Basketball Affects Bone Mineral Density Accrual in Boys More Than Swimming and Other Impact Sports: 9-mo Follow-Up

Does Swimming Exercise Impair Bone Health? A Systematic Review and Meta-Analysis Comparing the Evidence in Humans and Rodent Models

BACKGROUND

The effect of swimming on bone health remains unclear, namely due to discrepant findings between studies in humans and animal models.

OBJECTIVE

The aim of this systematic review and meta-analysis is to identify the available evidence on the effects of swimming on bone mass, geometry and microarchitecture at the lumbar spine, femur and tibia in both humans and rodent animal models.

METHODS

The study followed PRISMA guidelines and was registered at PROSPERO (CRD4202236347 and CRD42022363714 for human and animal studies). Two different systematic literature searches were conducted in PubMed, Scopus and Web of Science, retrieving 36 and 16 reports for humans and animal models, respectively.

RESULTS

In humans, areal bone mineral density (aBMD) was similar between swimmers and non-athletic controls at the lumbar spine, hip and femoral neck. Swimmers' tibia diaphysis showed a higher cross-sectional area but lower cortical thickness. Inconsistent findings at the femoral neck cortical thickness were found. Due to the small number of studies, trabecular microarchitecture in human swimmers was not assessed. In rodent models, aBMD was found to be lower at the tibia, but similar at the femur. Inconsistent findings in femur diaphysis cross-sectional area were observed. No differences in femur and tibia trabecular microarchitecture were found.

CONCLUSION

Swimming seems to affect bone health differently according to anatomical region. Studies in both humans and rodent models suggest that tibia cortical bone is negatively affected by swimming. There was no evidence of a negative effect of swimming on other bone regions, both in humans and animal models.

Sports participation plays a relevant role in the relationship between birth weight and bone mineral content in adolescents

The Developmental Origins of Health and Disease hypothesis (DOHaD) proposes that growth during the prenatal period might play a critical role in health, affecting the development of diseases, such as osteoporosis. Bone health is particularly affected by human behaviors when sports participation constitutes the main manifestation of physical exercise. The aim of this study is to analyze the relationship between birth weight (BW) and bone mineral content (BMC) among adolescents, as well as to identify if sports participation and maturity can affect this relationship. The sample was composed of adolescents with ages ranging from 11 to 18 years, stratified according to normal birth weight (n = 331), low birth weight (n = 36), and macrosomia (n = 47), extracted from a wider cross-sectional study (ABCD Growth Study). BW was self-reported by the adolescent's parent. Sports participation was assessed by face-to-face interview. BMC was assessed using dual-energy X-ray absorptiometry. In the multivariate models, the relationships between BW and BMC remained non-significant, while sports participation was significantly related to BMC on lower limbs among boys (r = 0.154; p value = .001) and BMC of upper limbs among girls (r = 0.124; p value = .044). APHV was related to BMC of upper limbs among boys (r = 0.137; p value = .001). In conclusion, BMC was not affected by BW, while this phenomenon seems to be significantly affected by the positive impact of sports participation and maturation on it.

The Impact of Sport-discipline and Sex on Physical Fitness and Bone Markers in Athletes

This study was performed to determine the impact of sex and sport-discipline on physical fitness and bone markers in young sub-elite track and field athletes. One hundred and forty-four track and field sub-elite athletes (78 males aged 17.8±1.6 years; 66 females aged 17.2±1.9 years) volunteered to participate in this study and were categorized according to their disciplines in endurance (EG: n=67) or power athletes (PG: n=77). A significant main effect of sex was observed for C-telopeptide type I collagen (CTx) (F=11.37; p<0.001; η2=0.10, moderate), for osteocalcin (OC) (F=8.58; p<0.004; η2=0.09, moderate) and for N-terminal propeptide of procollagen type I (PINP) (F=7.96; p<0.05; η2=0.07, moderate). The average CTx, OC and P1NP levels were significantly higher in males compared with females (0.05 Collapse

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MESH Headings

• Female
• Humans
• Male
• Sports
• Athletes
• Collagen Type I
• Exercise
• Physical Fitness
• Biomarkers
• Peptide Fragments

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Grants Collapse

Affiliation(s)

Ammar Nebigh Research Laboratory Education, Motricity, Sports and Health, High Institute of Sport and Physical Education, Sfax University, Sfax, Tunisia Higher Institute of Sport and Physical Education of Ksar Saîd, University of "La Manouba", Tunis, Tunisia
Imed Touhami National Center of Medicine and Science in Sports, Tunisian Research Laboratory "Sports Performance Optimization", National Center of Medicine and Science in Sports (CNMSS), Tunis, Tunisia
Mokhtar Chtara Unit Head, Science Studies and Research, Sharjah Women's Sports, UAE Tunisian Research Laboratory "Sport Performance Optimization", National Center of Medicine and Science in Sports, Tunis, Tunisia
Karuppasamy Govindasamy Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
Chandrababu Surech Department of Physical Education & Sports Science, SRM Institute of Science and Technology, Kattankulathur, Tamilnadu, India
Rawad El Hage Department of Physical Education, University of Balamand, Balamand, Lebanon
Ayoub Saeidi Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Kurdistan, Iran
Daniel Boullosa INISA, Federal University of Mato Grosso do Sul, Campo Grande, Brazil Faculty of Physical Activity and Sports Sciences, Universidad de León, León, Spain
Cain C T Clark Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom of Great Britain and Northern Ireland
Urs Granacher University of Freiburg, Department of Sport and Sport Science, Exercise and Human Movement Science, Freiburg, Germany
Hassane Zouhal UFR APS, laboratoire Mouvement Sport Sante, Rennes, France Institut International des Sciences du Sport (2I2S), Irodouer, France

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Bone Tissue Responsiveness To Mechanical Loading-Possible Long-Term Implications of Swimming on Bone Health and Bone Development

PURPOSE OF REVIEW

To revisit the bone tissue mechanotransduction mechanisms behind the bone tissue response to mechanical loading and, within this context, explore the possible negative influence of regular swimming practice on bone health, particularly during the growth and development period.

