Effect of maturational timing on bone health in male adolescent athletes engaged in different sports: The PRO-BONE study

Height Restrictions for Dual-energy X-ray Absorptiometry: What Are Our Options for Body Composition and Bone Health Precision?

ABSTRACT

Redinger, AL, Russell, JL, Allen, SMF, and Baker, BS. Height restrictions for dual-energy X-ray absorptiometry: what are our options for body composition and bone health precision? J Strength Cond Res 38(7): e359-e365, 2024-Dual-energy X-ray absorptiometry (DXA) is commonly used for testing athlete's body composition, but many athletes are too tall. The first aim was to assess the viability of combining upper- and lower-body regions of interest (ROI), creating a combined scan for tall athletes who do not fit on the table and second, to provide practical solutions to DXA users who routinely scan tall athletes. Sixty subjects (34.8 ± 11.9 years; 171 ± 9 cm) completed 2 total-body DXA scans for baseline precision testing, using GE Lunar Prodigy (LP) or Hologic Horizon A (HA) models. Next, an upper body ROI from the skull to the distal femoral condyles was combined with a flipped scan (feet-to-head) ROI encompassing the proximal tibial plateau to the distal foot. Soft and bone tissue coefficient of variance (CV%) were calculated between the baseline scans and for the newly combined ROI scan. The combined ROI scan added 0.25-0.63% and 0.01-4.35% error rates for the LP and HA, respectively. An exploratory assessment of a GE Lunar iDXA demonstrated results similar to the HA with 4%+ error. The combined ROI scan is a user-friendly and precise method for older LP systems adding less than 1% error; however, newer DXA systems cannot use the stitched scan technique. Coaches and practitioners who use newer DXAs must prioritize consistently using the same boney landmarks (head, jaw, or feet) and ROI heights to provide precise longitudinal assessments of tall athletes' bone and body composition, until larger DXA tables become available.

Disaggregating the influence of maturity status on training, anthropometric, performance, skeletal periphery, and hormonal factors in athletic boys

Maturity offset (i.e., age from peak height velocity [PHV]) is widely used to assess maturational status among youth athletes, but details on the skeletal periphery, hormones and training factors are lacking. More precision is also needed to explicate the timing, tempo, and sequence of growth-related events. These gaps were addressed in a cross-sectional study. One hundred and two athletic boys (aged 14.1 ± 0.5 years) were evaluated for training details, salivary testosterone and cortisol, height, body mass, body mass index, body fat, fat-free mass (FFM), hand and carpal bone area, bone mineral content (BMC) and density (BMD), and countermovement jump performance. Participants were assigned to circa-PHV (N = 56) and post-PHV (N = 46) groups for comparisons, before data pooling and disaggregation using generalized additive and linear regression models. The older post-PHV group had a larger body size, more testosterone, and better performance and skeletal outcomes, whilst weekly training and school-based exercise favored the younger circa-PHV group (all p < 0.001). Smoother plots verified these differences via linear, or weakly non-linear, associations. Maturity offset was predicted (R2 = 0.848) by the linear combination of FFM (42.0 % relative contribution), hand BMD (31.5 %), chronological age (16.0 %), testosterone (6.7 %), and training hours (3.8 %). In conclusion, athletic boys who presented at different stages of maturity (-0.98 to 2.84 years from PHV) also differed on many developmental features. Most variables increased at constant, or near-constant, tempo with a higher maturity offset, with FFM and hand BMD emerging as the strongest linear predictors of maturational status.

Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis

Background: Although regular physical activity and exercise programs might improve bone health caused by oncological treatment and the disease itself, it remains unknown the pooled effect of exercise interventions following frequency, intensity, time and type prescriptions.

Objective: This systematic review and meta-analysis aimed to synthesise evidence regarding the effectiveness of exercise interventions on bone health in children and adolescents with cancer during and after oncological treatment.

