.4 and 36%, plus us present osteopenia and osteoporosis respectively equal shape, projected introduce oneself 2.5 times more risk of another fracture in the future; also in chronic that the number of people with these terms increase to 2,884,150 with osteopenia and 1,573,173 spinal presents with pain and deformity generating disability, increased risk with up with osteoporosis for å~ to 5 times further fracture column and 2 to 3 times to have fractures in other parts of no 2020 3 . The Osteoporosis is a condition asymptomatic, characterized by low bone mass the body; and mu~ and impaired microarchitecture bone, it is leading to bone instability and an increased NECA limitation is presented to perform activities of daily living 7.8 . These risk of fractures of the hip, spine and mu~ neca events directly affect the quality of life related to health (HRQOL), altering the mainly. Is pathology is generated around the maintenance and bone metabolism by physical, mental and social functions, in addition to pain management and changes loss of balance between Formation and reabsorption thereof. The speed at which this in health precepción 9 . Therefore, fractures in adults should be considered by health process is generated changes along the lifetime, It is the slowest adulthood, appearing personnel as an important event in the diagnosis and monitoring of osteoporosis 10 . a higher decreased bone mass, affects men and women of all races presenting an increased incidence with aging, in the case of women this process own accelerated by hormonal factors postmenopause 4 . Another important factor is spending on health services, because fractures caused by osteoporosis represent 432,000 hospital admissions and 2.5 million doctor visits in the United States eleven . According to Gonzalez in Colombia fractures in women with osteoporosis show a high economic impact generated by the management of The Organization World Health establishes densitometry bone mineral (DMO) as fractures warning about the need for the study of choice for diagnosis and Monitoring of this condition, it How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related to health in adults with osteopenia and osteoporosis: a systematic review and meta-analysis. Physiotherapy. 2016. + Model FT-424; No. of Pages 10 ARTICLE IN PRESS Effects of physical activity on quality of life in adults with osteoporosis 3 priorization 12 . In addition, it is estimated that although it has strategies pharmacologic Table 1 Selection criteria and Pharmacological and effective for the prevention and treatment, few people Risk Dise~do not factors that use 6 . Among the strategies Preventive measures for the general Randomized controlled trials population are, the intake adequate calcium and vitamin D, the regular practice of exercise for muscle strengthening, avoid consume of snuff and alcohol, and prevention Participants measures falls 1,5,6 . Adults and seniors with osteopenia or osteoporosis (WHO classification according to the first group å~ 18-64 we and the second largest of 65 å~ us) Intervention In As for the physical activity recommendations have reported benefits in programs physical activity unrestricted mode speci fi c training and various walking, jogging, dancing, Tai Chi, pilates or practicing a sport 13 --- 19 , interventions (eg, aerobic, strength, stretch, balance training) example, Granacher et al. 18 and Gillespie et al. 14 , exhibit effects Muscle strengthening and balance in reducing the risk of falls and fractures, likewise, Howe et al. 17 , They highlighted that exercise is effective and safe for prevent waste of bone density in Results measurement postmenopausal women. By Finally, Caputo and Costa 19 They conclude that in women Quality of life related to health (SF-36, QUALEFFO-41, OQLQ, postmenopausal with osteoporosis exercise is a strategy that improves independence OPCW AQoL, GHQ-20, MENQOL) and a positive impact on the quality of life. Thus, the purpose of this review systematics Bone mineral density (bone mineral densitometry of hip, femoral neck literature is to identify the effect of activity physical quality of life related to health adults osteopenia and lumbar / T Score column, x) and osteoporosis. physical activity (PAR LAPAQ, PASE) comparisons usual care as a daily intake of calcium, vitamin D and exercise regularly Maintain current lifestyle strategy search methodological quality Is revision systematics literature was reported according to the guidelines described in PRISMA Score equal to or greater than 5 as the PEDro scale AQoL: The Assessment of Quality statement 20,21 of Life; GHQ-20 General Health Questionnaire; LAPAQ: LASA Physical Activity Questionnaire; MENQOL: The Speci fi c-Menopause Quality of Life; OPCW: The Y at Manual Cochrane for Driving Systematic Reviews interventions version 5.1.0 22 . Osteoporosis Assessment Questionnaire; OQLQ: The Osteoporosis Quality of Life Questionnaire; PAR: Seven-Day Physical Activity Recall; PASE: the Physical Activity Scale The Search was performed by two blinded, independent authors against the results in the months of March and April 2015. To search recommendations were followed Robinson for the Elderly; QUALEFFO-41: Quality of Life Questionnaire of the European Foundation for Osteoporosis; SF-36: The Short Form-36 Health Survey. Source: self made. and Dickersin 2. 