The Effect of Aquatic Vs Land Exercise on Bone Mineral Density and Balance among Postmenopausal Women with Osteoporosis

Document Type : Original Article

Authors

1 Department of Sports Biomechanics, Faculty of Physical Education and Sports Science, CT.C,, Islamic Azad University, Tehran, Iran

2 Department of Biomechanics and Sport Injuries,, Kharazmi University, Tehran, Iran

3 Department of Sport Biomechanics and Rehabilitation, Kinesiology Research Center, Kharazmi University, Tehran, Iran

4 Department of Mechanical Engineering, CT.C,, Islamic Azad University, Tehran, Iran

Abstract

Purpose:
Osteoporosis is one of the most prevalent systemic bone diseases. The present study aimed to investigate the effects of 12 weeks of aquatic and land-based exercise on bone mineral density and postural balance in postmenopausal women with osteoporosis.
Methods:
This semi-experimental study was conducted on 36 women aged 50 to 65 years diagnosed with osteoporosis. Participants were randomly assigned to three groups: aquatic exercise, land-based exercise, and control. The intervention groups performed balance-strength training for 12 weeks (three sessions per week). Bone mineral density (BMD) of the femoral neck and lumbar spine, as well as postural balance, were assessed by calculating the mean center of pressure (COP) velocity in anterior-posterior (AP) and medial-lateral (ML) directions during four static balance tests: (1) two-legged stand with eyes open (TLEO), (2) two-legged stand with eyes closed (TLEC), (3) semi-tandem stand with eyes open (STEO), and (4) semi-tandem stand with eyes closed (STEC). Data were analyzed using paired t-tests and ANCOVA in SPSS.
Results:
Significant between-group differences were observed in BMD and functional balance between the exercise and control groups (p<0.001, η²≥0.14). Compared to the aquatic group, the land-based exercise group showed greater improvements in BMD with larger effect sizes. Conversely, the aquatic group demonstrated significantly greater improvements in balance performance in TLEO and STEC (AP and ML), as well as in TLEC (ML), compared to the land-based group (p≤0.05, η²≥0.14).
Conclusion:
Land-based balance-strength exercises significantly improve bone mineral density, while aquatic exercises markedly enhance functional balance in postmenopausal women with osteoporosis. Therefore, combining both modalities may offer an effective strategy for managing osteoporosis.

