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Updated: Jan 11, 2026
Visualization of Intensity Levels to Reduce the Gap Between Self-Reported and Directly Measured Physical Activity
Published on: March 7, 2019
What is the association between physical activity and fracture risk in middle-aged adults (aged 30-60): a systematic
Catherine Rolls1,2,3, Oliver Bastiani4, Manuel Antuna5
1Translational and Applied Research Group, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK. catherine.rolls@bristol.ac.uk.
Background:
This systematic review examines the relationship between habitual physical activity (PA) in mid-life and fracture outcomes.
Objectives:
To determine whether habitual physical activity undertaken in mid-life is associated with the risk of fractures occurring at any later time.
Methods:
We searched PubMed, CINAHL, and Embase (from inception to May 2025) and included non-experimental studies reporting a relationship between habitual physical activity undertaken in mid-life and a subsequent fracture. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was established with the GRADE approach.
Results:
From 1779 abstracts, we included 10 cohort studies and 3 case-control studies. There was high variation in how physical activity was measured and categorised across studies, limiting comparability. Due to study heterogeneity in exposure and outcome reporting, we conducted a synthesis without meta-analysis (SWIM). Following the GRADE approach, we found low certainty of evidence for a protective effect of moderate activity in mid-life on hip fracture in men (n = 2) and moderate certainty of evidence for a protective effect of high physical activity in mid-life on hip fracture in women (n = 4). There was very low certainty of evidence for the effect of either moderate or high activity on other types of fracture outcomes in men or women (n = 3). Qualitative review of two large studies of moderate to high quality provided further support for these findings.
Conclusions:
The temporal relationship between physical activity intensity in mid-life and subsequent fracture risk remains unclear. Further studies using device-measured physical activity and detailed time-to-event data are required.
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