State of the Evidence Regarding the Effect of Water Exercises on Bone Outcomes in Postmenopausal Women with Osteoporotic Vertebral Fractures

Evidence-based exercise recommendations for postmenopausal women with osteoporotic vertebral fractures are lacking. Exercising in water can strengthen muscles while reducing spinal compression loading. Despite the fact that the water exercise sessions occur during a brief period of time compared to the time spent in weight-bearing activities each week, the water environment has been considered a limitation for slowing the rate of bone loss. The overall objective of this literature review is to determine the effect of aquatic exercise on bone in postmenopausal women with osteoporosis of the spine and at high risk for future osteoporotic fracture. Few randomized controlled trials have evaluated the effectiveness of aquatic exercise in postmenopausal women with established osteoporosis, and fewer still have included primary outcome measures related to fracture incidence and bone strength (density and/or geometry). The medical imaging methods available for assessing bone adaptations to exercise targeting the spine are also limited. Further research is required to determine the effect of aquatic exercise on bone and to develop exercise guidelines for this particular group at high risk for osteoporotic fracture.