RECENT FINDINGS

Bone is a dynamic tissue, responsive to mechanical loading and unloading, being these adaptative responses more intense during the growth and development period. Cross-sectional studies usually report a lower bone mass in swimmers compared to athletes engaged in weigh-bearing sports. However, studies with animal models show contradictory findings about the effect of swimming on bone health, highlighting the need for longitudinal studies. Due to its microgravity characteristics, swimming seems to impair bone mass, but mostly at the lower limbs. It is unkown if there is a causal relationship between swimming and low BMD or if other confounding factors, such as a natural selection whithin the sport, are the cause.

The Effect of Professional Sports Participation on Bone Content and Density in Elite Female Athletes

Background: The role of exercise in osteoporosis prevention has been proven. Nevertheless, there is no consensus about the types of sports, especially at professional levels. Non-impact sports such as swimming may have a negative effect or no effect. Objectives: Thus, the present study aimed to compare the effect of different sports on bone mineral content (BMC) and bone mineral density (BMD) of elite female athletes. Methods: This was a cross-sectional study consisting of 48 athletes in five groups of long-distance running, volleyball, basketball, swimming (n = 12 for each), and ten control subjects. For measuring the lumbar spine (L2 - L4) and proximal femur (femoral neck, trochanter, and Ward’s triangle), the dual-energy X-ray absorptiometry (DEXA) method was applied. Results: Indicated that the running, basketball, and volleyball groups had a significantly higher lumbar spine and proximal femur BMD than the swimming and control groups (P < 0.05). Running resulted in significantly higher lumbar spine BMC compared to volleyball, basketball, swimming, and control groups, respectively (P < 0.01), while basketball had higher proximal femur BMC than running and controls (P < 0.01). The Z-score of the lumbar spine in the running was significantly higher than in basketball, swimming, and controls (P < 0.05), while basketball had a significantly higher femur neck Z-score than volleyball, running, and controls (P < 0.001). Finally, the swimmers had significantly higher Z-scores in the lumbar and the proximal femur than non-athletes (P < 0.001). Conclusions: Although all sports are effective for improving the bone health, the swimmers had much better bone status than non-athletes, while the sports of long-distance running and basketball were more efficient than others; therefore, a combination of endurance and jumping exercises seems to be the best way to prevent osteoporosis.

Exercise in school Physical Education increase bone mineral content and density: Systematic review and meta-analysis

ABSTRACTThis systematic review and meta-analysis aimed to evaluate the effectiveness of interventions through Physical Education (PE) exercises on bone mineral content (BMC) and density (BMD) of children and adolescents. The research was conducted using the online electronic databases PubMed, Science Direct, Web of Science and Scopus (March 2021). The analysis was restricted to school-based studies that examined the effect of PE interventions on BMC and BMD in schoolchildren (<18 years old). Standardised mean differences (SMD) with 95% confidence interval (CI) and random-effects models were calculated. The heterogeneity and inconsistency of the studies were estimated using Cochran's Q-statistic and I², respectively. Twenty-two studies with 2,556 participants were selected. PE interventions were associated with a significant increase in BMC (SMD = 1.348; 95% CI, 1.053-1.643) and BMD (SMD = 0.640; 95% CI, 0.417-0.862). Femoral neck subgroup analysis indicate an increase in BMC for boys (SMD = 1.527; 95% CI, 0.990-2.065) and girls (SMD = 1.27; 95% CI, 0.782-1.767), and in BMD for boys (SMD = 0.518; 95% CI, 0.064-0.972) and girls (SMD = 0.817; 95% CI, 0.349-1.284). Finally, increases are reported in the lumbar spine BMC for boys (SMD = 1.860; 95% CI, 1.018-2.700) and girls (SMD = 1.275; 95% CI, 0.782-1.767). This meta-analysis provides insights into the effectiveness of interventions aimed at including physical exercise in PE on bone mass, suggesting that increasing the proportion of curriculum time allocated to PE may improve students' BMD and BMC, especially in the femoral neck and lumbar spine.

Influential role of lean soft tissue in the association between training volume and bone mineral density among male adolescent practitioners of impact-loading sports: ABCD Growth study

BACKGROUND

Training volume is associated with direct and indirect pathways of bone adaptations. In addition, training volume is a training variable associated with lean soft tissue (LST), which has been shown to be an important predictor of areal bone mineral density (aBMD). Thus, the aim of this study is to investigate the influential role of lean soft tissue (LST) in the association between training volume and aBMD in male adolescent athletes.

METHODS

This cross-sectional study was composed of 299 male adolescent athletes, mean age 14.1 (1.8) years, from 9 different weight-bearing modalities. The Ethical Board approved the investigation. The adolescents reported the number of days per week they trained and the time spent training and, from this, the training volume (h/wk) was estimated. The LST and aBMD were assessed by dual-energy x-ray absorptiometry. Somatic maturation was estimated by the peak of height velocity. Mediation analysis was performed to investigate the role of LST in the association between training volume and aBMD. Level of significance was set at p < 0.05.

