The role and regulation mechanism of Chinese traditional fitness exercises on the bone and cartilage tissue in patients with osteoporosis: A narrative review

Osteoporosis (ops) is a systemic degenerative bone disease characterized by bone mass reduction, bone mineral density loss, bone microstructure destruction, bone fragility, and increased fracture susceptibility. Thus far, drug therapy is the main method used to prevent and treat osteoporosis. However, long-term drug treatment will inevitably lead to drug resistance and certain side effects. In response, rehabilitation treatment is generally recommended, which involves drug supplementation combined with the treatment. A Chinese traditional fitness exercise is an organic combination of sports and traditional Chinese medicine with a series of advantages such as being safe, convenient, non-toxic, and harmless. Hence, it is one of the rehabilitation methods widely used in clinical practice. By searching the CNKI, PubMed, Web of Science, Embase, Cochrane Library, and other relevant databases, our research clarifies the current situation of four kinds of Chinese traditional fitness exercises widely used in clinical practice, namely, Taijiquan, Baduanjin, Wuqinxi, and Yijin Jing. In addition, the molecular mechanism of osteoporosis is summarized in this study. Based on the research, Chinese traditional fitness exercises are expected to directly stimulate the bone through a mechanical load to improve bone density. Moderate and regular traditional Chinese fitness exercises also improve osteoporosis by regulating the endocrine system with the secretion of hormones and factors such as estrogen and irisin, which are beneficial for bone formation. Finally, the purpose of promoting bone formation, reducing bone loss, and preventing and treating osteoporosis is achieved. The various means of Chinese traditional fitness exercises have different emphases, and the effect of improving bone density differs in various parts of the body. The exercisers may choose the exercise flexibly based on their own needs. Chinese traditional fitness exercises can improve the bone density of the exercisers and relieve pain, improve balance, and regulate the psychological state. Consequently, it is worth promoting to be applied in clinical practices.

[1]  Stephen A. Foulis,et al.  Load carriage aerobic exercise stimulates a transient rise in biochemical markers of bone formation and resorption. , 2022, Journal of applied physiology.

[2]  Yong Cheng,et al.  Effects of Traditional Chinese Fitness Exercises on Negative Emotions and Sleep Disorders in College Students: A Systematic Review and Meta-Analysis , 2022, Frontiers in Psychology.

[3]  O. Bruyère,et al.  Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in Adults: Consensus Recommendations From the Belgian Bone Club , 2022, Frontiers in Endocrinology.

[4]  Q. Shi,et al.  Wheel-Running Exercise Protects Ovariectomized Mice from Bone Loss via IFN-γ-Mediated Suppression of the NF-κB and MAPK Pathways , 2022, Oxidative medicine and cellular longevity.

[5]  E. Billington,et al.  Drug therapy for osteoporosis in older adults , 2022, The Lancet.

[6]  A. Gosset,et al.  Menopausal hormone therapy for the management of osteoporosis. , 2021, Best practice & research. Clinical endocrinology & metabolism.

[7]  P. Camacho,et al.  Postmenopausal Osteoporosis: Latest Guidelines. , 2021, Endocrinology and metabolism clinics of North America.

[8]  Peng Sun,et al.  Exercise improves bone formation by upregulating the Wnt3a/β-catenin signalling pathway in type 2 diabetic mice , 2021, Diabetology & Metabolic Syndrome.

[9]  Mengxue Zheng,et al.  Irisin promotes osteogenic differentiation of bone marrow mesenchymal stem cells by activating autophagy via the Wnt//β-catenin signal pathway. , 2020, Cytokine.

[10]  R. Aurora,et al.  Ovariectomy Activates Chronic Low‐Grade Inflammation Mediated by Memory T Cells, Which Promotes Osteoporosis in Mice , 2020, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[11]  Zhaojun Jing Effects of Tai Chi Chuan on the changes of bone mineraldensity of perimenopausal women , 2020 .

[12]  Weihua Xu,et al.  The shift in the balance between osteoblastogenesis and adipogenesis of mesenchymal stem cells mediated by glucocorticoid receptor , 2019, Stem Cell Research & Therapy.

[13]  R. Sirdeshmukh,et al.  Estrogen enhances human osteoblast survival and function via promotion of autophagy. , 2019, Biochimica et biophysica acta. Molecular cell research.

[14]  Jun Zou,et al.  The Effect of Exercise on the Prevention of Osteoporosis and Bone Angiogenesis , 2019, BioMed research international.

[15]  J. Mielgo-Ayuso,et al.  Effect of Iron Supplementation on the Modulation of Iron Metabolism, Muscle Damage Biomarkers and Cortisol in Professional Cyclists , 2019, Nutrients.

[16]  N. Lane Glucocorticoid-Induced Osteoporosis: New Insights into the Pathophysiology and Treatments , 2019, Current Osteoporosis Reports.

