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Effects of Weight-Bearing Exercise on Bone Health in Girls: A Meta-Analysis

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Abstract

Background

Because growing bone possesses a greater capacity to adapt to mechanical loading than does mature bone, it is important for girls to engage in weight-bearing activities, especially since the prevalence of osteoporosis among older women is considerably higher than that of older men. In recent years, the osteogenic potential of weight-bearing activities performed by children and adolescents has received increasing attention and accumulating evidence suggests that this type of activity may improve bone health prior to adulthood and help prevent osteoporosis later in life.

Objective

Because previous interventions have varied with respect to the exercise parameters studied and sometimes produced conflicting findings, this meta-analysis was undertaken to evaluate the impact of weight-bearing exercise on the bone health of female children and adolescents and quantify the influence of key moderating variables (e.g. pubertal stage, exercise mode, intervention strategy, exercise duration, frequency of exercise, programme length and study design) on skeletal development in this cohort.

Methods

A comprehensive literature search was conducted using databases such as PubMed, MEDLINE, CINAHL, Web of Science, Physical Education Index, Science Direct and ProQuest. Search terms included ‘bone mass’, ‘bone mineral’, ‘bone health’, ‘exercise’ and ‘physical activity’. Randomized- and non-randomized controlled trials featuring healthy prepubertal, early-pubertal and pubertal girls and measurement of areal bone mineral density (aBMD) or bone mineral content (BMC) using dual energy x-ray absorptiometry were examined. Comprehensive Meta-Analysis software was used to determine weighted mean effect sizes (ES) and conduct moderator analyses for three different regions of interest [i.e. total body, lumbar spine (LS), and femoral neck].

Results

From 17 included studies, 72 ES values were retrieved. Our findings revealed a small, but significant influence of weight-bearing exercise on BMC and aBMD of the LS (overall ES 0.19; 95 % confidence interval (CI) 0.05, 0.33 and overall ES 0.26, 95 % CI 0.09, 0.43, respectively) and BMC of the femoral neck (ES 0.23; 95 % CI 0.10, 0.36). For both aBMD and BMC, overall ES was not affected by any moderator variables except frequency of exercise, such that weight-bearing activity performed for more than 3 days per week resulted in a significantly greater ES value for LS aBMD compared with programmes lasting 3 or fewer days per week [Cochran’s Q statistic (Qbetween) = 4.09; p < 0.05].

Conclusion

The impact of weight-bearing activities seems to be site specific, and a greater frequency of weight-bearing activities is related to greater aBMD of LS in growing girls. Future investigations are warranted to better understand the dose-response relationship between weight-bearing activity and bone health in girls and explore the mediating role of pubertal status in promoting skeletal development among female youth.

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References

  1. Ahlborg HG, Rosengren BE, Jarvinen TL, et al. Prevalence of osteoporosis and incidence of hip fracture in women: secular trends over 30 years. BMC Musculoskelet Disord. 2010;11:48.

    Article  PubMed  Google Scholar 

  2. National Institutes of Health. Osteoporosis and Related Bone Diseases National Resource Center [online]. http://www.niams.nih.gov/bone (Accessed 31 July 2011).

  3. Ioannidis G, Papaioannou A, Hopman WM, et al. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ. 2009;181:265–71.

    Article  PubMed  Google Scholar 

  4. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22:465–75.

    Article  PubMed  Google Scholar 

  5. Salaffi F, Cimmino MA, Malavolta N, et al. The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. J Rheumatol. 2007;34:1551–60.

    PubMed  Google Scholar 

  6. Hui SL, Slemenda CW, Johnston CC Jr. The contribution of bone loss to postmenopausal osteoporosis. Ostoporos Int. 1990;1:30–4.

    Article  CAS  Google Scholar 

  7. Ralson SH, de Crombrugghe B. Genetic regulation of bone mass and susceptibility to osteoporosis. Genes Dev. 2006;20:2492–506.

    Article  Google Scholar 

  8. Recker RR, Deng HW. Role of genetics in osteoporosis. Endocrine. 2002;17:55–66.

    Article  PubMed  CAS  Google Scholar 

  9. Haapasalo HH. Physical activity and growing bone: development of peak bone mass with special reference to the effects of unilateral physical activity. Ann Chir Gynaecol. 1998;87:250–2.

    PubMed  CAS  Google Scholar 

  10. Johnston CC Jr, Miller JZ, Slemenda CW, et al. Calcium supplementation and increases in bone mineral density in children. N Engl J Med. 1992;327:82–7.

