A claim you hear on longevity podcasts
The claim checked: Muscle and flexibility make a fall much less likely to break a bone Hear it at 44:38
Eight of ten studies, mostly in older adults, found resistance training kept or added muscle. Two did not: a weight-loss trial saw no fat-free mass preserved, and a small sarcopenia trial saw no significant muscle gain.
Computed from 10 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.
“but if you've got muscles and you're flexible you do say Pilates in your older age and stretch build up the muscles particularly around your waist uh then you're much less likely to break a bone when you fall”
pooled analysis · 2015 · landmark
“We pooled weighted mean SMDbs across the nine studies and observed a small effect (mean SMDbs = 0.42; 95 % CI 0.18–0.66) of RT on measures of muscle morphology.”
Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med
Who: Healthy adults aged 60-90 (study mean age >=65) in RCTs of machine-based resistance training vs inactive controls
PMID 26420238
pooled analysis · 2011 · landmark
“The pooled estimate of LBM change from baseline to postintervention, combining data from 81 treatment cohorts (49 studies) was 1.1 kg (95% CI, 0.9 kg to 1.2 kg) (p < 0.001).”
Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc
Who: adults aged 50 and older (mostly 60-75, mean 65.5 y), mostly healthy, men and women
PMID 20543750
pooled analysis · 2019 · landmark
“Evidence shows a positive and significant effect of resistance training on muscle mass, muscle strength, and physical performance.”
Exercise Interventions for the Prevention and Treatment of Sarcopenia. A Systematic Umbrella Review. J Nutr Health Aging
Who: older adults (mostly 65+) in systematic reviews of exercise for sarcopenia outcomes
PMID 31233069
controlled trial · 2019 · landmark
“The main finding of this intervention study is that an easy-to-use, functional resistance training program was effective in maintaining functional strength and increasing muscle mass in older adults with pre-sarcopenia.”
Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial. J Am Med Dir Assoc
Who: 70 Swedish men and women aged 70 with pre-sarcopenia (low appendicular lean mass index) from the Healthy Ageing Initiative, Umeå
PMID 30414822
controlled trial · 2017
“This prospective study revealed that 12 weeks of elastic RET exerted positive effects on the body composition and functional mobility outcomes in elderly women with sarcopenic obesity.”
Effects of elastic resistance exercise on body composition and physical capacity in older women with sarcopenic obesity: A CONSORT-compliant prospective randomized controlled trial. Medicine (Baltimore)
Who: Women aged 60-80 (mean 67.3) with sarcopenic obesity, Taiwan
PMID 28591061
controlled trial · 2018
“In conclusion, this prospective study demonstrated that 12 weeks of elastic RET exerted positive benefits on muscle mass and functional capacity outcomes in older women with sarcopenic obesity.”
Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial. Sci Rep
Who: 56 women aged 60-80 (mean 67.3 ± 5.1) with sarcopenic obesity, Taipei
PMID 29396436
pooled analysis · 2022
“This study found that resistance training significantly improved the skeletal muscle mass index of patients with sarcopenia.”
The Effect of Resistance Training on the Rehabilitation of Elderly Patients with Sarcopenia: A Meta-Analysis. Int J Environ Res Public Health
Who: RCTs of adults aged 60-91 meeting EWGSOP/AWGS sarcopenia criteria
PMID 36497565
pooled analysis · 2019 · landmark
“Averaged percentage increases of muscle mass were 6.2 ± 5.1% and 4.2 ± 4.2% in the LL-BFR and HL groups, respectively.”
Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med
Who: Healthy older adults (> 50 years) in controlled training studies
PMID 30306467
controlled trial · 2025 · landmark
“For ASMI, only the WBVT group showed a significant increase (P = 0.004) compared to baseline.”
Effects of 12-week whole-body vibration training versus resistance training in older people with sarcopenia. Sci Rep
Who: 27 physically inactive adults aged 65 or older with sarcopenia (AWGS-2019), mean age 73.6, Chongming, Shanghai, China
PMID 40011687
controlled trial · 2017
“In the present randomized controlled trial in overweight and obese older adults during weight loss, we observed no significant effect of the high protein diet (although at a lower level than targeted) and resistance exercise on FFM preservation and no statistically significant interaction between high protein and resistance exercise.”
Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults: a randomized controlled trial. Nutr J
Who: overweight and obese adults aged 55 and over (mean age 62.4, 36% male, mean BMI 32.2) in Amsterdam on a hypocaloric diet
PMID 28166780
None.
Four pooled analyses and reviews found exercise cut fall-related fractures. Two large trials found no drop, and four other studies found smaller or unclear effects.
Computed from 10 studies that test this point, each judged by two readers, in full. 6 more studies are waiting for a full read and do not count yet.
pooled analysis · 2020
“The findings of this study suggested that exercise intervention reduces fall-related fractures in older adults.”