Methods: A systematic search was conducted in the MEDLINE (via PubMed), Web of Science and Scopus databases from November 2021 to January 2022. Randomised controlled trials (RCTs) and non-RCTs reporting pre-post changes of the effectiveness of exercise interventions on DXA-measured bone parameters in young population (1–19 years) during or after oncological treatment were included. Pooled (ESs) and 95% confidence intervals (95%CIs) were calculated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

Results: A total of eight trials with 341 participants were included. The meta-analyses did not reveal a statistically significant increase in whole body areal bone mineral density (ES = 0.10; 95%CI: −0.14, 0.34), lumbar spine (ES = 0.03; 95%CI: −0.21, 0.26) or femoral neck (ES = 0.10; 95%CI: −0.37, 0.56). Similarly, during the oncological treatment phase the ES was 0.04 (95%CI: −0.17, 0.25) and after the ES was 0.07 (95%CI: −0.20, 0.33).

Conclusion: To date, exercise interventions have been inappropriate and therefore, ineffective to illustrate any beneficial effect on bone health in children and adolescents with cancer during and after oncological treatment.

Systematic Review Registration: PROSPERO registration number: CRD42022310876

REHABILITATION OF KNEE INJURIES IN BASKETBALL PLAYERS

ABSTRACT Introduction Basketball games are extremely combative, and the knee joint is severely impacted between runs and jumps inherent to the sport, and its injury is often inevitable. Objective Investigate the rehabilitation processes for knee joint injuries in basketball players. Methods In this paper, six athletes were questioned about the rehabilitation approach used for their injuries. In all, the centrifugal training system was used. The frequency of the exercises was three times a week, with one-day intervals. The overall training lasted nine weeks. Before and after the experiment, the athletes’ knee joint mobility and pain scores were measured, and the data were compared and analyzed. Results After nine weeks of training, the pain score by the visual analog scale was 2-4 points, corresponding to the score of mild pain without expressive impacts on activities of daily living. Conclusion The form of lower limb centrifugal training proposed in this study may help the recovery of functional status in the athletes’ knee joint, improve their joint mobility and reduce pain, presenting itself as an effective training method to be incorporated into rehabilitation. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

EFFECT OF HIGH-INTENSITY TRAINING ON BONE MINERAL DENSITY IN BASKETBALL PLAYERS

ABSTRACT Introduction Increasing the bone mineral density of athletes can provide better basic physical conditions for basketball players, prevent fractures caused by osteopenia and reduce the occurrence of serious sports injuries. Objective Explore the effect of high-intensity training on bone mineral density in basketball players. Methods In this experiment, 30 subjects were divided into male and female groups, and high-intensity exercise training was performed for 60 minutes, three times a week, for eight weeks. The relevant indices were measured before and after training, and their data were classified and analyzed. Results High-intensity training can significantly improve the bone mineral density of basketball players, and the increase of bone mineral density of female basketball players is slightly lower than that of male players. In addition, the increase in bone mineral density can comprehensively improve athletes’ muscular strength and physical fitness. Conclusion High-intensity training can improve basketball players’ bone mineral density and sports skills, requiring promoting studies for its popularization in colleges and universities. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

EFFECTS OF SPORT ON SKELETAL DEVELOPMENT IN ADOLESCENTS

ABSTRACT Introduction Incomplete skeletal development in adolescents and children depends on several factors such as genetic load, diet, and environment. Appropriate physical exercise can improve youth’s physical fitness, but its effect on bone density is still questioned. Objective Verify the influence of appropriate physical activity on adolescents’ bone development. Methods Among 3240 students aged 12 to 16 years from 4 schools, 96 students (52 males) were selected for observation. They were divided into a control and an experimental group, with a sports activity protocol inserted into the latter. Family and student questionnaires, physical examinations, and X-rays were used for data collection. Statistical analysis of factors including sports and development of adolescents’ height quality was extensively documented. Results The skeletal development in adolescents on regular participation in sports is better than that in adolescents not involved in sports. Conclusion Physical exercise can promote skeletal development in adolescents. Evidence Level II; Therapeutic Studies - Investigating the result.

