What is the association between physical activity and fracture risk in middle-aged adults (aged 30–60): a systematic review and synthesis without meta-analysis (SWIM)
Authors' conclusion
The temporal relationship between physical activity intensity in mid-life and subsequent fracture risk remains unclear.
Study context
- Population
- Middle-aged adults with habitual physical activity (PA) in mid-life; non-experimental studies of subsequent fracture10 cohort and 3 case-control studies
- Comparison
- Levels of habitual PA in mid-life and subsequent fracture
- Outcome
- Risk of fractures occurring at any later time
Methodological detailssynthesis without meta-analysis (SWIM), Newcastle-Ottawa Scale risk of bias, GRADE certainty of evidence, High variation in how PA was measured and categorised across studies, limiting comparability
- Synthesis without meta-analysis (SWIM)
- Newcastle-Ottawa Scale risk of bias
- GRADE certainty of evidence
- High variation in how PA was measured and categorised across studies, limiting comparability
Pooled result
As reported in the abstract
Fracture risk by mid-life PA (GRADE certainty)
- Low certainty of evidence for a protective effect of moderate activity in mid-life on hip fracture in men (n = 2 studies)
- Moderate certainty of evidence for a protective effect of high PA in mid-life on hip fracture in women (n = 4 studies)
- Very low certainty of evidence for the effect of moderate or high activity on other types of fracture outcomes in men or women (n = 3 studies)
- Qualitative review of two large studies of moderate to high quality provided further support
Original publication
What is the association between physical activity and fracture risk in middle-aged adults (aged 30–60): a systematic review and synthesis without meta-analysis (SWIM). Osteoporos Int. Published 18 November 2025. doi:10.
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