3 , with the purpose of obtaining Searches sensitive and speci fi c in compilation of essays clinical Pubmed. He They considered as Boolean operators: [OR physical exercise activity] AND [osteoporosis OR osteopenia] AND [quality of life OR health related quality of life]. He made the search in PubMed / MEDLINE, EMBASE, LILACS and the Cochrane Central Register essays controlled (CENTRAL), added to resources Additional as Scielo seekers and Science Direct. I dont know they applied limitations language with the aim of prevent possible bias idiomatic. Data extraction Two authors independently extraction data which were recorded on a sheet of standard electronic spreadsheet. Process veri fi ed by a third author blinded against the results of other authors. Data extracted from each study were: authors, å~ Is revision included systematic studies experimental that met the provisions established in the Declaration of Helsinki approved by the Committees concerning Ethics, where the patients fi rmed the informed consent. One author made the verification of the considerations ethics publication dise~ in studies included. do not no study sample and allocation, intervention characteristics (intensity, frequency and duration), mode (s) of physical activity implemented and measurement scales thereof, osteopenia or osteoporosis, patient age and outcomes: HRQOL and bone mineral density. Selection of studies A time fi nished the analysis of search results two authors They blinded independently Assessment of methodological quality and risk of bias assessed the study eligibility collected veri fi ed that met the Selection criteria established pursuant Acronym PICO (population, intervention, comparison results) 22 ( Table 1 ). The disagreements resolved by consensus and participation of a third author. Three authors conducted the evaluation of methodological quality and risk of bias of included studies independently, for which the scale was used PEDro 24 , based on the Delphi list 25 . Proposed scale scores How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related health in adults with osteopenia and osteoporosis: systematic review and meta-analysis. Physiotherapy. 2016. + Model FT-424; No. of Pages 10 ARTICLE IN PRESS 4 M. Prieto-Peralta et al. from 0 to 10 for quality methodological controlled trials random. The score for each model metaanalysis. The risk assessment showed an average score of 7 ± 0.75 in the study were obtained from the information available from the published version. A PEDro scale, indicating a methodological consistent quality and a low risk of bias ( table score of 5/10 is It established as the minimum for inclusion in the this review 26 . 3 ). The A not published averaged 2010 ± 0.98. The studies were conducted in Australia 30.32 , Norway 31 , Brazil 33 , Netherlands 3. 4 and the United States 35 . The Figure 1 It presents the flow diagram PRISMA twenty . Measures of result The HRQOL was the measure of Primary outcome assessed in this study. Vinaccia, defines it as a construct which includes different dimensions as including functional status, functioning psychological and operation Social 27 . Based on the literature review, Characteristics of Adult The average age of adults was 66.7 ± 6.35 â~ we are the following instruments were considered for measurement HRQOL: QUALEFFO-41, intervention performed in a total of 191 adults with low bone mineral density and of Life Instrument, Health Survey. included studies are shown. The Osteoporosis Quality of Life Questionnaire, Osteoporosis Assessment Questionnaire, osteoporosis, through exercise programs. In turn, the control group consisted of 180 adults, whom you were given usual care. In the table 2 The characteristics of the Assessment of Quality of Life, The General Health Questionnaire, Menopause Quality He They established as secondary outcome measures: DMO measure through bone Characteristics of interventions in physical activity mineral densitometry, activity level Physical according to validated scales: The physical activity Scale for the Elderly questionnaire, LASA Physical Activity Questionnaire, Self-Reported physical activity. Also in all randomized clinical trials aerobics, such as exercises we were conducted: postural control, muscle strengthening 30.31 , balance, stretching 31 --- 33 , Analysis statistical For him analysis of the heterogeneity, the dispersion was checked with diagram of forest, subsequently the ratio was observed between the confidence intervals, and finally he studied rates of heterogeneity. HRQOL was reported with data continuous, for which the changes were recorded in the average and standard deviation from the line base and post force, walk, weight bearing 3. 