{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:35:11Z","timestamp":1747186511717,"version":"3.40.5"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T00:00:00Z","timestamp":1594166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Buddhist Tzu Chi Medical Foundation Academic Advancement, Hualien, Taiwan","award":["TCMMP106-06-04"],"award-info":[{"award-number":["TCMMP106-06-04"]}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study systematically reviewed evidence regarding the effectiveness of exercise in slowing breastfeeding\u2010induced bone loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The evidence\u2010based approach of a systematic review (PROSPERO registration No. CRD42019111623) was adopted. The inclusion criteria were randomized controlled trials or observational studies. Study samples were breastfeeding women, the intervention was any form of exercise, and bone mineral density (BMD) of the total body, lumbar spine and hip\/femur neck before 6\u2009months and at 1\u2009year were the outcome measures. Meta\u2010analyses were performed using a random effect model, and calculations of mean differences of BMD change and 95% confidence intervals (CIs) were carried out. Studies were further evaluated through trial sequential meta\u2010analysis (TSA), and the \u2018Grading of Recommendations Assessment, Development and Evaluation\u2019 methodology was used to assess the certainty of evidence (CoE).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1049 studies were screened, and 4 met the inclusion criteria. Weight\u2010bearing aerobic exercise and resistance training before the 6\u2010month evaluation slowed breastfeeding\u2010induced bone loss in the lumbar spine (1.62% BMD change [95% CI = 0.53\u20132.71]; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 8%). The TSA <jats:italic>Z<\/jats:italic>\u2010curve revealed crossing of the TSA boundary and line of information size, indicating sufficient sampling and significance. The CoE of exercise benefit in the lumbar spine at 6\u2009months was low, whereas the CoE for other areas ranged from low to very low.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This first systematic review and meta\u2010analysis provided some evidence of the advantages of exercise for slowing breastfeeding\u2010induced bone loss. However, additional randomized controlled trials are warranted to generate more conclusive evidence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.14346","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T01:24:31Z","timestamp":1594257871000},"page":"1790-1800","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of exercise on slowing breastfeeding\u2010induced bone loss: A meta\u2010analysis and trial sequential analysis"],"prefix":"10.1111","volume":"46","author":[{"given":"Ling\u2010Ling","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Nursing, College of Nursing Tzu Chi University of Science and Technology  Hualien Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sen\u2010Fang","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Physical Education Teaching, College of Education and Communication Tzu Chi University  Hualien Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9143-7395","authenticated-orcid":false,"given":"Pei\u2010Chun","family":"Lai","sequence":"additional","affiliation":[{"name":"School of Medicine Tzu Chi University  Hualien Taiwan"},{"name":"Department of Pediatrics Buddhist Tzu Chi General Hospital  Hualien Taiwan"},{"name":"Evidence\u2010based Medicine Center, Department of Medical Education Buddhist Tzu Chi General Hospital  Hualien Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yen\u2010Ta","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Experimental Surgery, Department of Surgery Buddhist Tzu Chi General Hospital  Hualien Taiwan"},{"name":"Department of Pharmacology, School of Medicine Tzu Chi University  Hualien Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cphy.c110025"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0193945908328473"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNR.0000000000000217"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12581"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/scientificamerican0813-74"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nutr.20.1.249"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-015-0649-3"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1385\/ENDO:17:1:49"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001941"},{"key":"e_1_2_6_11_1","unstructured":"HigginsJPT GreenS. 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