THE EFFECT OF SPORTS IN PROMOTING THE ENHANCEMENT OF ADULT BONE DENSITY

ABSTRACT Introduction: Exercise is an important part of osteoporosis treatment. A moderate amount of exercise can improve bone metabolism, improve bone biomechanics and increase bone density. Objective: To study the effects of different sports on adult bone mineral density. Methods: We selected volunteers to perform different exercises and used quantitative ultrasound and bioelectrical impedance methods to test the volunteers. Results: Exercise can increase the content of lean body mass in body composition and reduce body fat percentage. The calcaneal bone mineral density of physical education students is positively correlated with low body weight. Conclusion: Exercise can promote the bone mineral density of young adults. Stronger weight-bearing exercises can better promote the increase of bone density. Level of evidence II; Therapeutic studies - investigation of treatment results.

More than Sports Participation: The Role of Ground Reaction Force, Osteocalcin and Lean Soft Tissue on Bone Density Accrual in Adolescents: ABCD Growth Study

The objective of this study was to identify predictors of 12-mo areal bone density accrual in different body segments, lean soft tissue, and osteogenic characteristics attributed to sports participation among adolescent girls and boys. Adolescents (Girls [n = 64], [aged = 14.7]); Boys [n = 129], [aged = 14.6]) were stratified into three groups according to their engagement in different sports (Control [n = 68], Swimming [n = 25], and Weight-bearing sports [n = 100]). Areal bone density (aBMD [g/cm²]) and lean soft tissue (LST) [kg] were measured by dual-energy x-ray absorptiometry (DXA; Lunar DPX-NT; General Electric Healthcare, Little Chalfont, Buckinghamshire, United Kingdom). The ground reaction force (GRF) index attributed to sports participation (Sport-GRF) was created considering the GRF attributed to each sport, body weight of the adolescent, and the amount of time spent in sports participation. Osteocalcin levels (ng/mL) were estimated from a venous blood sample. Multiple regression analysis showed that after adjusting for covariates, the models involving sport-GRF, LST (Δ), and osteocalcin explained 15.8% to 76.2% of the aBMD gains. Specifically in girls, OC was only associated with lower limb aBMD accrual. In boys, however, sport ground reaction forces were positively associated with total spine aBMD accrual. Furthermore, the LST (Δ) was positively associated with aBMD accrual in all body sites (β = 0.003 to 0.011) in both sexes. Increases in LST contributed significantly to gains in aBMD accrual in both sexes, being a more important predictor of changes in bone outcomes than ground reaction forces and osteocalcin.

Lumbar Bone Mineral Adaptation: The Effect of Fast Bowling Technique in Adolescent Cricketers

INTRODUCTION

Localised bone mineral density (BMD) adaptation of the lumbar spine, particularly on the contralateral side to the bowling arm, has been observed in elite male cricket fast bowlers. No study has investigated this in adolescents, or the role of fast bowling technique on lumbar BMD adaptation. This study aims to investigate lumbar BMD adaptation in adolescent cricket fast bowlers, and its relationship with fast bowling technique.

METHODS

39 adolescent fast bowlers underwent antero-posterior DXA scan of their lumbar spine. Hip, lumbopelvic and thoracolumbar joint kinematics, and vertical ground reaction kinetics were determined using 3D motion capture and force plates. Significant partial (covariate: fat free mass) and bivariate correlations of the technique parameters with whole lumbar (L1-L4) BMD and BMD asymmetry (L3 and L4) were advanced as candidate variables for multiple stepwise linear regression.