Effectiveness of exercise intervention on fall-related fractures in older adults: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatr
Who: Older adults (trial inclusion age >=50) in 20 RCTs of exercise programs (mostly strength, balance, walking; some Tai Chi) vs usual care
PMID 32887571
pooled analysis · 2019
“Among the fall-induced injuries, the events that needed medical care or caused fractures were also pronouncedly decreased by exercise intervention, with RR 0.681 (0.562–0.825, 10 studies, 2756 participants, I 2 = 0%) and 0.561 (0.366–0.860, 11 studies, 2855 participants, I 2 = 0%), respectively (Fig. 3 ).”
The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr
Who: Adults aged 60 and over in RCTs, including people with osteoporosis, high fall risk and stroke survivors, in community and institutional settings
PMID 31795944
pooled analysis · 2022
“The mixed-effects conditional Poisson regression revealed significant effects of exercise on low-trauma overall incidence (rate) ratio (IR 0.67, 95% confidence interval [95% CI] 0.51-0.87) and major osteoporotic fractures IR (0.69, 95% CI 0.52-0.92).”
Exercise Reduces the Number of Overall and Major Osteoporotic Fractures in Adults. Does Supervision Make a Difference? Systematic Review and Meta-Analysis. J Bone Miner Res
Who: community-dwelling adults aged 45-95 without fracture-related therapies/diseases in controlled exercise trials
PMID 36082625
systematic review · 2019 · landmark
“Also, fall prevention programs using multicomponent activity reduced the risk of fall-related bone fractures by 40-66% among older adults in community and home settings.”
Physical Activity, Injurious Falls, and Physical Function in Aging: An Umbrella Review. Med Sci Sports Exerc
Who: Community-dwelling older adults; umbrella review of systematic reviews/meta-analyses of RCTs plus cohort and case-control studies (non-ambulatory, hospitalized excluded)
PMID 31095087
systematic review · 2021 · landmark
“This was no longer evident once disentangled down to the C‐NMA level, where no effect of exercise on fracture outcomes was observed.”
Interventions for preventing falls and fall-related fractures in community-dwelling older adults: A systematic review and network meta-analysis. J Am Geriatr Soc
Who: community-dwelling adults aged 65+ in RCTs of fall-prevention interventions
PMID 34318929
controlled trial · 2016
“In this trial, which was underpowered to detect small, but possibly important reductions in serious fall injuries, a structured physical activity program compared with a health education program did not reduce the risk of serious fall injuries among sedentary older people with functional limitations.”
Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ
Who: Sedentary adults aged 70-89 with functional limitations (SPPB <=9) able to walk 400 m
PMID 26842425
controlled trial · 2010
“The incidence rate of fractures during the total follow-up among women in the exercise group vs women in the control group was 0.05 vs 0.08 per 1000 person-years (Poisson incidence rate ratio, 0.68; 95% confidence interval, 0.34-1.32).”
Long-term outcomes of exercise: follow-up of a randomized trial in older women with osteopenia. Arch Intern Med
Who: 160 Finnish women aged 70-73 at baseline with osteopenia, population-based sample from Oulu
PMID 20876406
pooled analysis · 2024 · landmark
“Exercise interventions were not statistically significantly associated with a reduction in the risk of an individual having of an injurious fall (RR, 0.90 [95% CI, 0.79–1.02]; I2=26.7%; k=9; n=3,924) or a fall-related fracture (RR range 0.36 [95% CI, 0.15–0.89] to 1.95 (95% CI, 0.22–17.3]; k=4; n=7,994), or the number of fall-related fractures (IRR, 0.81 [95% CI, 0.57–1.15]; I2=39.1%; k=8; n=8,537) (Figure 3; eFigures 17–18).”
Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA
Who: community-dwelling adults aged 65+ in RCTs of fall prevention
PMID 38833257
controlled trial · 2021
“There was no difference in the fracture rate between the advice and exercise arms (rate ratio 1.20, 95% confidence interval 0.91 to 1.59) or between the advice and multifactorial falls prevention arms (rate ratio 1.30, 95% confidence interval 0.99 to 1.71).”
Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT. Health Technol Assess
Who: 9803 community-dwelling people aged 70-101 (mean 78, 52.5% female) in 63 English general practices
PMID 34075875
controlled trial · 2020 · landmark
“There were no statistically significant differences for any of the 3 treatments compared with their respective placebo/control in the SPPB, the MoCA, or nonvertebral fractures (Table 2 and Table 3).”
Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults: The DO-HEALTH Randomized Clinical Trial. JAMA
Who: Community-dwelling adults aged >=70 without major health events in prior 5 years, 5 European countries (mean age 74.9, 61.7% women)
PMID 33170239
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