Ask an answerable question (PICO)：
Osteoporosis is a degenerative or systemic bone disease characterized by low bone mass and deterioration of bone tissue, which increases the risk of fracture (Going, 2003). According to the World Health Organization, 30% of postmenopausal women suffer from osteoporosis (National Osteoporosis Foundation, 1999). The age of menopause for normal women is 51 years old, and 95% of menopause is between 45 and 55 years old (Martin, & Barbieri, 2018). The most common clinical manifestations of osteoporosis are hip, vertebrae, or wrist fractures (Howe et al., 2011). Weight-bearing exercise training includes each lasting 60 minutes, lasting 6 months, and 3 times a week, which could reduce the risk of osteoporosis (Marchese et al., 2012). For menopausal women, it is recommended to exercise 3 times a week for at least 30 minutes each time to increase bone mineral density (BMD) (Rosen & Drezner, 2018). Forms a clinical question-does weight-bearing exercise increase bone mineral density in menopausal women? P: menopausal women. I: weight-bearing exercise. C: no weight-bearing exercise. O: bone mineral density.
The Method and Analysis of Literature Review：
The search method and analysis of literature review forms a "PICO" problem. Searching databases of the Cochrane library, PubMed, Up To Date, Medline, DynaMed, Chinese Electronic Periodical Services (CEPS), Networked Digital Library of Theses and Dissertations (NDLTD) based on the synonyms. In addition, use keywords of P, I, C, and O, which include MeSH, synonyms, Boolean characters "OR", "AND", and filter with Chinese and English to search literature review.
Critical Appraisal：
According to the results of literature review, there are total 62 articles with Chinese and English database, which including 8 articles are duplicated, 40 articles do not meet PICO, and 12 articles do not have full-text. After the articles are excluded and deleted, a total of 2 articles are reviewed, which include Systematic Reviews (SR) and Randomized Controlled Trial (RCT), respectively. The quality appraisal based on Critical Appraisal Skills Programme (CASP) with the latest version 31.05.13 to SR and RCT.
Clinical Application of Evidence：
This evidence application conducted experimental with pilot study. The medical team members included obstetricians and gynecologists, rehabilitation physicians, family physicians, physical therapists, and nursing staff. The subjects of the study were the community menopausal women and follow-up in the outpatient department (OPD). The experimental group received weight-bearing exercise, including single leg standing with support, sit to stand, step up, and forward lunge. The physical therapists educated the subjects for weight-bearing exercise 3 times a week and 1 hour each time in the rehabilitation classroom. The control group did not receive any load-bearing or expert-guided exercises. The study conducted from August 10, 2018 to June 1, 2019, a total of 10 months.
Evaluation of Effectiveness：
A total of 30 valid subjects were recruited, including 15 subjects in the experimental group and in the control group, respectively. Statistical analysis included descriptive analysis, independent samples t test, and paired t test. The T-score and bone density were compared before and after the weight-bearing exercise with Dual Energy X-ray Absorptiometry (DXA). The results showed that: (1) the average age of the experimental group and the control group was 65.13 to 65.27 years old, and the Body Mass Index (BMI) was 20.94 (kg/m2) -24.41 (kg/m2). (2) the experimental group and the control group were homogeneous. (3) T-score of the lumbar spine and left femur in the experimental group was improved after the weight-bearing exercise, reaching a significant difference (t=-2.191, p. =0.037) and (t=-2.541, p. =0.017), respectively. (4) after the weight-bearing exercise, the posttest compared with the pretest of experimental group on the lumbar spine (T-score), lumbar spine (bone density), left femur (T-score), right femur (T-score), and right femur (bone density), reaching a significant difference improved, except the left femur (bone density).
Conclusions and Recommendations：
Through evidence literature review and the pilot study results, the answer to the topic that weight-bearing exercise could increase bone density in menopausal women. In terms of limitation, the subjects were accepted as an outpatient department (OPD),
the exercise needs to be guided by professional physical therapists and space considerations. Limited by the need for manpower and generalized exercise guidance. Therefore, the exercise is recommended that medical staff joining health promotion training would be included in the future. At the same time, medical staff will be included in relevant training courses to facilitate the popularization of exercise education and the widespread promotion of clinical practice. In addition, it is hoped that this effective weight-bearing exercise can be included as part of the lifestyle of such cases in the future.