Keywords

References

  1. Erhan B, Ataker Y. Rehabilitation of patients with osteoporotic fractures. J Clin Densitom 2020; 23(4): 534-538.
  2. Walker MD, Shane E. Postmenopausal osteoporosis. N Engl J Med 2023; 389(21): 1979-1991.
  3. Rao M, Awasthi M. A review on interventions to prevent osteoporosis and improve fracture healing in osteoporotic patients. AIMS Med Sci 2020;7(4): 243-268.
  4. Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y, Afanador-Restrepo DF, et al. Current status of the diagnosis and management of osteoporosis. Int J Mol Sci 2022; 23(16): 9465.
  5. Hughes JM. Revisiting Harold Frost's Mechanostat Theory of Bone Functional Adaptation: New Interpretations Based on New Evidence: University of Minnesota; 2010.
  6. Graves M, Snyder K, McFelea J, Szczepanski J, et al. Quantitative Measurement of the Improvement Derived from a 10-Mo Progressive Exercise Program to Improve Balance and Function in Women at Increased Risk for Fragility Fractures. J Clin Densitom 2020; 23(2): 286-293.
  7. Seyedjafari E, Sahebozamani M, Ebrahimipour E. Effect of Eight Weeks of Water Exercises on Deep Part of the Pool on the Static Balance of the Elderly Man. SALMAND 2017; 12(3): 384-393.
  8. Zaravar F, Tamaddon G, Zaravar L, Jahromi MK. The effect of aquatic training and vitamin D3 supplementation on bone metabolism in postmenopausal obese women. J Exerc Sci Fit 2024; 22(2): 127-133.
  9. Yilmaz N, Kösehasanoğulları M. The effectiveness of virtual reality exercise games on balance functions and fear of falling in women with osteoporosis. Rheumatol Int 2024; 44(6): 1071-1076.
  10. Sun C, Chen M, Wang X, Qi B, et al. Effect of Baduanjin exercise on primary osteoporosis: study protocol for randomized controlled trial. BMC Complement Med Ther 2023; 23(1): 325.
  11. Miko I, Szerb I, Szerb A, Bender T, et al. Effect of a balance-training programme on postural balance, aerobic capacity and frequency of falls in women with osteoporosis: A randomized controlled trial. J Rehabil Med 2018; 50(6): 542-547.
  12. Burke TN, França FJR, de Meneses SRF, Cardoso VI, et al. Postural control in elderly persons with osteoporosis: efficacy of an intervention program to improve balance and muscle strength: a randomized controlled trial. Am J Phys Med Rehabil 2010; 89(7): 549-556.
  13. Bakhtiar Tartibian AM, Sheikhlou Z. Does 12 weeks of moderate-intensity aerobic exercise (W-WJMIEP-R) effects on bone density and content of upper and lower limbs in sedentary postmenopausal women? journal of Applied Exercise Physiology 2017; 13(25): 37-50.
  14. Angın E, Erden Z, Can F. The effects of clinical pilates exercises on bone mineral density, physical performance and quality of life of women with postmenopausal osteoporosis. J Back Musculoskelet Rehabil 2015; 28(4): 849-858.
  15. Ghasemi S RA, Basiri Z. The effect of combined exercise on bone mineral density of premenopausal females. Education and Community Health 2016; 9(3): 36-42.
  16. Vanaky B SH, Piri M, Ramezan N. The Effect of weight bearing water aerobic exercise on the bone density of the lumbar spine of 50-70 years old overweight women. Rehab Med 2015; 4(2): 46-52.
  17. Fronza F, Moreira-Pfrimer LDF, dos Santos RN, Teixeira L, et al. Effects of high-intensity aquatic exercises on bone mineral density in postmenopausal women with and without vertebral fractures. Am J Sport Sci 2013; 1(1): 1.
  18. Aveiro MC, Avila MA, Pereira-Baldon VS, Ceccatto Oliveira ASB, et al. Water-versus land-based treatment for postural control in postmenopausal osteoporotic women: a randomized, controlled trial. Climacteric 2017; 20(5): 427-435.
  19. Balsamo S, Mota LMHd, Santana FSd, Nascimento DdC, et al. Resistance training versus weight-bearing aquatic exercise: a cross-sectional analysis of bone mineral density in postmenopausal women. Rev Bras Reumatol 2013; 53: 193-198.
  20. Murtezani A, Nevzati A, Ibraimi Z, Sllamniku S, et al. The effect of land versus aquatic exercise program on bone mineral density and physical function in postmenopausal women with osteoporosis: a randomized controlled trial. Ortop Traumatol Rehabil 2014; 16(3): 319-325.
  21. Shojaa M, Von Stengel S, Schoene D, Kohl M, et al. Effect of exercise training on bone mineral density in post-menopausal women: a systematic review and meta-analysis of intervention studies. Front Physiol 2020; 11: 652.
  22. Kemmler W, Shojaa M, Kohl M, von Stengel S. Effects of different types of exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis. Calcif Tissue Int 2020; 107(5): 409-439.
  23. Low DC, Walsh GS, Arkesteijn M. Effectiveness of exercise interventions to improve postural control in older adults: a systematic review and meta-analyses of centre of pressure measurements. Sports med 2017; 47(1): 101-112.
  24. Quijoux F, Nicolaï A, Chairi I, Bargiotas I, et al. A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open‐access code. Physiol Rep 2021; 9(22): e15067.
  25. Rhea CK, Kiefer AW, Wright WG, Raisbeck LD, et al. Interpretation of postural control may change due to data processing techniques. Gait Posture 2015; 41(2): 731-735.
  26. Riemann BL, Piersol K. Intersession reliability of self-selected and narrow stance balance testing in older adults. Aging Clin Exp Res 2017; 29: 1045-1048.
  27. Alsubaie SF, Whitney SL, Furman JM, Marchetti GF, et al. Reliability of postural sway measures of standing balance tasks. J Appl Biomech 2018; 35(1): 11-18.
  28. Gonzalez DRG, Imbiriba LA, Jandre FC. Comparison of body sway measured by a markerless low-cost motion sensor and by a force plate. Research on Biomedical Engineering 2021; 37(3): 507-517.
  29. Hernandez ME, Snider J, Stevenson C, Cauwenberghs G, et al. A correlation-based framework for evaluating postural control stochastic dynamics. IEEE Trans Neural Syst Rehabil Eng. 2015; 24(5): 551-561.
  30. Huurnink A, Fransz DP, Kingma I, van Dieën JH. Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks. J Biomech 2013; 46(7): 1392-1395.
  31. Wang C, Zhang F, Wang J, Doyle JK, et al. How indoor environmental quality affects occupants’ cognitive functions: A systematic review. Building and environment 2021; 193: 107647.
  32. Chiu H-L, Yeh T-T, Lo Y-T, Liang P-J, et al. The effects of the Otago Exercise Programme on actual and perceived balance in older adults: A meta-analysis. PLoS One 2021; 16(8): e0255780.
  33. Sinaki M. Musculoskeletal rehabilitation in patients with osteoporosis–Rehabilitation of Osteoporosis Program-Exercise (ROPE). J Mineral Muskulosk 2010; 17(2): 60-65.
  34. Rotstein A, Harush D, Vaisman A. The effect of a water exercise program on bone density among postmenopausal women. J Sports Med Phys Fitness 2008; 48(3): 352-359.
  35. Swanenburg J, de Bruin ED, Stauffacher M, Mulder T, et al. Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study. Clin Rehabil 2007; 21(6): 523-534.
  36. Jorgensen MG. Assessment of postural balance in community-dwelling older adults. Dan Med J 2014; 61(1): B4775.
  37. Kim Y, Vakula MN, Waller B, Bressel E. A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults. BMC Geriatr 2020; 20(1): 1-14.
  38. Marinho-Buzelli AR, Rouhani H, Masani K, Verrier MC, et al. The influence of the aquatic environment on the control of postural sway. Gait & Posture 2017; 51: 70-76.
  39. de Castro LA, Felcar JM, de Carvalho DR, Vidotto LS, et al. Effects of land-and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial. Physiotherapy 2020; 107: 58-65.
Journal of Paramedical Sciences & Rehabilitation
Volume 14, Issue 4
February 2026
Pages 7-24

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