    Article  PubMed  Google Scholar 

  11. Gunter KB, Almstedt HC, Janz KF. Physical activity in childhood may be the key to optimizing lifespan skeletal health. Exerc Sport Sci Rev. 2012;40:13–21.

    Article  PubMed  Google Scholar 

  12. McDevitt H, Ahmed SF. Establishing good bone health in children. Paediatr Child Health. 2010;20:83–7.

    Article  Google Scholar 

  13. Hind K, Burrows M. Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone. 2007;40:14–27.

    Article  PubMed  CAS  Google Scholar 

  14. Courteix D, Lespessailles E, Jaffre C, et al. Bone mineral acquisition and somatic development in highly trained girl gymnasts. Acta Paediatr. 1999;88:803–8.

    Article  PubMed  CAS  Google Scholar 

  15. Ward KA, Roberts SA, Adams JE, et al. Bone geometry and density in the skeleton of pre-pubertal gymnasts and school children. Bone. 2005;36:1012–8.

    Article  PubMed  CAS  Google Scholar 

  16. Bachrach LK. Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol Metab. 2001;12:22–8.

    Article  PubMed  CAS  Google Scholar 

  17. Bass S, Pearce G, Bradney M, et al. Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active pre-pubertal and retired female gymnasts. J Bone Miner Res. 1998;13:500–7.

    Article  PubMed  CAS  Google Scholar 

  18. Kirchner EM, Lewis RD, O’Connor PJ. Effect of past gymnastics participation on adult bone mass. J Appl Phyisol. 1996;80:226–32.

    Article  CAS  Google Scholar 

  19. Linden C, Ahlborg HG, Besjakov J, et al. A school curriculum-based exercise program increases bone mineral accrual and bone size in prepubertal girls: two-year data from the pediatric osteoporosis prevention (POP) study. J Bone Miner Res. 2006;21:829–35.

    Article  PubMed  Google Scholar 

  20. MacKelvie KJ, Khan KM, Petit MA, et al. A school-based exercise intervention elicits substantial bone health benefits: a 2-year randomized controlled trail in girls. Pediatrics. 2003;112:e447–52.

    Article  PubMed  Google Scholar 

  21. Valdimarsson O, Linden C, Johnell O, et al. Daily physical education in the school curriculum in prepubertal girls during 1 year is followed by an increase in bone mineral accrual and bone width: data from the prospective controlled Malmo pediatric osteoporosis prevention study. Calcif Tissue Int. 2006;78:65–71.

    Article  PubMed  CAS  Google Scholar 

  22. Hasselstrom HA, Karlsson MK, Hansen SE, et al. A 3-year physical activity intervention program increases the gain in bone mineral and bone width in prepubertal girls but not boys: the prospective Copenhagen school child interventions study (CoSCIS). Calcif Tissue Int. 2008;83:243–50.

    Article  PubMed  CAS  Google Scholar 

  23. McKay HA, Petit MA, Schutz RW, et al. Augmented trochanteric bone mineral density after modified physical education classes: a randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr. 2000;136:156–62.

    Article  PubMed  CAS  Google Scholar 

  24. Van Langendonck L, Claessens AL, Vlietinck R, et al. Influence of weight-bearing exercises on bone acquisition in prepubertal monozygotic female twins: a randomized controlled prospective study. Calcif Tissue Int. 2003;72:666–74.

    Article  PubMed  Google Scholar 

  25. Alwis G, Linden C, Stenevi-Lundgren S, et al. A one-year exercise intervention program in pre-pubertal girls does not influence hip structure. BMC Musculoskelet Disord. 2008;9:9.

    Article  PubMed  Google Scholar 

  26. Burr DB, Yoshikawa T, Teegarden K, et al. Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18–31 years of age. Bone. 2000;27:855–63.

    Article  PubMed  CAS  Google Scholar 

  27. French SA, Story M, Fulkerson JA, et al. Increasing weight-bearing physical activity and calcium-rich foods to promote bone mass gains among 9–11 year old girls: outcomes of the Cal-Girls study. Int J Behav Nutr Phys Act. 2005;2:8.

    Article  PubMed  Google Scholar 

  28. Karlsson MK, Nordqvist A, Karlsson C. Physical activity increases bone mass during growth. Food Nutr Res. 2008;52.

  29. Ondrak KS, Morgan DW. Physical activity, calcium intake and bone health in children and adolescents. Sports Med. 2007;37:587–600.

    Article  PubMed  Google Scholar 

  30. Rizzoli R, Bianchi ML, Garabedian M, et al. Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone. 2010;46:294–305.

