Predictors of Functional Responsiveness to Exercise in Postmenopausal Women

Osteoporosis and functional decline are major health concerns among postmenopausal women. Identifying factors associated with exercise responsiveness may improve understanding of interindividual variability in exercise adaptations and support the development of more individualized intervention strategies. This study investigated whether baseline body composition, bone health, and functional fitness characteristics were associated with exercise responsiveness in postmenopausal women. Eighty women participated in a 30-week supervised multicomponent exercise program and were classified as responders or non-responders according to changes in functional performance following the intervention. Body composition and bone health were assessed by dual-energy X-ray absorptiometry (DXA), and functional fitness was evaluated using the Senior Fitness Test battery. Unadjusted analyses suggested small differences in baseline Z-score (p = 0.038) and upper-body flexibility assessed by the Back Scratch test (p = 0.030), while total bone mineral content showed a trend toward significance (p = 0.056). However, none of these differences remained statistically significant after Benjamini–Hochberg false discovery rate correction. As a complementary analysis, multiple linear regression adjusted for baseline performance identified baseline body mass (p = 0.007), total bone mineral content (p = 0.018), and upper-body flexibility (p = 0.020) as factors independently associated with post-intervention functional performance. Exploratory machine learning analyses demonstrated limited ability to discriminate responders from non-responders using baseline characteristics alone, although Random Forest variable importance highlighted similar variables to those identified in the regression analysis. Overall, these findings suggest that baseline musculoskeletal characteristics alone are insufficient to accurately classify exercise responsiveness and that larger studies incorporating additional clinical, behavioural, physiological, and biological variables are needed to improve individualized exercise prescription.