RESULTS

Adolescent fast bowlers demonstrated high lumbar Z-Scores (+1.0; 95%CI: 0.7 - 1.4) and significantly greater BMD on the contralateral side of L3 (9.0%; 95%CI: 5.8 - 12.1%) and L4 (8.2%; 95%CI: 4.9 - 11.5%). Maximum contralateral thoracolumbar rotation and maximum ipsilateral lumbopelvic rotation in the period between back foot contact (BFC) and ball release (BR), as well as contralateral pelvic drop at front foot contact (FFC), were identified as predictors of L1-L4 BMD, explaining 65% of the variation. Maximum ipsilateral lumbopelvic rotation between BFC and BR, as well as ipsilateral lumbopelvic rotation and contralateral thoracolumbar side flexion at BR, were predictors of lumbar asymmetry within L3 and L4.

CONCLUSION

Thoracolumbar and lumbopelvic motion are implicated in the aetiology of the unique lumbar bone adaptation observed in fast bowlers whereas vertical ground reaction force, independent of body mass, was not. This may further implicate the osteogenic potential of torsional rather than impact loading in exercise-induced adaptation.

Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study

INTRODUCTION

Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy.

METHODS

In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad).

RESULTS

There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12-30) days; II: 10 (95% CI: 7.3.1-13.4)]. Apophyseal injuries of the hip-pelvis resulted in the greatest burden [median: 13 (95% CI: 10-17); II: 2.5 (95% CI: 2.1-3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot-ankle (II: 2.4; 95% CI: 1.0-4.9), U-14 for knee (II: 4.5; 95% CI: 2.7-7.1), and U-17 for hip-pelvis (II: 6.4; 95% CI: 4.2-9.3).

CONCLUSION

Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip-pelvic apophyseal injuries accounted for the largest injury burden.

HIGH INTENSITY SPORTS PROMOTE THE DEVELOPMENT OF HEALTHY BONE TISSUE

ABSTRACT Introduction: Physical exercise can promote the growth and development of bones and delay bone loss; it is more effective when started young. Objective: This paper analyzes the impact of human exercise on human bone health. Methods: A questionnaire survey was conducted on elementary school students, and basic physical fitness monitoring was conducted. The physical fitness monitoring indicators covered ten items such as height and weight. Results: After the questionnaire survey and physical examination, it was found that there are differences in various physiological indicators between students who exercise frequently compared with students who exercise less frequently. Conclusion: Physical exercise can promote skeletal tissue development, therefore, young people should increase the practice of physical exercise. Level of evidence II; Therapeutic studies - investigation of treatment results.

Categorizing 10 Sports According to Bone and Soft Tissue Profiles in Adolescents

PURPOSE

Considering the different loading and training characteristics of the sports practiced during growth, it is important to specify and categorize the bone and soft tissue adaptations in adolescent athletes. This study aimed to categorize 10 different loading sports and a nonsport group and identify the differences in bone density and soft tissues.

METHODS

The sample included 625 adolescents (10 to 17 yr of age) of 10 sports (soccer, basketball, volleyball, track and field, judo, karate, kung fu, gymnastics, baseball, and swimming) and a nonsport group. Dual-energy x-ray absorptiometry assessed areal bone mineral density (aBMD), bone mineral apparent density (BMAD), and soft tissues (lean soft tissue and fat mass). The results were adjusted for sex, peak height velocity status, lean soft tissue, fat mass, and weekly training volume.

RESULTS

The comparisons among groups showed that soccer had the highest whole-body aBMD (mean ± SEM: 1.082 ± 0.007 g·cm) and lower limb aBMD (1.302 ± 0.010 g·cm). Gymnastics presented the highest upper limb aBMD (0.868 ± 0.012 g·cm) and whole-body BMAD (0.094 ± 0.001 g·cm). Swimming presented the lowest aBMD values in all skeletal sites (except at the upper limbs) and whole-body BMAD. The soft tissue comparisons showed that soccer players had the highest lean soft tissue (43.8 ± 0.7 kg). The lowest fat mass was found in gymnasts (8.04 ± 1.0 kg).

