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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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Catherine Applegate, Mackenzie Mueller and Krystle E. Zuniga

Diet composition can affect systemic pH and acid-base regulation, which may in turn influence exercise performance. An acidic environment in the muscle impairs performance and contributes to fatigue; therefore, current trends in sports nutrition place importance on maximizing the alkalinity of the body with ergogenic aids and dietary strategies. This review examines the evidence on the effects of dietary manipulations on acid load and exercise performance. Ten studies that investigated the effect of high versus low dietary acid loads on athletic performance generally identified that low dietary acid loads increased plasma pH, but did not consistently improve exercise performance at maximal or submaximal exercise intensities. In addition, the few studies conducted have several limitations including lack of female subjects and use of exercise tests exclusive to cycling or treadmill running. Although the research does not strongly support a performance benefit from low dietary acid loads, a more alkaline dietary pattern may be beneficial for overall health, as dietary induced acidosis has been associated with greater risk of cardiovascular disease and bone disease. The review includes dietary recommendations for athletes to reduce dietary acid load while still meeting sports nutrition recommendations.

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Alessandra Madia Mantovani, Manoel Carlos Spiguel de Lima, Luis Alberto Gobbo, Enio Ricardo Vaz Ronque, Marcelo Romanzini, Bruna Camilo Turi-Lynch, Jamile Sanches Codogno and Rômulo Araújo Fernandes

risk of osteoporosis and other bone diseases. In this cross-sectional study, 36.4% of the participants reported participation in organized sport during childhood or adolescence. A similar rate has been observed among Brazilian adults (35.5% of the individuals aged 50 y or older reported sports

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Lorraine Cale and Jo Harris

functional capacity) (exercise effects)  c. explain a range of long-term benefits of exercise on physical health (e.g., reduced risk of chronic disease—heart disease, reduced risk of bone disease—osteoporosis, reduced risk of some health conditions—obesity, back pain, and improved management of some health

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Alon Eliakim, Ita Litmanovitz and Dan Nemet

technologies, has placed an increased need to address other preterm diseases that develop later in the neonatal period like osteopenia of prematurity ( 27 ). Metabolic bone disease is relatively common in preterm infants because the period of greatest bone mineral accretion occurs in the last trimester of

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Caroline Lisee, Tom Birchmeier, Arthur Yan, Brent Geers, Kaitlin O’Hagan, Callum Davis and Christopher Kuenze

. Participants Due to an audio data collection error, only 26 participants were included. Exclusion criteria included history of lower-extremity injury that required clinical care within the past 3 months, family history of bone disease which predisposed participants to fracture, and acute or chronic conditions

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Panagiota Klentrou, Kirina Angrish, Nafisa Awadia, Nigel Kurgan, Rozalia Kouvelioti and Bareket Falk

. 2006 ; 39 ( 5 ): 1043 – 7 . PubMed doi:10.1016/j.bone.2006.05.017 10.1016/j.bone.2006.05.017 16860618 15. Kim JH , Liu X , Wang J , et al . Wnt signaling in bone formation and its therapeutic potential for bone diseases . Ther Adv Musculoskelet Dis . 2013 ; 5 ( 1 ): 13 – 31 . PubMed doi:10

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Jennifer Dekker, Katlynne Nelson, Nigel Kurgan, Bareket Falk, Andrea Josse and Panagiota Klentrou

. Growth at Adolescence . 2nd ed . Oxford, UK : Blackwell Scientific Publications ; 1962 . 41. Westendorf JJ , Kahler RA , Schroeder TM . Wnt signaling in osteoblasts and bone diseases . Gene . 2004 ; 341 : 19 – 39 . PubMed doi:10.1016/j.gene.2004.06.044 10.1016/j.gene.2004.06.044 15474285

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Heather L. Colleran, Andrea Hiatt, Laurie Wideman and Cheryl A. Lovelady

mineral density changes during lactation: maternal, dietary, and biochemical correlates . Am J Clin Nutr . 1997 ; 65 ( 6 ): 1738 – 1746 . PubMed ID: 9174469 doi:10.1093/ajcn/65.6.1738 9174469 10.1093/ajcn/65.6.1738 3. National Institute for Health Osteoporosis and Related Bone Disease National

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Graeme L. Close, Craig Sale, Keith Baar and Stephane Bermon

, 655 – 670 . PubMed ID: 24435468 doi:10.1007/s40279-013-0137-7 10.1007/s40279-013-0137-7 Paterson , C.R. ( 1988 ). Collagen chemistry and the brittle bone diseases . Endeavour, 12 , 56 – 59 . PubMed ID: 2458906 10.1016/0160-9327(88)90081-6 Peeling , P. , Binnie , M.J. , Goods , P