    Article  PubMed  Google Scholar 

  31. Slemenda CW, Miller JZ, Hui SL, et al. Role of physical activity in the development of skeletal mass in children. J Bone Miner Res. 1991;6:1227–33.

    Article  PubMed  CAS  Google Scholar 

  32. Faulkner KG, Gluer CC, Majumdar S, et al. Noninvasive measurements of bone mass, structure, and strength: current methods and experimental techniques. AJR AM J Roentgenol. 1991;157:1229–37.

    Article  PubMed  CAS  Google Scholar 

  33. NIH Consensus Development Panel on Osteoporosis Prevention. Diagnosis, and therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285:785–95.

    Article  Google Scholar 

  34. Haapasalo H, Kannus P, Sievanen H, et al. Long-term unilateral loading and bone mineral density and content in female squash players. Calcif Tissue Int. 1994;54:249–55.

    Article  PubMed  CAS  Google Scholar 

  35. Kannus P, Haapasalo H, Sievanen H, et al. The site-specific effects of long-term unilateral activity on bone mineral density and content. Bone. 1994;15:279–84.

    Article  PubMed  CAS  Google Scholar 

  36. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions. J Epidemiol Commun Health. 1998;52:377–84.

    Article  CAS  Google Scholar 

  37. Slemenda CW, Reister TK, Hui SL, et al. Influences of skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity. J Pediatr. 1994;125:201–7.

    Article  PubMed  CAS  Google Scholar 

  38. MacKelvie KJ, McKay HA, Khan KM, et al. A school-based exercise intervention augments bone mineral accrual in early pubertal girls. J Pediatr. 2001;139:501–8.

    Article  PubMed  CAS  Google Scholar 

  39. Kohrt WM, Bloomfield SA, Little KD, et al. American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc. 2004;36:1985–96.

    Article  PubMed  Google Scholar 

  40. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks: SAGE Publications, Inc.; 2001. p. 247.

    Google Scholar 

  41. Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic Press Inc.; 1985. p. 361.

    Google Scholar 

  42. Cohen J. Statistical power for the behavioral sciences. 2nd rev. ed. Hillsdale: Erlbaum; 1999. p. 569.

    Google Scholar 

  43. Bax L, Yu LM, Ikeda N, et al. A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Med Res Methodol. 2007;7:40.

    Article  PubMed  Google Scholar 

  44. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  PubMed  CAS  Google Scholar 

  45. Morseth B, Emaus N, Jorgensen L. Physical activity and bone: the importance of the various mechanical stimuli for bone mineral density. A review. Nor Epidemiol. 2011;20:173–9.

    Google Scholar 

  46. Ferretti JL, Schiessl H, Frost HM. On new opportunities for absorptiometry. J Clin Densitom. 1998;1:41–53.

    Article  PubMed  CAS  Google Scholar 

  47. Greene DA, Naughton GA. Adaptive skeletal responses to mechanical loading during adolescence. Sports Med. 2006;36:723–32.

    Article  PubMed  Google Scholar 

  48. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures: the Study of Osteoporotic Fractures Research Group. Lancet. 1993;34:72–5.

    Article  Google Scholar 

  49. Gunter K, Baxter-Jones AD, Mirwald RL, et al. Impact exercise increases BMC during growth: an 8-year longitudinal study. J Bone Miner Res. 2008;23:986–93.

    Article  PubMed  Google Scholar 

  50. Gunter K, Baxter-Jones AD, Mirwarld RL, et al. Jump starting skeletal health: a 4-year longitudinal study assessing the effects of jumping on skeletal development in pre and circum pubertal children. Bone. 2008;42:710–8.

    Article  PubMed  Google Scholar 

  51. Janz KF, Letuchy EM, Eichenberger Gilmore JM, et al. Early physical activity provides sustained bone health benefits later in childhood. Med Sci Sports Exerc. 2010;42:1072–8.

    PubMed  Google Scholar 

  52. Mackelvie KJ, Khan KM, McKay HA. Is there a critical period for bone response to weight-bearing exercise in children and adolescents? A systematic review. Br J Sports Med. 2002;36:250–7.

    Article  PubMed  CAS  Google Scholar 

  53. Baxter-Jones AD, Kontulainen SA, Faulkner RA, et al. A longitudinal study of the relationship of physical activity to bone mineral accrual from adolescence to young adulthood. Bone. 2008;43:1101–7.

    Article  PubMed  Google Scholar 

  54. Cullen DM, Smith RT, Akhter MP. Bone loading response varies with strain magnitude and cycle number. J Appl Physiol. 2001;91:1971–6.