CONCLUSION

The present study investigated and categorized for the first time 10 different sports according to bone density and soft tissue profiles. Soccer and gymnastics sport groups were found to have the highest bone density in most body segments, and both sports were among the groups with the lowest fat mass.

The Mediating Role of Lean Soft Tissue in the Relationship between Somatic Maturation and Bone Density in Adolescent Practitioners and Non-Practitioners of Sports

This study aimed to identify the mediating effect of lean soft tissue (LST) in the association between somatic maturation and areal bone mineral density (aBMD) in adolescents by sex and sport participation. The sample included 558 adolescents (401 males, mean age of 14.0 years) that were practitioners of sports (11 sport modalities, n = 402) and a non-sport group (n = 157). Somatic maturation was assessed by using a validated peak height velocity prediction equation. Dual-energy X-ray absorptiometry (DXA) was used to assess aBMD (upper and lower limbs, spine and total body less head—TBLH) and LST. For both sexes, LST mediated the association between somatic maturation and aBMD at all skeletal sites (mediation percentage ranging from 36.3% to 75.4%). For sport and non-sport groups, the LST also mediated the association between somatic maturation and aBMD at all skeletal sites (mediation percentage ranging from 51.6% to 85.6%). The direct effect was observed in all groups, except for lower limbs and TBLH in the non-sport group. The association between somatic maturation and aBMD was mediated by LST in adolescents of both sexes and regardless of involvement in organized sports. Our findings highlighted the role of improving LST to mitigate the association of somatic maturation with aBMD.

Sclerostin, preadipocyte factor-1 and bone mineral values in eumenorrheic adolescent athletes with different training patterns

INTRODUCTION

The specific aims of the study were to compare possible differences in sclerostin and preadipocyte factor-1 (Pref-1) between rhythmic gymnasts (RG), swimmers (SW) and untrained controls (UC), and to investigate the relationships of sclerostin and Pref-1 with bone mineral characteristics in studied groups.

MATERIALS AND METHODS

This study included 62 eumenorrheic adolescents (RG = 22; SW = 20; UC = 20). Bone mineral and body composition characteristics were measured by dual-energy X-ray absorptiometry, and sclerostin, Pref-1, osteocalcin and C-terminal telopeptide of type I collagen (CTx) were measured.

RESULTS

Sclerostin was higher (P = 0.001) in RG (129.35 ± 51.01 pg/ml; by 74%) and SW (118.05 ± 40.05 pg/ml; by 59%) in comparison with UC (74.32 ± 45.41 pg/ml), while no differences (P = 0.896) were seen in Pref-1 (RG: 1.42 ± 0.16 ng/ml; SW: 1.41 ± 0.20 ng/ml; UC: 1.39 ± 0.26 ng/ml) between groups. Osteocalcin (RG: 7.74 ± 4.09 ng/ml; SW: 8.05 ± 4.18 ng/ml; UC: 7.04 ± 3.92 ng/ml; P = 0.843) and CTx (RG: 0.73 ± 0.22 ng/ml; SW: 0.64 ± 0.16 ng/ml; UC: 0.62 ± 0.20 ng/ml; P = 0.173) were not different between groups. Sclerostin correlated (P < 0.05) with whole-body bone mineral content (r = 0.61) and lumbar spine (LS) areal bone mineral density (aBMD) (r = 0.43) in RG, and femoral neck aBMD (r = 0.45) in UC. No correlation was found between sclerostin and bone mineral values in SW, and Pref-1 was not correlated with any bone mineral characteristics in studied groups. Sclerostin was the independent variable that explained 14% of the total variance (R² × 100) in LS aBMD value only in RG.

CONCLUSIONS

Adolescent athletes have higher sclerostin compared to UC. Sclerostin was correlated with bone mineral values and predicted areal bone mineral density in RG.

