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Maja Zamoscinska, Irene R. Faber, and Dirk Büsch

Clinical Scenario: Reduced bone mineral density (BMD) is a serious condition in older adults. The mild form, osteopenia, is often a precursor of osteoporosis. Osteoporosis is a pathological condition and a global health problem as it is one of the most common diseases in developed countries. Finding solutions for prevention and therapy should be prioritized. Therefore, the critically appraised topic focuses on strength training as a treatment to counteract a further decline in BMD in older adults. Clinical Question: Is strength training beneficial in increasing BMD in older people with osteopenia or osteoporosis? Summary of Key Findings: Four of the 5 reviewed studies with the highest evidence showed a significant increase in lumbar spine BMD after strength training interventions in comparison with control groups. The fifth study confirmed the maintenance of lumbar spine density due to conducted exercises. Moreover, 3 reviewed studies revealed increasing BMD at the femoral neck after strength training when compared with controls, which appeared significant in 2 of them. Clinical Bottom Line: The findings indicate that strength training has a significant positive influence on BMD in older women (ie, postmenopausal) with osteoporosis or osteopenia. However, it is not recommended to only rely on strength training as the increase of BMD may not appear fast enough to reach the minimal desired values. A combination of strength training and supplements/medication seems most adequate. Generalization of the findings to older men with reduced BMD should be done with caution due to the lack of studies. Strength of Recommendation: There is grade B of recommendation to support the validity of strength training for older women in postmenopausal phase with reduced BMD.

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Andrea S. Hartmann, Florian Steenbergen, Silja Vocks, Dirk Büsch, and Manuel Waldorf

Fitness training to attain the lean body ideal is becoming increasingly popular among women. However, it remains unclear how the drive for leanness (DL), as compared to the drives for thinness (DT) and muscularity (DM), relates to body image pathology and substance use in female weight-trainers. Participants (N = 168) completed a survey assessing DL, DT, DM, eating and body dysmorphic disorder pathology, and substance use. DT and DM were related to eating disorder and body dysmorphic disorder symptoms (all r ≥ .29; all ps < .01), while DL only to the former (r = .19, p < .05). Supplement use was associated with DL and DM (r = .17 and .55; both p < .01) and pharmaceutical use with DT and DM (r ≥ .21; both p < .01). Female weight-trainers should not be neglected in body image disorder prevention, with a particular focus on DT and DM.