The Effect of Aerobic Exercise on Bone Formation and Resorption Markers And The Quality of Life Tests in Postmenopausal Osteopenic Patients
Phase: NA
Conditions: Postmenopausal Osteopenia
Sponsor: Bursa Yuksek Ihtisas Training and Research Hospital

"The Effect of Aerobic Exercise on Bone Formation and Resorption Markers And The Quality 
of Life Tests in Postmenopausal Osteopenic Patients" 
Kübra Nur Deniz1, Meliha Kasapoğlu Aksoy2,  
1 Varto Public Hospital , Department of Physical Medicine and Rehabilitation Muş, Türkiye (Aff2||Turkey) 
2 University of HealthSciencesBursa Yüksek İhtisas Training and Research Hospital, Department of Physical 
Medicine and Rehabilitation, Bursa, Türkiye (Aff2||Turkey) 
Corresponding author: 
Kübra Nur Deniz, M.D. 
Varto Public Hospital , Department of Physical Medicine and Rehabilitation 49600 Muş, Türkiye 
Tel.: +90 436 711 2013 
Fax: +90 436 711 2734 
E-mail address: kbr.dnz.26@gmail.com 
Document date(D/M/Y) : 23/12/2024 
 
Declaration of conflicting interests 
Kübra Nur Deniz and Meliha Kasapoğlu Aksoy declared no conflicts of interest with respect to the 
authorship and/or publication of this article. 
 
Human Ethics and Consent to Participate declarations: 
Ethical approval for the study was obtained from University of Health Sciences Bursa Yüksek Ihtisas 
Training and Research Hospital the local ethics committee (number 2011-KAEK-252022/10-02) at 19 
Oct 2022, and with the Helsinki declaration and comparable ethical standarts. 
Each patient included in the study was informed about the purpose of the study, the method of 
application, duration, possible problems and side effects, and signed a consent form. 
 
Clinical trial number: not available 
 
NCT number: not available 
 
Funding: The authors received financial support for there search and/or authorship of this article 
from University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital 
 

               MATERIALS AND METHODS 
               This prospective, randomized, controlled, single-blind clinical study was planned at the Physical 
Medicine and Rehabilitation (PMR) Clinic of Bursa Yüksek Ihtisas Training and Research Hospital. Ethical 
approval for the study was obtained from the local ethics committee (number 2011-KAEK-252022/10-02).  The 
study included volunteer participants who were postmenopausal women from Türkiye aged 45-65 years, who 
presented to the PMR clinic as outpatients between November 2022 and November 2023. Participants were 
selected based on bone mineral density (BMD) T-scores between -1 and -2.5, measured by dual-energy X-ray 
absorptiometry (DXA), and were evaluated according to the exclusion criteria to ensure eligibility for inclusion 
in the study. Patients with conditions other than osteoporosis that could affect the concentrations of bone 
formation and resorption markers, such as vertebral compression fracture, a history of traumatic or nontraumatic 
fractures in the past year, thyroid hormone disorders, parathyroid hormone disorders, liver function disorders, 
kidney function disorders, chronic heart failure, a history of malignancy, a history of rheumatological diseases, 
corticosteroid use, immunosuppressive drug use, anticonvulsant and heparin use, and those who could not 
complete sessions due to mechanical pain exacerbated during aerobic exercise on a treadmill (such as knee and 
hip osteoarthritis, back pain, etc.) were excluded from the study. Participants were determined to be in 
menopause by their gynecology and obstetrics doctors. FSH and estrogen levels, which can be used in the 
diagnosis of menopause, were not evaluated. Participants were not taking antiresorptive or anabolic agent 
treatments used in the pharmacological treatment of osteoporosis or HRT, which can be used during menopause. 
            Fifty patients who met these criteria were included in the study. Each patient was informed about the 
purpose of the study, the application method, duration, potential problems, and side effects, and they signed a 
consent form. The patients included in the study were numbered and divided into two groups by simple 
randomization using the closed envelope method: aerobic exercise group (n=25) and control group (n=25). Three 
patients in the exercise group and two patients in the control group did not participate in the follow-up examination 
conducted in the 12th week, so the study included 45 patients (exercise, n=22; control, n=23) (Figure 1). 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1 
 
 Treatment Protocol  
              All patients were prescribed 2000 IU of vitamin D (cholecalciferol) and 1200 mg of calcium carbonate 
daily for 12 weeks. The aerobic exercise program and assessments were conducted at the Exercise Room of 
Hospital. The exercise group participated in a supervised aerobic exercise program involving treadmill walking 
(model: Grand Power: 2.5 HP, DP2011017654) for 4 weeks, 3 days a week, for 30 minutes a day, at an intensity 
of 40-60% of the maximal heart rate. Additionally, they were shown an exercise program at the initial assessment 
that included balance, posture, and endurance exercises using body weight and weights to be performed 3 days a 
week, with 3 sets of 10 repetitions. The exercise program consisted of a 10-minute warm-up, 30 minutes of aerobic 
exercise, and a 10-minute cool-down. All participants completed the exercise program under supervision. Blood 
pressure, pulse, and oxygen saturation were measured with a pulse oximeter before and after each exercise session. 
The control group was not included in any exercise program. Patients in the exercise group continued outdoor 
walking, balance, posture, and resistance exercises for up to 12 weeks of follow-up between November 2022 and 
May 2023 and were followed up by phone once a week.  
Simple randomization into 2 groups using the 
closed envelope method  
(n:50) 
Exercise Group 
n:25 
Control Group 
n:25 
who quit the exercise 
programme  
n:3 
Who did not participated 12th 
week control evaluation 
n:2
Exercise Group 
n:22 
Control Group 
n:23 
First evaluation             
(n:50) 

Statistical analysis 
SPSS version 25 statistical software was used for data analysis. Descriptive findings for categorical variables are 
expressed as percentages, and continuous variables are presented as the mean ± standard error and median, 
minimum, and maximum values. For binary analyses, the chi-square test was used for categorical variables, while 
the Mann‒Whitney U test and the Wilcoxon signed-rank test were employed for continuous variables since they 
did not meet the normal distribution prerequisites.