4 and taichí 35 . For its part, physical activity interventions had an average duration of 60 ± 0 min per session during 23.41 ± 22.24 weeks on average, where the sessions were held in March ± 0 times a week. These sessions are usually developed in three stages: heating and cooling core activity ( table 2 ). intervention. For the analysis of statistical I two , he They considered the following cutoffs: 0-40% mild heterogeneity, 40-70%, moderate heterogeneity 70-100% high heterogeneity 28 . In Features usual care turn, researchers take into account for the selection of statistical model that protocols Revised intervention in studies including elements are not uniform such as the type of intervention, Usual care, is described by investigators of the articles included in this review, as time, frequency and duration of physical activity, in addition to finding the existence of various shares in the care and treatment of osteopenia and osteoporosis among which are: forms of measuring HRQL and levels physical activity ( table 2 ); This variability among studies, causes Variances are changing so both are employs a random effects model for calculationdaily intake of calcium, vitamin estimates of effect on each outcome assessed in the case where uniformity in the protocols presented and measures the fixed effects model is applied. He they D, regular exercise, fall prevention education and the development of everyday calculated average mean differences and standardized with 95% CI as precision activities. measurement and a value of signification of p <0.05 22 . For calculating estimates effect it used the software established by the Partnership Cochrane Review Manger 5.3 ( RevMan) Adverse events 29 . The included studies reported minor adverse events such as increased muscle injuries and joint pain in 15 participants, which may be due to the underlying disease and not properly follow the instructions 30,35 . Estimates combined effects of outcomes Of the six studies 30 --- 35 including, at the time of analysis of heterogeneity, should take into account the aspects that contributed to the high levels of statistical results heterogeneity, such as: first, the different scales used for measuring HRQL and physical activity level second, the use of various intervention protocols in physical activity added at different times to monitor the primary and secondary variables to Features studies included identify outcomes and results, and the third, Six studies 30 --- 35 ( n = 371) were included in the systematic review and They offered to turn Valid estimates How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related to health in adults with osteopenia and osteoporosis: a systematic review and meta-analysis. Physiotherapy. 2016. + Model ARTICLE IN PRESS FT-424; No. of Pages 10 Effects of physical activity on quality of life in adults with osteoporosis 5 table 2 Characteristics of studies included in the systematic review and meta-analysis study Condition Participants (n) Intervention Results measurement Bennell et al., 2010 30 people with osteoporosis and history Male Female = 17 = experimental group = postural control exercises of fracture column vertebral and muscle strengthening. Time = 10 weeks 3 Qualeffo-41 duration, frequency, intensity = established by experimental group = 11 Age (â~ nos) = 66.2 (8.0) each specialist. Which it was monitored by a weekly self Control group = conventional care Control = 9 Age Group (â~ Bergland et al., 2011 31 nos) = 66.3 (11.8) women with osteoporosis and history Female = 70 experimental group = balance exercises, postural of fracture column vertebral control and stretching. Time = 3 months Length = experimental group = 38 Age (â~ nos) = 70.8 (5.9) Qualeffo-41 60 min / session. Frequency, intensity = adjusted according to the participant's ability. Care conventional control group = Control = 32 Age Group (â~ Bolton nos) = 72.0 (5.8) Women postmenopausal with osteopenia Female = 39 experimental group = muscle strengthening SF36 exercises and stretching time = 52 weeks Duration et al., 2012 32 experimental group = 19 Age (â~ nos) = 60.3 (5.6) = 60 min / session. Frequency = 3 times a week Intensity = adjusted according to the participant's ability. = control group conventional care Age = 20 Control Panel (â~ Madureira women with senile osteoporosis et al., 2010 33 nos) = 56.3 (4.7) Female = 60 experimental group = 30 Age (â~ nos) = 74.75 (4.82) = 30 Age Group Control (â~ experimental group = balance training time = 12 OPCW (Osteoporosis months. Duration = 1 hour / session frequency = 3 Assessment sessions / week Intensity = adjusted according to Questionnaire) the participant's ability Control group = conventional care nos) = 73.4 (4.61) Smulders et al., 2010 3. 4 people with osteoporosis and falls related Female = 106 experimental group = walking, weight-bearing to this condition exercises, correction of gait and falling techniques. experimental group = 50 Age (â~ nos) = 70.5 (5.0) Control group = 46 Age (å~ Qualeffo-41 time = 5.5 weeks. Duration, frequency, intensity = they adjusted according to the participant's ability Control group = conventional care nos) = 71.6 (4.4) Wayne Women postmenopausal with osteopenia Female = 86 experimental group = tai chi exercises. Time = 9 SF36 weeks. Duration, frequency, intensity = they et al., 2012 35 experimental group = 43 Age (å~ nos) = 58.8 (5.6) Control adjusted according to the participant's ability Control group = conventional care = 43 Age Group (å~ nos) = 60.4 (5.3) Source: own calculations. the characteristics population, whereas are adults between 50 and 75 å~ Results of primary measures We, who are also in differences tes stadiums osteoporosis joined the comorbidities elements allow to speak of clinical The analysis included studies showed a high level of statistical heterogeneity based heterogeneity. on the relationship How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related health in adults with osteopenia and osteoporosis: systematic review and meta-analysis. Physiotherapy. 