RESULTS

LST partially explained the association between training volume and aBMD in all body segments: upper limbs (58.37%; β = 0.00142), lower limbs (28.35%; β = 0.00156), spine (33.80%; β = 0.00124), and whole body (41.82%, β = 0.00131). There was no direct effect of training volume on aBMD in upper limbs (CI -0.00085 to 0.00287).

CONCLUSION

The association between training volume and aBMD is influenced by LST in different body segments, mainly upper limbs, demonstrating that interventions aiming to enhance aBMD should also consider LST as an important variable to be managed.

Impact of sports participation on incidence of bone traumatic fractures and health-care costs among adolescents: ABCD - Growth Study

Objective: To analyze the risk of bone traumatic fractures according to the engagement in sports, as well as to identify the potential impact of sports participation and traumatic fractures on health-care costs among adolescents. Methods: This is a longitudinal 12-month study of 285 adolescents of both sexes in Brazil. We assessed the occurrence of traumatic fractures and health-care services (hospitalizations, medicine use, medical consultations, and exams) by phone contact every month for 12 months. Adolescents were divided into four groups according to sport characteristics: non-sport (n = 104), non-impact sport (swimming [n = 34]), martial arts (n = 49 [judo, karate, kung-Fu]) and impact sports (n = 98 [track-and-field, basketball, gymnastics, tennis, and baseball]). Results: The incidence of new fractures was 2.1%. The overall costs accounted during the 12-month follow-up were U$ 3,259.66. Swimmers (US$ 13.86) had higher health-care costs than non-sport (US$ 1.82), martial arts (US$ 2.23), and impact sports (US$ 2.32). Conclusion: swimming seems to be related to higher health-care costs among adolescents.

Basketball players possess a higher bone mineral density than matched non-athletes, swimming, soccer, and volleyball athletes: a systematic review and meta-analysis

Basketball athletes possess a higher bone mineral density (BMD) than matched non-athletes and swimming, soccer, and volleyball athletes. Differences appear to be exacerbated with continued training and competition beyond adolescence. The greater BMD in basketball athletes compared to non-athletes, swimming, and soccer athletes is more pronounced in males than females.

PURPOSE

The aim of this study was to examine differences in total and regional bone mineral density (BMD) between basketball athletes, non-athletes, and athletes competing in swimming, soccer, and volleyball, considering age and sex.

METHODS

PubMed, MEDLINE, ERIC, Google Scholar, and Science Direct were searched. Included studies consisted of basketball players and at least one group of non-athletes, swimming, soccer, or volleyball athletes. BMD data were meta-analyzed. Cohen's d effect sizes [95% confidence intervals (CI)] were interpreted as: trivial ≤ 0.20, small = 0.20-0.59, moderate = 0.60-1.19, large = 1.20-1.99, and very large ≥ 2.00.

RESULTS

Basketball athletes exhibited significantly (p < 0.05) higher BMD compared to non-athletes (small-moderate effect in total-body: d = 1.06, CI 0.55, 1.56; spine: d = 0.67, CI 0.40, 0.93; lumbar spine: d = 0.96, CI 0.57, 1.35; upper limbs: d = 0.70, CI 0.29, 1.10; lower limbs: d = 1.14, CI 0.60, 1.68; pelvis: d = 1.16, CI 0.05, 2.26; trunk: d = 1.00, CI 0.65, 1.35; and femoral neck: d = 0.57, CI 0.16, 0.99), swimming athletes (moderate-very large effect in total-body: d = 1.33, CI 0.59, 2.08; spine: d = 1.04, CI 0.60, 1.48; upper limbs: d = 1.19, CI 0.16, 2.22; lower limbs: d = 2.76, CI 1.45, 4.06; pelvis d = 1.72, CI 0.63, 2.81; and trunk: d = 1.61, CI 1.19, 2.04), soccer athletes (small effect in total-body: d = 0.58, CI 0.18, 0.97), and volleyball athletes (small effect in total-body: d = 0.32, CI 0.00, 0.65; and pelvis: d = 0.48, CI 0.07, 0.88). Differences in total and regional BMD between groups increased with age and appeared greater in males than in females.

CONCLUSION

Basketball athletes exhibit a greater BMD compared to non-athletes, as well as athletes involved in swimming, soccer, and volleyball.

Physical Activity Associations with Bone Mineral Density and Modification by Metabolic Traits

Objective

To assess the relationship of physical activity with bone mineral density (BMD) at various sites and examine potential modifying metabolic factors.

Methods

Responses from physical activity questionnaires were used to determine total physical activity (PA), moderate physical activity (mod-PA), and sedentary time. Regression analyses were performed to evaluate association of activity traits with insulin sensitivity by euglycemic clamp, adiponectin, C-reactive protein (CRP), and plasminogen activator inhibitor-1 (PAI-1) in 741 healthy subjects.

Results

The cohort was relatively sedentary. Activity level was associated with arm, pelvis, and leg BMD in univariate analyses. In multivariate association analyses of arm BMD, only female sex (β = -0.73, P < 0.0001) and adiponectin (β = -0.076, P = 0.0091) were significant. Multivariate analyses of pelvis BMD found independent associations with body mass index (BMI) (β = 0.33, P < 0.0001), adiponectin (β = -0.10, P = 0.013), female sex (β = -0.18, P < 0.0001), sedentary time (β = -0.088, P = 0.034), PA (β = 0.11, P = 0.01), and mod-PA (β = 0.11, P = 0.014). Age (β = -0.10, P = 0.0087), female sex (β = -0.63, P < 0.0001), BMI (β = 0.24, P < 0.0001), and mod-PA (β = 0.10, P = 0.0024) were independently associated with leg BMD.

