Positive, site-specific associations between bone mineral status, fitness, and time spent at high-impact activities in 16- to 18-year-old boys
Introduction
Osteoporosis and its associated fractures is a significant contributory factor to morbidity and mortality in the elderly. Recent data from the European Prospective Osteoporosis Study (EPOS) of men and women aged 50–79 years confirm that the incidence of limb fracture is a major public health issue and will become a greater burden as the proportion of elderly rises [1]. In the United Kingdom, the lifetime risk of an osteoporotic fracture of hip, spine, or distal forearm for a man is 1 in 12, and 30% of all fractures occur in men [2]. Furthermore, the effects of hip fracture on morbidity have been reported to be greater in men than women [3].
There is limited knowledge about the effects of lifestyle factors on male bone health, and more research is needed to identify potential risk factors and preventative strategies for male osteoporosis. To date, there have been no studies conducted in older adolescent boys which have considered relationship between bone mineral status at whole body and regional sites and physical activity participation and fitness. Physical activity is considered to be a key lifestyle factor affecting the achievement of optimum peak bone mass and may reduce later fracture risk. Intervention studies in children and adolescents have shown that activities with a weight-bearing or high-impact component (such as jumping) increase bone mineral content (BMC) at the femoral neck and spine in both girls and boys [4], [5], [6], [7], [8], [9]. The long-term effects of exercise during childhood and adolescence on adult bone mineral status remain unclear, but population-based studies suggest that participation in high-impact activities may need to be continued from adolescence to adulthood, in order to maintain a positive differential in bone mineral content [10], [11].
The relationship between bone mineral status and physical activity in prepubertal and adolescent boys and girls has been assessed using a variety of questionnaires, which have endeavored to capture the habitual physical activity pattern and the degree of participation in load-bearing activities [12], [13], [14], [15], [16], [17], [18], [19], [20]. Not all of these studies have shown a positive relationship between bone mineral status and time spent at high-impact activities. This may be due to the inclusion of broad age range of subjects, which introduces a confounding effect of puberty, aging, and variations in bone and body size on BMC and bone mineral density (BMD) measurements.
Questionnaire design and suitability for accurately addressing habitual activity patterns, particularly in high-impact sports, have also been a limitation. Many studies have focused on the intensity of the activity, in term of energy expenditure, rather than its weight-bearing effects. Because activities that are of high-energy intensity can include low-impact activities (such as swimming) as well as high-impact sports, significant associations between bone mineral status and load-bearing activity may have been obscured by the use of assessment tools focused on energy expenditure [13], [14], [16], [17], [20]. Activity duration is also considered to be critical when evaluating the effects of physical activity on bone, as it may influence the responsiveness of the osteoblast to the activity being carried out [21].
The EPIC (European Prospective Investigation into Cancer) physical activity questionnaire (EPAQ) allows the quantification of different dimensions of activity, such as energy expenditure and impact (in both duration and frequency), over the previous year. In a recent study in 2296 men and 2914 women aged 45–74 years who completed EPAQ, ultrasound attenuation at the heel (which is an index of bone status) was strongly positively associated with self-reported time in high-impact activities [22]. The aims of the present study were to address the current deficits in knowledge on the relationships between bone mineral status and participation time in activities of varying impact and intensity in older adolescent boys. Coupled with this, we also investigated whether measures of fitness and strength were positive determinants of bone mineral status in this age group.
Section snippets
Subjects
One hundred forty-three male students were recruited from two Sixth-Form Colleges in Cambridge, UK, to take part in a 15-month calcium and exercise intervention study. Recruitment was carried out in two phases between 1997 and 1998. Exclusion criteria included any medical problem, a history of eating disorders, recent fractures, and medication known to affect bone metabolism. Written informed consent was obtained from the participants and their parents or guardians. Ethical approval for the
Results
Of the 143 subjects who participated in the study, 13 were excluded due to incomplete or inaccurate questionnaires leaving 128 subjects with complete bone mineral status activity and fitness data sets (see Table 1, Table 2 for summary statistics).
The most popular activity in the no-impact activity category was leisurely swimming, at which 85 boys spent a median of 0.25 (interquartile range, 0.10–0.63) h/week. For low-impact activities, the most popular activity was floor exercises (i.e.,
Discussion
This is the first observational study to show that participation by adolescent boys in high-impact activities, including football, rugby, basketball, jogging, tennis, for one or more hours per day is associated with an average 3.4% more bone mineral at the whole body and 8.5% more at the total hip (after adjustment for body size) compared to those with the least participation time in high-impact activities (median of 7 min/day). If maintained through adulthood, this differential may reduce
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