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Promoting and impeding factors for exercise in patients with osteopenia or osteoporosis: A systematic review
Yi Liu1, Chenxin Zhang1, Liping Zhang1
1School of Nursing, Xinjiang Medical University, Urumqi 830017, Xinjiang, China.
Background:
Osteopenia and osteoporosis are pressing public health issues associated with aging.
Objective:
To systematically identify and synthesize the facilitators and barriers to exercise intervention adherence among individuals with osteopenia or osteoporosis.
Design:
Systematic review.
Data Sources:
PubMed, Cochrane, EMBASE, Medline (Ovid), and Web of Science from inception to 31 March 2025.
Methods:
Inclusion criteria: (1) Population: individuals with osteopenia/osteoporosis; (2) Intervention: exercise interventions targeting osteopenia/osteoporosis-related impairments; (3) Comparison: clear control group; (4) Outcomes: primary (adherence facilitators/barriers, e.g., pedometer/log data); secondary (dropout/adherence, adherence-promotion strategies, participant views); (5) Study type: randomized controlled trials. Exclusion criteria: (1) studies that were duplicates or had overlapping datasets; (2) incomplete publications/insufficient extractable data; (3) non-English literature. Two reviewers independently extracted data in duplicate and assessed bias risk.
Results:
Thirty randomized controlled trials tested median 31-week programs (aerobic, balance, resistance, flexibility, impact, or functional training). Participants adhered to 83 % (59-100 %) of sessions; "lack of time" was the primary barrier (n=11/30) . Nine trials had low overall bias risk; allocation concealment or participant blinding was infrequently reported.
Conclusion:
For individuals with osteopenia or osteoporosis, key barriers to activity were lack of time and existing health issues. Conversely, facilitators included expert coaching, engaging routines, group camaraderie, accessible facilities, and safety precautions. Future researchers should explore bone health-optimized exercises, identify activity facilitators/barriers, and develop tailored approaches to sustain patients' fitness regimens.
Registration:
The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration CRD420251013691).
Tweetable Abstract:
Exercise boosts bone health but poor adherence limits efficacy. Our systematic review identifies top facilitators and barriers to optimize adherence.
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