[17]  M. Benedetti,et al.  The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients , 2018, BioMed research international.

[18]  Yue Meng,et al.  Phospholipase C signaling activated by parathyroid hormone mediates the rapid osteoclastogenesis in the fracture healing of orchiectomized mice , 2018, BMC Musculoskeletal Disorders.

[19]  Sunyoung Kim,et al.  Dehydrodiconiferyl Alcohol Inhibits Osteoclast Differentiation and Ovariectomy-Induced Bone Loss through Acting as an Estrogen Receptor Agonist. , 2018, Journal of natural products.

[20]  Zhi-fang Shen,et al.  Yi Jin Jing (Sinew-transforming Qigong Exercises) for primary osteoporosis in the elderly: a clinical trial , 2018, Journal of Acupuncture and Tuina Science.

[21]  P. A. Friedman,et al.  Site-specific polyubiquitination differentially regulates parathyroid hormone receptor–initiated MAPK signaling and cell proliferation , 2018, The Journal of Biological Chemistry.

[22]  Joey C. Y. Cheung,et al.  Qigong and Tai-Chi for Mood Regulation. , 2018, Focus.

[23]  Xiao Yu,et al.  Effect of parathyroid hormone on healing in osteoporotic fractures via a phospholipase C-independent pathway , 2017, The Journal of international medical research.

[24]  J. Tuckermann,et al.  Activation of dimeric glucocorticoid receptors in osteoclast progenitors potentiates RANKL induced mature osteoclast bone resorbing activity. , 2016, Bone.

[25]  Xi Chen,et al.  The roles of exercise in bone remodeling and in prevention and treatment of osteoporosis. , 2016, Progress in biophysics and molecular biology.

[26]  Xi Chen,et al.  Treadmill running exercise prevents senile osteoporosis and upregulates the Wnt signaling pathway in SAMP6 mice , 2016, Oncotarget.

[27]  R. Cheng,et al.  Irisin promotes osteoblast proliferation and differentiation via activating the MAP kinase signaling pathways , 2016, Scientific Reports.

[28]  J. Woo,et al.  Effects of Tai Chi and Walking Exercises on Weight Loss, Metabolic Syndrome Parameters, and Bone Mineral Density: A Cluster Randomized Controlled Trial , 2015, Evidence-based complementary and alternative medicine : eCAM.

[29]  J. Caverzasio,et al.  Ablation of p38α MAPK Signaling in Osteoblast Lineage Cells Protects Mice From Bone Loss Induced by Estrogen Deficiency. , 2015, Endocrinology.

[30]  Yingzhi Lu,et al.  Simplified Tai Chi Resistance Training versus Traditional Tai Chi in Slowing Bone Loss in Postmenopausal Women , 2015, Evidence-based complementary and alternative medicine : eCAM.

[31]  Joseph D. Gardinier,et al.  PTH Signaling During Exercise Contributes to Bone Adaptation , 2015, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[32]  Yingfeng Cai,et al.  The Effect of the Modified Eighth Section of Eight-Section Brocade on Osteoporosis in Postmenopausal Women , 2015, Medicine.

[33]  T. Notomi,et al.  Insulinogenic sucrose+amino acid mixture ingestion immediately after resistance exercise has an anabolic effect on bone compared with non-insulinogenic fructose+amino acid mixture in growing rats. , 2014, Bone.

[34]  Quan-Hai Zhang,et al.  Effect of Tai-chi exercise on lower limb muscle strength, bone mineral density and balance function of elderly women. , 2014, International journal of clinical and experimental medicine.

[35]  G. Musumeci,et al.  RANKL is downregulated in bone cells by physical activity (treadmill and vibration stimulation training) in rat with glucocorticoid-induced osteoporosis. , 2013, Histology and histopathology.

[36]  G. Qian,et al.  Mitigation of Oxidative Damage by Green Tea Polyphenols and Tai Chi Exercise in Postmenopausal Women with Osteopenia , 2012, PloS one.

[37]  Chwan-Li Shen,et al.  Effect of green tea and Tai Chi on bone health in postmenopausal osteopenic women: a 6-month randomized placebo-controlled trial , 2012, Osteoporosis International.

[38]  Roger B. Davis,et al.  Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial , 2012, BMC Complementary and Alternative Medicine.

[39]  E. Lewiecki,et al.  Osteoporosis , 2011, Annals of Internal Medicine.

[40]  Elisa A. Marques,et al.  Effects of resistance and aerobic exercise on physical function, bone mineral density, OPG and RANKL in older women , 2011, Experimental Gerontology.

[41]  Steven F Sawyer,et al.  Effects of tai chi exercise on posturography, gait, physical function and quality of life in postmenopausal women with osteopaenia: a randomized clinical study , 2010, Clinical rehabilitation.

