Examining how resistance training affects bone strength in older adults with rheumatic diseases: a systematic review

Rheumatic diseases significantly impact global healthcare through disability, lost productivity, and reduced quality of life, making them an important focus for researchers. As physiological changes associated with aging decrease bone mineral density, rheumatic diseases further elevate fracture risk in older adults. Resistance training has been shown to counteract age-related declines through increases in muscle, strength, and bone mineral density, demonstrating its potential for mitigating bone mineral density loss. This systematic review examines the effectiveness of resistance training interventions in maintaining or improving bone mineral density in older adults with rheumatic diseases, an issue of relevance given impaired skeletal integrity linked to these diseases.

Articles were included if written in English, published after December 31, 1999, and in peer-reviewed journals with full-text, examined adults aged 65 years and above with diagnosed rheumatic disease, and used prospective longitudinal resistance training interventions on bone mineral density outcomes. Through the Web of Science Core Collection, SPORTDiscus (EBSCOhost), PubMed, ScienceDirect, and Wiley Online Library databases, the search yielded 17 eligible studies, of which 12 were deemed high-quality using the PEDro scale.

Results were organized into four themes: (1) Resistance training alone on bone mineral density, (2) Combining resistance training with supplement intake, (3) Pairing resistance training with other exercises, and (4) How resistance training influences balance and fall risk. While most studies showed that resistance training positively impacts bone health, interpretations are limited as supplements or additional exercises were often combined with resistance training.

Resistance training interventions appear to be well tolerated in older individuals and generally have a positive impact on bone health. Nevertheless, we propose that future research should focus more on longitudinal resistance training-only interventions to isolate the specific effects of resistance training on bone mineral density, in addition to prioritizing high-quality randomized controlled trials to strengthen the evidence base.