Objective: To conduct a systematic review and network meta-analysis on the effects of traditional Chinese fitness exercises on bone mineral density (BMD) among middle-aged and elderly individuals.
Methods: Randomized controlled trials were collected from seven electronic databases: PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, VIP, and Wan fang. Studies were selected according to the PICOS principles. Totally 27, 28, 12 and 16 studies pertaining to lumbar spine BMD, femoral neck BMD, greater trochanter BMD, and Ward's triangle BMD, respectively, were comprehensively collected. The effectiveness of various exercise interventions was compared via network meta-analysis using the surface under the cumulative ranking area (SUCRA) to rank effectiveness.
Results: Thirty one studies were included in the risk assessment and network meta-analysis. In the network diagrams formed by the four BMD outcome measures, closed loops were identified within sequences Ba DuanJin, Yi JinJing, and CON; sequences Ba DuanJin, Wu QinXi, and CON; sequences Yi JinJing, Wu QinXi, and CON, allowing for direct and indirect comparisons. Tai Chi, Ba DuanJin, Yi JinJing, and Wu QinXi affected BMD in varying ways. As for lumbar spine BMD, the effect of Yi JinJing was ranked first (SUCRA = 69.3 %), followed by Wu QinXi (SUCRA = 66.7 %). In femoral neck BMD, Ba DuanJin was most the effective (SUCRA = 64.9 %). Tai Chi was ranked the highest in both greater trochanter BMD (SUCRA = 66.7 %) and Ward's triangle BMD (SUCRA = 61.6 %). Inconsistency assessment showed high reliability.
Conclusion: Traditional Chinese exercises may provide safe and feasible interventions for improving BMD in middle-aged and elderly people. Although there are no significant differences among most interventions, the SUCRA rankings suggest each exercise has potential advantages in different areas, providing a reference for personalized bone health management.
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