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The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis
  1. Anneka Elizabeth Antoniak1,
  2. Carolyn A Greig1,2
  1. 1 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2 MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Birmingham, UK
  1. Correspondence to Mrs. Anneka Elizabeth Antoniak; aea423{at}


Objectives In older adults, there is a blunted responsiveness to resistance training and reduced muscle hypertrophy compared with younger adults. There is evidence that both exercise training and vitamin D supplementation may benefit musculoskeletal health in older adults, and it is plausible that in combination their effects may be additive. The aim of this systematic review was to evaluate the effectiveness of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health in older adults.

Data sources A comprehensive search of electronic databases, including Science Direct, Medline, PubMed, Google Scholar and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL accessed by Wiley Science) was conducted. Eligible studies were randomised controlled trials including men and women (aged ≥65 years or mean age ≥65 years); enlisting resistance exercise training and vitamin D3 supplementation; including outcomes of muscle strength, function, muscle power, body composition, serum vitamin D/calcium status or quality of life comparing results with a control group. The review was informed by a preregistered protocol (

Results Seven studies including a total of 792 participants were identified. Studies were categorised into two groups; group 1 compared vitamin D3 supplementation and exercise training versus exercise alone (describing the additive effect of vitamin D3 supplementation when combined with resistance exercise training) and group 2 compared vitamin D3 supplementation and exercise training versus vitamin D3 supplementation alone (describing the additive effect of resistance exercise training when combined with vitamin D3 supplementation).

Meta-analyses for group 1 found muscle strength of the lower limb to be significantly improved within the intervention group (0.98, 95% CI 0.73 to 1.24, p<0.001); all other outcomes showed small but non-significant positive effects for the intervention group. The short physical performance battery (SPPB), timed up and go (TUG), muscle strength of the lower limb and femoral neck bone mineral density showed significantly greater improvements in the intervention group for group 2 comparisons.

Conclusions This review provides tentative support for the additive effect of resistance exercise and vitamin D3 supplementation for the improvement of muscle strength in older adults. For other functional variables, such as SPPB and TUG, no additional benefit beyond exercise was shown. Further evidence is required to draw firm conclusions or make explicit recommendations regarding combined exercise and vitamin D3 supplementation.

  • Physiology
  • Bone diseases
  • Musculoskeletal disorders

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  • Contributors AEA has planned, conducted and written the report for this study. CAG has been involved in all stages, particularly in critically reviewing and approving the final draft of the report. Asma Alrushud was involved in the search for literature and data extraction stages. Lynn Harris assisted in formulating the search strategy.

  • Funding This research received no grant from any funding agency in the public, commercial or not-for-profit sectors. AEA is supported and funded by the National Osteoporosis Society via the Linda Edwards Memorial PhD Studentship.

  • Competing interests None declared.

  • Patient consent None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This publication is supported by multiple datasets, which are openly available at locations cited in the reference section. Additional data for this article have been provided as supplementary files. There is no additional unpublished data.