Caroline Fitzgerald

People living with osteoporosis can experience worse mental health and quality of life (QoL), including pain and psychological distress than those without. Psychological stress and poor mental health are associated with an increased risk of osteoporosis (OP). We conducted a systematic review and meta-analysis of randomised controlled trials investigating the effect of exercise on mental health, QoL and pain in people living with OP. A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD42023440020). Inclusion criteria were randomised controlled trials investigating exercise in people diagnosed with OP, including QoL, mental health, and/or pain outcomes. Exclusion criteria were non-human studies or studies not translatable into English. An electronic search of the literature was performed from inception to December 2025 in PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science. Bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The Consensus on Exercise Reporting Template was used to assess reporting quality. Three authors independently extracted data into Microsoft Excel. Data were analysed using Cochrane Review Manager Web (version 9.4.1), including mean differences (MD) and standardised mean differences (SMD) using a random-effects inverse variance model. Moderator analyses assessed modality, intensity, duration, frequency, setting, participant age, the presence of fracture (%), the nature of fracture and the osteoporosis diagnosis (postmenopausal or other). Certainty and quality of evidence were assessed using the GRADE approach. Twenty-three trials (n = 2120, mean age 67.1 ± 5.98yrs, 95.1% female) were included: five resistance training, six balance training, six combined resistance and balance training, three multi-modality, two Clinical Pilates, one aquatic, one combined aerobic, strength and Yi Jin Jing. A total of 1135 participants underwent exercise (low-high intensity, 2-7 times weekly) for 19 ± 12 weeks targeting upper, lower and full body, with seventeen studies reporting progression. Exercise improved mental health (SMD 0.53 [0.25, 0.81], p = 0.0002, moderate certainty evidence), QoL (SMD 0.62 [0.29, 0.95], p = 0.0003, moderate certainty evidence) pain (SMD 0.36 [0.17, 0.55], p = 0.0002, low certainty evidence), and pain at rest MD - 1.69 [- 2.38, - 0.99], p < 0.00001, moderate certainty evidence). Clinical Pilates was most effective for mental health (p = 0.006), QoL (p < 0.00001) and pain (p = 0.01). For mental health, the largest effect was seen with interventions performed three times per week for 4-11 weeks. Reporting quality varied (CERT, mean 11.1 ± 3.4, range 5-18), as did bias, with concerns regarding evidence certainty, internal validity and statistical conclusion validity bias. Exercise improves mental health, QoL, and pain. Pilates appeared most effective for all outcomes; however, resistance training was also effective for both QoL and pain. Further high-quality research following standardised reporting guidelines is needed for people living with osteoporosis. KEY POINTS: • Exercise improves mental health, quality of life and pain for people living with osteoporosis. Pilates was most effective, while resistance training also showed an effect for quality of life and pain outcomes. Further high-quality research is needed for people living with osteoporosis and poor mental health.

This study aimed to evaluate the impact of various dietary interventions on managing osteoarthritis (OA), a condition significantly affecting global health due to joint alterations driven by inflammatory mediators. A systematic review and meta-analysis, adhering to PRISMA guidelines, examined Randomized Controlled Trials (RCTs) investigating dietary interventions in OA. Two reviewers independently conducted study selection, data extraction, and quality assessment. Random effects models calculated standardized mean differences (SMD) and mean differences (MD). Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB2), and heterogeneity was assessed using I² values. Nine RCTs (898 participants) were identified, assessing various diets: reduced energy (n = 4), Mediterranean (n = 2), low-fat (n = 2), anti-inflammatory (n = 1), low-carbohydrate (n = 1), and plant-based (n = 1). Dietary interventions significantly improved pain (SMD: –0.67; 95% CI: [–1.01, –0.34]; p < 0.0001), and physical function (SMD: –0.62; 95% CI: [–0.94, –0.30]; p = 0.0001) and body weight (MD: –3.18; 95% CI: [–3.52, –2.83], p < 0.0001). Subgroup analyses revealed reduced energy diets improved pain (SMD: –0.85; 95% CI: [–1.15, –0.55], p < 0.0001), physical function (SMD: –0.95; 95% CI: [–1.33, –0.58], p < 0.0001) and body weight (MD: –3.13; 95% CI: [–3.77, –2.49], p < 0.0001). The Mediterranean diet did not significantly impact pain (SMD: –0.27; 95% CI: [–1.14, 0.60], P = 0.54), or physical function (SMD = –0.28; 95% CI: [–0.79, 0.24], p = 0.29). This study emphasizes the significant impact of dietary interventions on pain, physical function, and weight management in people with OA, with reduced energy diets showing the most effectiveness. Specific dietary patterns show promise but require further investigation.