[42]  Fang-Yu Lin,et al.  A Comprehensive Review of Health Benefits of Qigong and Tai Chi , 2010, American journal of health promotion : AJHP.

[43]  H. Blair,et al.  Estrogen inhibits RANKL-stimulated osteoclastic differentiation of human monocytes through estrogen and RANKL-regulated interaction of estrogen receptor-alpha with BCAR1 and Traf6. , 2009, Experimental cell research.

[44]  Mei-Ling Yeh,et al.  Qigong Improving Physical Status in Middle-Aged Women , 2008, Western journal of nursing research.

[45]  Betsy B. Singh,et al.  Effects of 5-Form, Yang Style Tai Chi on older females who have or are at risk for developing osteoporosis , 2008, Physiotherapy theory and practice.

[46]  R. Turner,et al.  Intermittent parathyroid hormone (PTH) treatment and age‐dependent effects on rat cancellous bone and mineral metabolism , 2007, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[47]  M. Bouxsein,et al.  Contributions of parathyroid hormone (PTH)/PTH-related peptide receptor signaling pathways to the anabolic effect of PTH on bone. , 2007, Bone.

[48]  J. Woo,et al.  A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. , 2007, Age and ageing.

[49]  Zining Wu,et al.  Intermittent treatment with parathyroid hormone (PTH) as well as a non-peptide small molecule agonist of the PTH1 receptor inhibits adipocyte differentiation in human bone marrow stromal cells. , 2006, Bone.

[50]  Lin Tang,et al.  Effects of different magnitudes of mechanical strain on Osteoblasts in vitro. , 2006, Biochemical and biophysical research communications.

[51]  J. Woo,et al.  A randomized, prospective study of the effects of Tai Chi Chun exercise on bone mineral density in postmenopausal women. , 2004, Archives of physical medicine and rehabilitation.

[52]  T. Einhorn,et al.  Mechanisms for the Enhancement of Fracture Healing in Rats Treated With Intermittent Low‐Dose Human Parathyroid Hormone (1–34) , 2002, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[53]  J. Woo,et al.  Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women: A case-control study. , 2002, Archives of physical medicine and rehabilitation.

[54]  T. Spector,et al.  Klotho Gene Polymorphisms Associated With Bone Density of Aged Postmenopausal Women , 2002, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[55]  S.‐K. Lee,et al.  Regulation of receptor activator of nuclear factor-kappa B ligand and osteoprotegerin mRNA expression by parathyroid hormone is predominantly mediated by the protein kinase a pathway in murine bone marrow cultures. , 2002, Bone.

[56]  Jian-xiong Ma,et al.  The effect of tail suspension and treadmill exercise on LRP6 expression, bone mass and biomechanical properties of hindlimb bones in SD rats. , 2019, American journal of translational research.

[57]  Que Wenju Research progress in bone turnover markers , 2014 .

[58]  Zhangfang Li Effect of Long Time Taijiquan Training on Bone Density and Balance Function in Post-menopause Women , 2011 .

[59]  A. Alp,et al.  Effects of Tai Chi Exercise on Functional and Life Quality Assessments in Senile Osteoporosis , 2009 .

[60]  Jing Fu-jie Effects of Sinew-Transforming Exercise on Bone Density of Patients with Primary Osteoporosis , 2008 .

[61]  Song Hua Effects of Taijiquan exercise on bone density and bone metabolism of primary osteoporosis sufferers , 2008 .

[62]  R. Szeklicki,et al.  Effect of Tai Chi on body balance: randomized controlled trial in men with osteopenia or osteoporosis. , 2007, The American journal of Chinese medicine.

[63]  James S. Williams,et al.  Comparison of the effects of Tai Chi and resistance training on bone metabolism in the elderly: a feasibility study. , 2007, The American journal of Chinese medicine.

[64]  Mei-Ling Yeh,et al.  The effects of Baduanjin qigong in the prevention of bone loss for middle-aged women. , 2006, The American journal of Chinese medicine.

[65]  Michele Martin Effects of Resistance and Aerobic Exercise on Physical Self-Efficacy and Social Physique Anxiety in Female College Students , 2006 .

[66]  Zhou Yong The Effect of Traditional Sports on Bone Density of Menopause Women , 2004 .

[67]  P. Leung,et al.  Beneficial effects of regular Tai Chi exercise on musculoskeletal system , 2004, Journal of Bone and Mineral Metabolism.

[68]  Wang Xiao-hong Clinical Research on the Effect of Progressive Resist and Brief Maximal Exercise Therapy for Treatment of Back Pain of Patients with Osteoporosis , 2003 .

[69]  R. Nuti,et al.  Clinical Interventions in Aging Dovepress Open Access to Scientific and Medical Research Open Access Full Text Article Dovepress Selective Estrogen Receptor Modulator (serm) for the Treatment of Osteoporosis in Postmenopausal Women: Focus on Lasofoxifene , 2022 .