2016. + Model ARTICLE IN PRESS FT-424; No. of Pages 10 6 M. Prieto-Peralta et al. table 3 Quality assessment and methodological bias risk with PEDro scale (n = 6) Reference P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 Total Bennell et al., 2010 30 + + + - - + + + + + 8/10 Bergland et al., 2011 31 + + + - - + - + + + 7/10 Bolton et al., 2012 32 + + + - - + + - + + 7/10 Madureira et al., 2010 33 + - + - - + + - + + 6/10 Smulders et al., 2010 3. 4 + + + - - + + + + + 8/10 Wayne et al., 2012 35 + - + - - + + + + + 7/10 Percentage of fulfillment 100% 66% 100% 0% 0% 100% 83% 66% 100% 100% Pedro (Physiotherapy Evidence Database): + Yes; - do not. P1: assignment random; P2: allocation concealment; P3: Similar groups in baseline; P4: Blinding of participants; P5: Blinding of therapists; Q6: assessor blinding; P7: dropouts <15%; Q8: intention to treat analysis; P9: reported differences between groups; P10: point estimate and variability reported. Source: own calculations. Number of studies identified by the Identified in other studies search databases sources (n = 2) ID (N = 520) Number of studies after eliminating duplicates screening (N = 288) Excluded studies (n = 191) Number of studies evaluated in (Publishing letters or other systematic reviews title / abstract (n = 234) studies, animal models) Excluded studies after text analysis full (n = 37) Intervention (n = 11) Unsupervised (n = 1) Studies included for analysis in text Design (n = 7) evaluate outcome full (n = 43) Eligibility (n = 12) High risk of bias (n = 5) Presentation of results (n = 1) Studies included in the systematic review and Inclusion metaanalysis (N = 6) Figure 1 PRISMA flow diagram. Conversely I presented between I2 and Chi square function Social, Contrary to this lumbar - hip and physical activity level ( table 4 ). In turn, the tama~ evidence homogeneity measurements primary and physical function, mental function, perceived health, pain and global quality lifetime. In Regarding this secondary measures evidence to bone densitometry column no effect suggests that the practice of physical activity and different activities included in the usual care have similar effects on most dimensions of HRQOL ( Fig. two ). How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related to health in adults with osteopenia and osteoporosis: a systematic review and meta-analysis. Physiotherapy. 2016. + Model ARTICLE IN PRESS FT-424; No. of Pages 10 Effects of physical activity on quality of life in adults with osteoporosis table 4 Estimates of tama~ 7 no effect for comparisons and secondary outcomes included in meta-analysis Result Tama~ estimate Effect size no effect random A highly diversified effects model --- DME - DM * (95% CI) statistics (I two) Function physical - 0.00; 95% CI [-0.23 --- 0.23] ( p = 1.00) 33% Function mental 0.10; 95% CI [-0.13 - 0.33] ( p = 0,41) Four. Five% Function Social - 0.21; 95% CI [-0.66 --- 0.25] 67% Perceived health - 0.30; 95% CI [-8.75 --- 9.35] ( p = 0.95) Pain - 0.15; 95% CI [-0.46 --- 0.15] ( p = 0.32) 0% Scale overall quality of life - 0.10; 95% CI [-0.34 --- 0.13] ( p = 0,39) 17% primary (HRQOL) 0% secondary DMO column lumbar - 0.01; 95% CI [-0.08 --- 0.06] ( p = 0,77) 0% DMO hip 0.02; 95% CI [-0.02 --- 0.06] ( p = 0.38) 0% Level of physical activity - 0.17; 95% CI [-0.44 --- 0.11] ( p = 0.23) 0% HRQOL: quality of life health-related; DM *: mean difference; SMD standardized mean difference; BMD: mineral density that is; I two: differences statistically significant ( p < 0.05). Source: own calculations. results measurements high schools parameters for prescribing physical activity and in turn varied responses to adapt to it. The emphasis on these study groups may be due to hormonal effects of Of same Thus, the effects are similar secondary measures for the two groups which no menopause on BMD and increased incidence of fractures of the spine and hip in esTabla tablece predominance of one of the two interventions (physical activity women, without ignoring history as smoking, early menopause and not perform physical activity 36 . --- watch out usual) ( table 4 ). As evidenced in the analysis results primary and side for the two groups, can be result of regular practice of exercise handles in the control group, which makes the development of other physical activity does not show differences statistically signi fi cant between groups. The results show that adults with low BMD and osteoporosis intervention with physical activity or usual care are equally safe and have effects on HRQOL and indicators BMD spine, hip and physical activity level, this may due to the control group practiced regularly exercise variable that does not really possible to determine the effects of a program according to the procedures outlined in the studies, in addition to the usual care education programs are added in disease, diet and healthy Discussion lifestyles taking into account the results of the eligible randomized trials to answer the research question that had low risk of bias 30 --- 35 . In relation to study subjects should be considered to be identi fi ed two groups of women Postmenopausal and the women with osteoporosis and fracture spine, condition that leads to think of a more advanced stage of the disease, which supports different Figure 2 osteopenia, osteoporosis and related quality of life (HRQOL). Source: own calculations. How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related health in adults with osteopenia and osteoporosis: systematic review and meta-analysis. Physiotherapy. 