    PubMed  CAS  Google Scholar 

  55. Robling AG, Hinant FM, Burr DB, et al. Shorter, more frequent mechanical loading sessions enhance bone mass. Med Sci Sports Exerc. 2002;34:196–202.

    Article  PubMed  Google Scholar 

  56. Baxter-Jones AD, Eisenmann JC, Sherar LB. Controlling for maturation in pediatric exercise science. Pediatr Exerc Sci. 2005;17:18–30.

    Google Scholar 

  57. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Lancet. 1999;354:1896–900.

    Article  PubMed  CAS  Google Scholar 

  58. Flather MD, Farkouh ME, Pogue JM, et al. Strengths and limitations of meta-analysis: larger studies may be more reliable. Control Clin Trials. 1997;18:568–79.

    Article  PubMed  CAS  Google Scholar 

  59. Scerpella TA, Dowthwaite JN, Rosenbaum PF. Sustained skeletal benefit from childhood mechanical loading. Osteoporos Int. 2011;22:2205–10.

    Article  PubMed  CAS  Google Scholar 

  60. Karlsson MK, Nordqvist A, Karlsson C. Sustainability of exercise-induced increases in bone density and skeletal structure. Food Nutr Res. 2008 (Epub 2008 Oct 1).

  61. Blimkie CJR, Rice S, Webber CE, et al. Effects of resistance training on bone mineral content and density in adolescent females. Can J Physiol Pharmacol. 1996;74:1025–33.

    Article  PubMed  CAS  Google Scholar 

  62. Iuliano-Burns S, Saxon L, Naughton G, et al. Regional specificity of exercise and calcium during skeletal growth in girls: a randomized controlled trial. J Bone Miner Res. 2003;18:156–62.

    Article  PubMed  Google Scholar 

  63. Laing EM, Wilson AR, Modlesky CM, et al. Initial years of recreational artistic gymnastics training improves lumbar spine bone mineral accrual in 4- to 8-year-old females. J Bone Miner Res. 2005;20:509–19.

    Article  PubMed  Google Scholar 

  64. Macdonald HM, Kontulainen SA, Petit MA, et al. Does a novel school-based physical activity model benefit femoral neck bone strength in pre- and early pubertal children? Osteoporos Int. 2008;19:1445–56.

    Article  PubMed  CAS  Google Scholar 

  65. Morris FL, Naughton GA, Gibbs JL, et al. Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res. 1997;12:1453–62.

    Article  PubMed  CAS  Google Scholar 

  66. Nichols DL, Sanborn CF, Love AM. Resistance training and bone mineral density in adolescent females. J Pediatr. 2001;139:494–500.

    Article  PubMed  CAS  Google Scholar 

  67. Stear SJ, Prentice A, Jone SC, et al. Effect of a calcium and exercise intervention on the bone mineral status of 16–18-y-old adolescent girls. Am J Clin Nutr. 2003;77:985–92.

    PubMed  CAS  Google Scholar 

  68. Stewart SR. The effects of an 18-month weight-training and calcium-supplementation program on bone mineral of adolescent girls [dissertation]. Vancouver: University of British Columbia; 1997. p. 357.

    Google Scholar 

  69. Weeks BK, Young CM, Beck BR. Eight months of regular in-school jumping improves indices of bone strength in adolescent boys and girls: the POWER PE Study. J Bone Miner Res. 2008;23:1002–11.

    Article  PubMed  Google Scholar 

  70. Witzke KA, Snow CM. Effects of plyometric jump training on bone mass in adolescent girls. Med Sci Sports Exerc. 2000;32:1051–7.

    Article  PubMed  CAS  Google Scholar 

  71. Moher D, Liberati A, Tezlaff J, The PRISMA Group, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was not supported by any funding. All authors state that they have no conflicts of interest. We thank Dr. Heather Macdonald for providing us with information needed for this analysis.

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  1. Department of Health and Human Performance, Middle Tennessee State University, P.O. Box 96, Murfreesboro, TN, 37132, USA

    Saori Ishikawa, Youngdeok Kim, Minsoo Kang & Don W. Morgan

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  1. Saori Ishikawa
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Correspondence to Saori Ishikawa.

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Ishikawa, S., Kim, Y., Kang, M. et al. Effects of Weight-Bearing Exercise on Bone Health in Girls: A Meta-Analysis. Sports Med 43, 875–892 (2013). https://doi.org/10.1007/s40279-013-0060-y

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