Conclusions

These results suggest that BMD increases with physical activity in the arms, legs, and pelvis and is inversely related to sedentary time in the pelvis and legs; these associations may be modified by age, sex, BMI, and adiponectin, depending on the site, with physical activity being more important to pelvis and leg BMD than arm BMD and sedentary time being important for pelvis BMD. Moreover, we demonstrated that CRP, PAI-1, and insulin sensitivity play a minor role in BMD.

Impact of physical activity during weekdays and weekends on fat mass among adults: 12-month cohort study

BACKGROUND

Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models.

OBJECTIVE

To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up.

DESIGN AND SETTING

Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil.

METHODS

A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models.

RESULTS

After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%.

CONCLUSION

Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.

Bone accrual over 18 months of participation in different loading sports during adolescence

This study investigated the impact and non-impact sports on bone mineral density accrual in adolescents over 18 months. The impact sports were beneficial for bone health (accrual of bone density). In contrast, swimmers had similar or lower bone mineral density compared with the control group depending on the skeletal site.

PURPOSE

To investigate the impact and non-impact sports on bone mineral density (BMD) accrual in adolescents over a period of 18 months METHODS: The sample was composed of 71 adolescents, avarage age of 12.7 (± 1.7) years old at baseline. Bone outcomes were compared according to the loading of the sports practiced (impact sports, n = 33 [basketball, karate, and judo], non-impact sport, n = 18 [swimming], and control group, n = 20). Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry (DXA) and bone mineral apparent density (BMAD) estimated through equation. The results were compared between the groups using analysis of variance and analysis of covariance.

RESULTS

Adjusted aBMD at lower limbs, whole body less head (WBLH), and adjusted WBLH BMAD were significantly greater in the impact sport group than the non-impact sport group at all time points. Adjusted upper limbs aBMD was significantly higher at the impact sports group compared to the non-impact sport group at 9 months and 18 months, besides compared to the control group at baseline and 18 months. Non-impact sport group presented a significant lower adjusted aBMD compared with control group at lower limbs and WBLH at 9 months, and at 9 months and 18 months in WBLH BMAD. There was a significant interaction (time × sport group) at upper limbs (p = 0.042) and WBLH aBMD (p = 0.006), and WBLH BMAD (p < 0.001).

CONCLUSION

Impact sports were more beneficial on accumulating aBMD and BMAD over a period of 18 months, while non-impact group (swimmers) had similar and lower aBMD and BMAD compared with the control group.

Bone Mineral Density and Sports Participation

The objective of our study was to identify differences in bone mineral density (BMD) according to different sports among adolescents, as well as to identify assessments of relevant mediators. The sample consisted of 429 adolescents with a mean age of 13.3 ± 1.7 yr. The sports modalities that we evaluated were judo, karate, kung fu, swimming, basketball, and soccer. Nonsports group was composed of 111 adolescents. Bone density was assessed using dual-energy X-ray absorptiometry. Regarding BMD values, female engaged in karate had higher BMD values than girls from the no sports group (p = 0.01). Boys engaged in soccer and karate presented the highest BMD values than all the other groups (p = 0.01). The most relevant mediators were the body mass index and lean soft tissue for boys and girls. Different sports presented different results regarding BMD gains, which were influenced by body mass index and whole-body lean soft tissue.

SWIMMING AND BONE MINERAL DENSITY: A SPORT WITHOUT OSTEOGENIC STIMULATION?

ABSTRACT Introduction: The osteogenic effects generated by different sports are the subject of a growing number of research projects. Regular physical activity is one of the main recommendations for the stimulation of bone mineral density (BMD). However, evidence has shown that not all physical activities promote similar effects. In this context, the osteogenic effects of swimming need to be clarified. Objective: To verify and compare total and regional BMD levels between male and female swimming athletes and university non-athletes. Methods: The sample, composed of 60 participants of both sexes, was divided into two groups: 30 swimming athletes (GA): 15 men (22.2 ± 3.92 years; 73.61 ± 16.55 kg; 1.76 ± 0.08 m) and 15 women (21.91 ± 2.21 years; 53.15 ± 8.36 kg; 1.64 ± 0.06 m) and a control group (CG): 30 university non-athletes: 15 men (20.73 ± 1.27 years; 74.4 ± 5.54 kg, 1.74 ± 0.04 m) and 15 women (19.93 ± 2.05 years; 59.72 ± 1.33 kg; 1.63 ± 0.004 m). BMD (total, arms, legs, pelvis and spine) was measured using dual energy X-ray absorptiometry (DXA). The results were compared with one-way ANOVA using Scheffé's post hoc test, when necessary. Results: When compared with the women, the men of both groups presented superior results for all BMD values analyzed. In addition, GA had higher BMD of arms and spine when compared to the CG, both for males (p = 0.016 and p = 0.001, respectively) and females (p = 0.0001 and p = 0.011, respectively). Conclusions: The results of this study demonstrate that young male adults, athletes and non-athletes, present higher levels of BMD than their peers of the opposite sex. In addition, the results suggest that when undertaken for competitive purposes and with a weekly training volume of 12 hours or more, swimming may be beneficial for the bone development of young athletes when compared to non-athlete controls. Level of evidence III; Retrospective comparative study.