3D DXA Hip Differences in Patients with Acromegaly or Adult Growth Hormone Deficiency

The skeleton is regulated by and responds to pituitary hormones, especially when the circulating levels are perturbed in disease. This study aims to analyse the between-group differences in 3D dual-energy X-ray absorptiometry (DXA) parameters at the hip site among patients with acromegaly or adult growth hormone deficiency (AGHD) and a healthy control group. The current cross-sectional study includes data for 67 adults, 20 with acromegaly, 14 with AGHD and 33 healthy controls. We obtained the areal bone mineral density (aBMD) outcomes using DXA and cortical and trabecular parameters using 3D-DXA software (3D-SHAPER). The mean-adjusted 3D-DXA parameters did not differ between acromegaly patients and the controls (p > 0.05); however, we found cortical bone impairment (−7.3% to −8.4%; effect size (ES) = 0.78) in AGHD patients (p < 0.05). Differences in the cortical bone parameters were more evident when comparing AGHD patients (−8.5% to −16.2%; ES = 1.22 to 1.24) with acromegaly patients (p < 0.05). In brief, the 3D mapping highlighted the trochanter as the site with greater cortical bone differences between acromegaly patients and the controls. Overall, AGHD patients displayed lower cortical parameters at the trochanter, femoral neck and intertrochanter compared to the controls and acromegaly patients. To sum up, 3D-DXA provided useful information about the characteristics of bone involvement in growth hormone (GH)-related disorders. Patients with AGHD showed distinct involvement of the cortical structure.

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.

The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

BACKGROUND

New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health.

METHODS

A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health.

DISCUSSION

Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society.

TRIAL REGISTRATION

Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.

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.

The effect of a high-impact jumping intervention on bone mass, bone stiffness and fitness parameters in adolescent athletes

This study demonstrates that a 9-month jumping intervention can improve bone mass gains and physical fitness performance in adolescent males participating in non-osteogenic sports, such as swimming and cycling.

PURPOSE

To examine the effect of a jumping intervention on bone mass, bone stiffness and fitness parameters in adolescents involved in different sports.

METHODS

Ninety-three adolescent male swimmers (SWI), footballers (FOO) and cyclists (CYC) were randomised to intervention (INT) and sport (INT-SWI = 19, INT-FOO = 15, INT-CYC = 14) or sport only (CON-SWI = 18, CON-FOO = 15, CON-CYC = 12) groups. The 9-month jumping intervention consisted of 3 levels (12 weeks each) of 20 repetitions per set of counter movement jumps (CMJ) using adjustable weight vests (level 1 = 20 CMJ jumps/set, 0 kg, 3 sets/day, 3 times/week; level 2 = 20 CMJ jumps/set, 2 kg, 4 sets/day, 3 times/week; level 3 = 20 CMJ jumps/set, 5 kg, 4 sets/day, 4 times/week). Total body bone mineral content (BMC) at total body less head (TBLH) was measured using dual-energy X-ray absorptiometry and bone stiffness using quantitative ultrasound. Fitness was assessed using the 20-m shuttle run (20mSRT), CMJ and standing long jump (SLJ) tests.

RESULTS

INT-SWI had significantly higher increase in BMC legs and bone stiffness compared to CON-SWI (4.2-12.7%). INT-CYC had significantly higher increase in BMC at TBLH and legs and bone stiffness compared to CON-CYC (5.0-12.3%). There were no significant differences between INT-FOO and CON-FOO in any bone outcomes (0.9-3.9%). The increase in CMJ performance was significantly higher in INT-SWI (3.1 cm) and INT-CYC (3.2 cm) compared to CON-SWI and CON-CYC groups, respectively.

CONCLUSIONS

A 9-month jumping intervention can improve bone mass, bone stiffness and muscular fitness in adolescent males participating in non-osteogenic sports, such as swimming and cycling.

CLINICAL TRIAL REGISTRATION

ISRCTN17982776.