2016. + Model FT-424; No. of Pages 10 ARTICLE IN PRESS 8 M. Prieto-Peralta et al. In turn, the studies where They worked with patients with osteoporosis report greater bone mass by å~ difficulties in carrying out the exercise, which is because mostly this group people are not in lumbar spine and femoral neck in pre- and postmenopausal women 42 . older and more comorbidities and complications of the disease as fracture column vertebral, which are not observed improvements in BMD, but as the gain is maintaining levels, observed no improvement turn signi fi cant statistically combining when HRQOL studies from Implications for practice areas such as mobility, decreased pain and falls, the state of encouragement and social The results reported in this study support the recommendations of management relationships 33.34 , This contrasts with improvements signi fi cant individually reported in articles guidelines for osteoporosis, as to the beneficent effects and insurance cos physical example in pain 30.31 . activity in adults with osteopenia and osteoporosis fi. Therefore the practice of physical activity of at least 150 minutes a week, where strength training and weight-bearing, work force and posture is done to improve outcomes and HRQOL, pain management, risk of falls is indicated, BMD of spine and hip, as a point of non-pharmacological treatment which eases symptoms and improves independence. These findings to the comprehensive management of patients with this condition In relation to duration times, frequencies and intensities handled in different should be applied, settling in local management guidelines, which promote access to protocols activity physics, one can say that variability is not possible decide really the this therapeutic point to the entire population. 43 and prevention of disorders involving effects on BMD and low osteoporosis, example some have a frequency less than three the movement limitations in daily activities and movements like walking conducting, times a week, less than two months duration and intensities that fail to represent running and jumping 44 . modifications signi fi cant in BMD, this type of activity is added made in the protocols including from work resistance cardiovascular, to the work force strengthening muscular, load bearing, work balance and position designed to prevent falls. These protocols respond to what currently it proposed as Evidence-based recommendations for prescribing physical activity, where among others, reinforcing the effect positive aerobic training like strength training combined with balance training for preventing risk of falls and fractures 14.36 . The above responds to physical activity it promotes the formation of bone and stimulates osteogenic differentiation and activity osteoblasts and osteocytes by mechanical effects and in turn inhibits osteoclastogenesis and resorption that is, improving BTMs, the What is it promoted by activities such as training of resistance and impact exercise --jump additionally have described these same benefits with vibration therapy 37 --- 39 . conclusion The usual practice of physical activity and usual care lead to positive effects on HRQOL, as well as improving biological indicators such as BMD. The results on HRQOL may be awarded to the heterogeneity of the population and intervention protocols and monitoring. ethical responsibilities Do not However, according to exercise prescription is recommended for obtain Protection of people and animals. The authors state that this research has not been experiments in humans or animals. positive effects, work during the 2-3 months with a 40-70% intensity frequency heart maximum for 20 to 30 min per session and 3 to 5 times week for aerobic training, while for the strength training, it is recommended that a labor intensity of 50% of 1 RM (> 20 RM), the which should increase progressively with a volume of 2 to 3 series 8 repetitions and two Confidentiality of the data. The authors declare that this article does not appear sessions per week for 20 to 40 min per session 39,40 . patient data. Right to privacy and informed consent. The authors declare that this article does not appear patient data. Also, for the balance training evidence shows that people who make ≥ 5,000 steps per day present top health conditions and decreased falls 41 . Similarly, physical activity produces excess effects that can decrease negative BMD 36 . Financing This work was fi nanced entirely by the University of Boyacá. Continuing, is finds that high-intensity exercise reduces the incidence of hip fracture by 50% in tracking 12 women â~ I we, together with that every time of brisk pace reduces the incidence of 6%, increases bone mineral density With fl ict of interest of the hip, spine and mu~ NECA, decreasing at least 1% of loss The authors declare no con fl ict of interest. How cite this Article: Prieto-Peralta M, et al. Effects of physical activity on quality of life related to health in adults with osteopenia and osteoporosis: a systematic review and meta-analysis. 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