Impact of changes in fat mass and lean soft tissue on bone mineral density accrual in adolescents engaged in different sports: ABCD Growth Study

Body composition can have a significant impact on bone mineral density (BMD) in pediatric patients and may cause bone disease. This study demonstrated that lean soft tissue (LST) seems to have a greater impact on BMD gain in the lower limbs of adolescents.

PURPOSE

To analyze the impact of changes in lean soft tissue (LST) and fat mass on areal bone mineral density (BMD) accrual in the lower limbs among adolescents engaged in sports with different weight-bearing levels.

METHODS

Longitudinal (12 months: measurements at two time points). Adolescents of both sexes (n = 191; 62 girls [32.5%] and 129 boys [67.5%]) were divided into three groups: control group (n = 65), swimming group (n = 25), and weight-bearing sports group (n = 100). Absolute changes in LST (kg) and fat mass (kg) were the independent variables, while BMD accrual (left and right legs) was the dependent variable. Linear regression was used to assess the relationship between dependent and independent variables in a multivariate model adjusted by sex, body weight, somatic maturation, serum osteocalcin, and baseline values of BMD of the lower limbs.

RESULTS

For the left leg, LST was positively related to areal BMD accrual in the control (β = 0.021 [95%CI: 0.001 to 0.042]) and weight-bearing sport groups (β = 0.051 [95%CI: 0.037 to 0.065]), but not among swimmers (β = 0.029 [95%CI: - 0.004 to 0.062]). For the right leg, LST was positively related to areal BMD accrual in the swimming group (β = 0.065 [95%CI: 0.031 to 0.100]) and weight-bearing sport groups (β = 0.048 [95%CI: 0.034 to 0.062]), but not in the control group (β = 0.014 [95%CI: - 0.002 to 0.030]). Fat mass was not significantly related to areal BMD in either leg.

CONCLUSIONS

Changes in LST were the most relevant determinant of BMD accrual in the lower limbs, mainly among adolescents engaged in sports.

Effects of Judo Training on Bones: A Systematic Literature Review

Ciaccioni, S, Condello, G, Guidotti, F, and Capranica, L. Effects of judo training on bones: a systematic literature review. J Strength Cond Res 33(10): 2882-2896, 2019-The aim of this study was to provide a systematic literature review on the osteogenic effects of judo (PROSPERO: CRD42016041803). The online search was conducted according to the inclusion criteria: observational studies and clinical/interventional trials in English from inception to June 2016; bone health, bone mineral density (BMD), diameters, impact force, and bone turnover marker (BTM) outcomes. Thirty-four studies were included and graded for their methodological quality ("fair" quality: 79.4%). The most used assessment method (44.1%) was X-ray absorptiometry. A positive association between judo and bone health/status emerged. Findings support site-specific BMD accrual in children, adolescents, adult athletes, and in premenopausal and postmenopausal female practitioners. Bone turnover markers revealed a hypermetabolic status in high-level judo athletes. The osteogenic stimuli of judo seem to protect athletes from alterations in bone metabolic balance due to weight loss cycling. Sexual dimorphism was found between judoka in bone diameters and mass, and significant differences in bone breadths emerged between elite and nonelite judokas. The fall techniques reduced bone impact force and velocity with respect to "natural" fall. Further longitudinal, cross-sectional, and interventional researches are required. This article provides useful information on bone for health sport scientists, coaches, and practitioners, stimulating future research lines on judo. In particular, coaches and physical trainers should consider introducing judo fall techniques in their training plans to prevent fall-related injuries, especially relevant in the older population. Conversely, coaches are urged to carefully control weight cycling dietary habits of their athletes, which can produce serious metabolic responses on bones.

Bone Health in Children and Youth with Cystic Fibrosis: A Systematic Review and Meta-Analysis of Matched Cohort Studies

OBJECTIVE

To assess the evidence regarding the differences in areal bone mineral density (aBMD) between children and adolescents with cystic fibrosis (CF) compared with their healthy peers, based on data from longitudinal studies.

STUDY DESIGN

We searched MEDLINE, SPORTDiscus, the Cochrane Library, PEDro (Physiotherapy Evidence Database), and Embase databases. Observational studies addressing the change of aBMD in children with CF and healthy children and adolescents were eligible. The DerSimonian and Laird method was used to compute pooled estimates of effect sizes (ES) and 95% CIs for the change of whole body (WB), lumbar spine (LS), and femoral neck (FN) aBMD.

RESULTS

Six studies with participants with CF and 26 studies with healthy participants were included in the systematic review and meta-analysis. For the analysis in children with CF, the pooled ES for the change of WB aBMD was 0.29 (95% CI -0.15 to 0.74), for the change of LS aBMD was 0.13 (95% CI -0.16 to 0.41), and for the change of FN aBMD was 0.09 (95% CI -0.39 to 0.57). For the analysis in healthy children, the pooled ES for the change of WB aBMD was 0.37 (95% CI 0.26-0.49), for the change of LS aBMD was 0.13 (95% CI -0.16 to 0.41), and for the change of FN aBMD was 0.52 (95% CI 0.19-0.85).

CONCLUSIONS

aBMD development might not differ between children and adolescents with CF receiving medical care compared with their healthy peers. Further longitudinal studies in a CF population during growth and development are required to confirm our findings.

Do the benefits of participation in sport and exercise outweigh the negatives? An academic review

Public health campaigns promote regular exercise and physical activity. These campaigns are founded on global recommendations that a combination of aerobic and resistance exercise is required, on a weekly basis, to maximise physical and mental health. However, participation in all forms of sports and physical activity has inherent risks that need to be considered by both health practitioners making activity recommendations and the people participating. This review examines biological, psychological and social benefits and harms of the three highest participation physical activities: walking/running, multidirectional sports and resistance exercise. While the remaining evidence indicates that the positives do outweigh the negatives, it demonstrates that moderate amounts of exercise provide the most optimal balance and that potential harms are typically associated with low or high participation.

Bone Health and Its Relationship with Impact Loading and the Continuity of Physical Activity throughout School Periods

Bone is influenced by physical activity (PA) throughout life, but childhood and adolescence provide a key opportunity to maximize peak bone mass. Thus, it is important to identify the relationship between PA practiced in childhood and young adulthood to design a promotion plan for bone health. The purpose of this study was to analyze the relationship between different impact-loading PAs (and their continuity throughout school periods from childhood to young adulthood) and bone stiffness index (SI). In this cross-sectional study, which was conducted on 145 university students aged 18-21 years, bone measurements were measured by quantitative ultrasonometry (QUS), and PA information was recalled using a self-administered questionnaire. Associations between the SI and the impact of PA performed during secondary school (p = 0.027), high school (p = 0.002), and university (p = 0.016) periods were observed. The continuity of PA over a longer period of time was related to a higher SI (p = 0.007). Those who practiced PA throughout all school periods had a higher SI than those who practiced during primary school only (p = 0.038) or through primary and secondary schools (p = 0.009). These results suggest that impact-loading PA practiced during different school periods is related to higher values of the SI. Therefore, continuous PA from an early age may be an important contributing factor to achieving and maintaining adequate bone health.

Sports participation and muscle mass affect sex-related differences in bone mineral density between male and female adolescents: A longitudinal study

BACKGROUND

Sports participation plays an important role in bone gain during childhood and adolescence. The aim here was to identify sex-related determinants of bone mineral density (BMD) differences between male and female adolescents, with emphasis on the role of sports participation.

DESIGN AND SETTING

Longitudinal study conducted in a public university in Presidente Prudente, Brazil.

METHODS

The sample comprised 48 adolescents aged 11-17 years, of both sexes, who were matched according to sex, age and sports participation. BMD was the main outcome, while muscle mass, sports participation, calendar age and biological maturation were treated as covariates. Participants were followed up after nine months.

RESULTS

At baseline, BMD values were similar between the sexes. However, adjustment for covariates showed that BMD was higher among girls at all sites, with a contribution from lean soft tissue (LST) in the model (partial eta-squared, ES-r = 0.619 in upper limbs; 0.643 in lower limbs; 0.699 in spine; and 0.599 in whole body). Sports participation only explained the upper-limb variance (ES-r = 0.99). At the follow-up, the results resembled the baseline except in the lower limbs (P = 0.109), in which BMD was similar between the groups. BMD gain over time was similar between girls and boys in all segments, and baseline LST affected upper-limb and whole-body BMD accrual (ES-r = 0.396 and 0.107, respectively).

CONCLUSION

Whole-body and specific-site BMD differed between baseline and follow-up. However,BMD accrual was similar between the sexes, given that muscle mass constituted the most relevant determinant of the difference between them.

Plantar pressures in male adolescent soccer players and its associations with bone geometry and strength

BACKGROUND

Mechanical loads exerted by soccer-specific actions increase bone remodeling activity. Nevertheless, little is known about the relationship between plantar pressure and bone structure. Therefore, the aim of this study was to compare bone geometry and strength between soccer players who exhibited different maximum values of the average pressures (MP) when performing a combination of soccer-specific tasks.

METHODS

Forty male adolescent soccer players (mean age 13.2±0.5 years) and 13 controls (mean age 13.1±0.9 years) participated in this study. Biofoot® system was used to measure MP at the non-dominant foot during a circuit of soccer-specific tasks. Cluster analysis was performed to classify players into groups of similar MP profiles resulting two different groups as follows: 15 players with high MP (SOC-HP; mean MP: 392.7±68.2 kPa) and 25 with low MP (SOC-LP; mean MP: 261.0±49.6 kPa). Total and cortical volumetric bone mineral content (Tt.BMC/Ct.BMC), cross-sectional area (Tt.Ar/Ct.Ar), cortical thickness (Ct.Th), fracture load in X-axis, and polar strength index (SSIp) were measured at 38% of the non-dominant tibia by peripheral quantitative computed tomography. Bone geometry and strength comparisons between SOC-HP and SOC-LP were performed using analyses of covariance controlling by weight and tibia length.

RESULTS

Greater Tt.BMC, Ct.BMC and Tt.Ar. were found in SOC-HP compared to CG (Tt.BMC: 3.22vs2.95 g, Ct.BMC: 2.95vs2.68 g, Ct.Ar: 280vs253 mm2; P<0.05). Nevertheless, no significant bone geometry and strength differences were found between soccer groups and between SOC-LP and CG (P>0.05).

CONCLUSIONS

Developing high MP when training and playing soccer might be favorable to bone development.

Sports Participation Decreases the Incidence of Traumatic, Nonsports-Related Fractures Among Adolescents

OBJECTIVES

To investigate the effects of different sports on the incidence of traumatic fractures (TF; sport-related fractures and those occurring in daily activities) among adolescents during the 9-month follow-up period.

METHODS

The adolescents were contacted in 11 different locations (3 public/private schools and 8 sports clubs), and the final sample was divided into 3 groups: control (n = 121), swimming (n = 51), and impact sports (n = 142). The incidence of TF was calculated by considering the exposure to sports (TF/1000 h).

RESULTS

In the overall sample, the incidence of TF was 1.29 TF/1000 hours of sports exposure, while the incidence of sport-related TF was 0.39 TF/1000 hours of sports exposure. Adolescents engaged in sports (P = .004), independently of type (P = .001), for 3 or more days per week (P = .004) and more than 60 minutes per day (P = .001) had lower incidence of TF. Adolescents engaged in more than 300 minutes per week of sport (0.17 TF/1000 h) had lower incidence than those who did not (2.06 TF/1000 h [P = .001]). A similar finding was observed for sport-related TF (≥300 min/wk: 0.08 TF/1000 h vs 300 min/wk: 0.615 TF/1000 h [P = .02]).

CONCLUSION

Adolescents engaged in sports showed a lower incidence of TF than nonengaged adolescents.

The NBA and Youth Basketball: Recommendations for Promoting a Healthy and Positive Experience

Participation in sports offers both short-term and long-term physical and psychosocial benefits for children and adolescents. However, an overemphasis on competitive success in youth sports may limit the benefits of participation, and could increase the risk of injury, burnout, and disengagement from physical activity. The National Basketball Association and USA Basketball recently assembled a group of leading experts to share their applied research and practices to address these issues. This review includes the group's analysis of the existing body of research regarding youth sports participation and the related health, performance, and psychosocial outcomes. Based upon this, age-specific recommendations for basketball participation are provided that aim to promote a healthy and positive experience for youth basketball players.

Adults Engaged in Sports in Early Life Have Higher Bone Mass Than Their Inactive Peers

Purpose: To analyze the relationship between engagement in sports in early life and bone variables among adults of both sexes. Methods: The sample was composed of 225 men and women. Demographic data were collected, and dual-energy X-ray absorptiometry was used to assess bone mineral density, bone mineral content, and lean soft tissue. Sports participation in early life was assessed by an interview including childhood and adolescence. Consumption of tobacco and alcohol was also assessed by interview and the habitual physical activity level by a pedometer. Results: Inactive men had bone mineral content around 11% lower than active men in childhood or adolescence, whereas for women, this difference represented around 14%. Active men had 74% less fat mass than inactive men in early life, and the difference was 67% for women. Early sports participation explained the differences in whole-body bone mineral content (16.8%, P-value = .005) and bone mineral density (8.8%, P-value = .015), as well as bone mineral density in lower limbs (18.9%, P-value = .001) among women. Conclusion: Adults engaged in sports in early life have higher bone mass than their inactive peers, especially women.

Track and Field Practice and Bone Outcomes among Adolescents: A Pilot Study (ABCD-Growth Study)

Background

Osteoporosis is considered a public health problem with high worldwide prevalence. One approach to prevention is through the promotion of physical activity, especially exercise, during adolescence.

Methods

This study compared bone variables in different body segments in adolescents according to participation in track and field. The study included 34 adolescents (22 boys), of whom 17 were track and field athletes and 17 were control subjects. Bone mineral density (BMD, g/cm²) and bone mineral content (BMC, g) were analyzed using dual energy X-ray absorptiometry (total body stratified by body segments). Peak height velocity was used to estimate somatic maturation.

Results

Athletes had higher BMD (P=0.003) and BMC (P=0.011) values in the lower limbs and higher whole body BMD (P=0.025) than the control group. However, when adjusted for confounding factors, the difference was not maintained. The groups had similar lean soft tissue values (P=0.094). Training overload was positively correlated with BMD in the upper limbs (r=0.504; 95% confidence interval, 0.031-0.793). Although track and field athletes had higher BMD and BMC values in the lower limbs, these differences were not significant when adjusted for confounding factors.

Conclusions

Track and field participation in adolescence appears to influence BMD and BMC in lower limbs, and fat-free mass seems to mediate this effect. Also, higher training loads were found to be positive for bone health in upper limbs.

Soccer helps build strong bones during growth: a systematic review and meta-analysis

The aim of this study was to analyze the effects of soccer practice on bone in male and female children and adolescents. MEDLINE, PubMed, SPORTDiscus and Web of Science databases were searched for scientific articles published up to and including October 2016. Twenty-seven studies were included in this systematic review (13 in the meta-analysis). The meta-analysis was performed by using OpenMeta[Analyst] software. It is well documented that soccer practice during childhood provides positive effects on bone mineral content (BMC) and density (BMD) compared to sedentary behaviors and other sports, such as tennis, weightlifting, or swimming. Furthermore, soccer players present higher BMC and BMD in most weight-bearing sites such as the whole body, lumbar spine, hip, and legs. Moreover, bone differences were minimized between groups during prepuberty. Therefore, the maturity status should be considered when evaluating bone. According to meta-analysis results, soccer practice was positively associated with whole-body BMD either in males (mean difference 0.061; 95%CI, 0.042-0.079) or in females (mean difference 0.063; 95%CI, 0.026-0.099).

CONCLUSION

Soccer may be considered a sport that positively affects bone mass during growth. Pubertal soccer players presented increased bone mass compared to controls or other athletes; however, these bone differences are minimized during the prepubertal stage. What is known: • It has been described that childhood and adolescence are important periods for bone mass and structure. • Previous studies have demonstrated that soccer participation improves bone mass in male and female children and adolescents. What is new: • The differences between soccer players and controls are more marked during puberty than prepuberty. • Weight-bearing sites such as lumbar spine, hip, femoral neck, trochanter, intertrochanteric region and both legs are particularly sensitive to soccer actions.

The Impact of Training Load on Bone Mineral Density of Adolescent Swimmers: A Structural Equation Modeling Approach

PURPOSE

To investigate the mediating effect of muscle mass on the relationship between training load and bone density in adolescent swimmers.

METHODS

A cross-sectional study involving 87 control and 22 swimmers aged 10-19 years (overall sample: n = 109). Swimmers had a minimum of 1 year of competition in regional and national championships, and control adolescents reported 1 year without any organized sport. Bone density was the main outcome (dual-energy X-ray absorptiometry), which was measured in upper limbs, lower limbs, spine, and whole body. Monthly training load was the independent variable, while the mediation effect of lean soft tissue was assessed. Maturity offset, age, inflammation, and vitamin D intake were treated as covariates.

RESULTS

Swimmers had lower bone density than controls; there was a significant and positive relationship between training load and muscle mass. In boys, training load presented a negative correlation with bone density in lower limbs [r = -.293; 95% confidence interval (CI), -.553 to -.034]. In girls, training load was negatively related to bone mineral density in lower limbs (r = .563; 95% CI, -.770 to -.356) and whole body (r = -.409; 95% CI, -.609 to -.209).

CONCLUSION

Training load had a negative relationship on bone density of swimmers of both sexes, independently of the positive effect of lean soft tissue on bone density.

Impact of Martial Arts (Judo, Karate, and Kung Fu) on Bone Mineral Density Gains in Adolescents of Both Genders: 9-Month Follow-Up

PURPOSE

To compare bone mineral density (BMD) gains in adolescents of both genders stratified according to different martial art styles in a 9-month follow-up study.

METHODS

The longitudinal study consisted of 29 adolescents of both genders and age between 11 and 17 years stratified into a control group (not engaged in any sport) and 50 fighters (kung fu/karate, n = 29; judo, n = 21). All 79 subjects underwent anthropometric measures (weight, height, leg length, and height set) and dual-energy X-ray absorptiometry (BMD, in g/cm²) at 2 moments, baseline and 9 months later. Maturity offset (age at peak height velocity), lean soft tissue, chronological age, and resistance training were treated as covariates.

RESULTS

Male judoists presented higher gains in BMD-spine [0.098 g/cm² (95% confidence interval, 0.068-0.128)] than control group [0.040 g/cm² (95% confidence interval, 0.011-0.069)] (post hoc test with P = .030). There was no effect of martial art on BMD gains among girls. Independently of gender, in all multivariate models, lean soft tissue constituted the most relevant covariate.

CONCLUSIONS

Judo practice in adolescents affected the bone accrual significantly after 9-month follow-up compared with controls, mainly in boys.

Bone tissue, blood lipids and inflammatory profiles in adolescent male athletes from sports contrasting in mechanical load

Exploring the effect of non-impact and impact sports is particular relevant to understand the interaction between skeletal muscle and bone health during growth. The current study aimed to compare total and regional bone and soft-tissue composition, in parallel to measurements of blood lipid and inflammatory profiles between adolescent athletes and non-athletes. Anthropometry, biological maturity, dual energy X-ray absorptiometry (DXA) scans, training load and lipid and inflammatory profiles were assessed in a cross-sectional sample of 53 male adolescents (20 non-athletes, 15 swimmers and 18 basketball players) aged 12–19 years. Multiple comparisons between groups were performed using analysis of variance, covariance and magnitude effects (ES-r and Cohen’s d). The comparisons of controls with other groups were very large for high-sensitivity C-reactive protein (d range: 2.17–2.92). The differences between sports disciplines, regarding tissue outputs obtained from DXA scan were moderate for all variables except fat tissue (d = 0.4). It was possible to determine small differences (ES-r = 0.17) between controls and swimmers for bone area at the lower limbs (13.0%). In parallel, between swimmers and basketball players, the gradient of the differences was small (ES-r range: 0.15–0.23) for bone mineral content (24.6%), bone area (11.3%) and bone mineral density (11.1%) at the lower limbs, favoring the basketball players. These observations highlight that youth male athletes presented better blood and soft tissues profiles with respect to controls. Furthermore, sport-specific differences emerged for the lower limbs, with basketball players presenting higher bone mineral content, area and density than swimmers.

Impact sports and bone fractures among adolescents

The objective of the present study was to investigate the effects of different sports on stress fractures among adolescents during a 9-month follow-up period. The sample was composed of 184 adolescents divided into three groups (impact sports [n = 102]; swimming [n = 35]; non-sports [n = 47]). The occurrence of stress fracture was reported by participants and coaches. As potential confounders we considered age, sex, resistance training, body composition variables and age at peak of height velocity. There were 13 adolescents who reported fractures during the 9-month period. Bone mineral density values were higher in adolescents engaged in impact sports (P-value = 0.002). Independently of confounders, the risk of stress fracture was lower in adolescents engaged in impact sports than in non-active adolescents (hazard ratio [HR] = 0.23 [95% confidence interval (CI) = 0.05 to 0.98]), while swimming practice was not associated to lower risk of fracture (HR = 0.49 [95% CI = 0.09 to 2.55]). In conclusion, the findings from this study indicate the importance of sports participation among adolescents in the reduction of stress fracture risk, especially with impact sports. More importantly, these results could be relevant for recognising adolescents in danger of not reaching their potential for peak bone mass and later an increased risk of fractures.