The prepubertal years: a uniquely opportune stage of growth when the skeleton is most responsive to exercise?

Inter-arm bone mass and size asymmetries in children tennis players are maturity status specific: a 9-month study on the effects of training time across pubertal change and somatic growth

PURPOSE

Bone growth with exercise is best assessed by tennis-induced inter-arm asymmetries. Yet, the effects of training and maturation across puberty were unclear. This study explored arm bone growth across 9 months of training in 46 tennis players 7-14 years (25 boys, 21 girls).

METHODS

Bone mineral content (BMC) and bone area (BA) were measured from DXA scans. Pubertal status was assessed by Tanner stage (TS) and somatic growth by maturity offset (MO). Children were grouped as pre- (TS I-I), early (TS I-II), and mid/late pubertal (TS II-III).

RESULTS

Training time (TT) change in the three groups was 160-170, 190-230, and 200-220 h, respectively. Bone asymmetries were large in all groups (d > 0.8, P < 0.001): 5-18 g (9-21%) and 9-17 g (17-23%) in girls and boys, respectively, for BMC, and 5-15 cm2 (6-13%) and 9-15 cm2 (12-15%) in girls and boys (10-13%), respectively, for BA. BMC and BA change asymmetry peaked at pre-puberty in girls (56%, 46%) and at early puberty in boys (57%, 43%). Asymmetry gains varied with baseline asymmetry (41%) and change in TT (38%) and TS (17%) in BMC, and with baseline asymmetry (58%) and change in MO (17%) and TS (12%) in BA.

CONCLUSION

All bone asymmetries were substantial. Tennis-induced bone gains were higher at pre- to early puberty in girls and at early to mid/late puberty in boys. Training enhanced mostly bone mass and maturity status enhanced mostly bone size; sex was not bone-change modeling impactful. Implications are discussed considering certain limitations.

Gains in relative cortical area during growth and their relationship to nutrition, body size, and physical activity

OBJECTIVES

In studies of growth in the past, low percentage of cortical area (%CA) is commonly attributed to poor general health, due to factors including poor nutrition, low socioeconomic status, or other physiological stressors. What constitutes low relative cortical dimensions has not been established across a diverse range of human skeletal samples. This study examines %CA in a large immature skeletal sample to establish typical variation in humans with consideration of both body mass and subsistence strategy.

MATERIALS AND METHODS

Percentage of cortical area was calculated at the midshaft of the humerus, femur, and tibia in seven skeletal samples. Age at death was estimated from dental development, and body mass from bone dimensions. Patterns of %CA with age and log-transformed body mass were examined in the pooled sample and compared among samples using LOESS regression, Welch's ANOVA, and Kruskal-Wallis tests.

RESULTS

Across all samples, %CA displays a generally non-linear pattern, but variation in %CA with age was high, particularly in samples with lower levels of %CA. There was no relationship between %CA and age-adjusted body mass.

DISCUSSION

The lack of a relationship between %CA and body mass suggests that %CA should not be used as an indicator of mechanical loading. The variation present across samples implies that appositional bone growth is affected by physiological stress in varying ways. Without a deeper understanding of what is "typical" for long bone development, it is impossible to draw conclusions about individual or population level health.

Strength Training in Swimming

This narrative review deals with the topic of strength training in swimming, which has been a controversial issue for decades. It is not only about the importance for the performance at start, turn and swim speed, but also about the question of how to design a strength training program. Different approaches are discussed in the literature, with two aspects in the foreground. On the one hand is the discussion about the optimal intensity in strength training and, on the other hand, is the question of how specific strength training should be designed. In addition to a summary of the current state of research regarding the importance of strength training for swimming, the article shows which physiological adaptations should be achieved in order to be able to increase performance in the long term. Furthermore, an attempt is made to explain why some training contents seem to be rather unsuitable when it comes to increasing strength as a basis for higher performance in the start, turn and clean swimming. Practical training consequences are then derived from this. Regardless of the athlete's performance development, preventive aspects should also be considered in the discussion. The article provides a critical overview of the abovementioned key issues. The most important points when designing a strength training program for swimming are a sufficiently high-load intensity to increase maximum strength, which in turn is the basis for power, year-round strength training, parallel to swim training and working on the transfer of acquired strength skills in swim training, and not through supposedly specific strength training exercises on land or in the water.

Weightlifting for Children and Adolescents: A Narrative Review

The involvement of youth in the sport of weightlifting and the use of weightlifting methods as part of training for youth sport performance appears to be increasing. Weightlifting for children and adolescents has been criticized in some circles and is a controversial aspect of resistance training for young people. Although injuries can occur during weightlifting and related activities, the incidence and rate of injury appear to be relatively low and severe injury is uncommon. A number of performance, physical, and physiological variables, such as body composition, strength, and power, are improved by weightlifting training in children, adolescents, and young athletes. Manipulating program variables, when appropriate, can have a substantial and profound influence on the psychological, physiological, physical, and performance aspects of weightlifters. An understanding of the sport, scientific training principles, and musculoskeletal growth development is necessary to properly construct a reasonable and appropriate training program. A scientific background aids in providing an evidenced basis and sound rationale in selecting appropriate methods and directing adaptations toward more specific goals and enables the coach to make choices about training and competition that might not otherwise be possible. If weightlifting training and competition are age group appropriate and are properly supervised, the sport can be substantially safe and efficacious.

Influence of Physical Fitness and Attention Level on Academic Achievements of Female and Male Military Academy Cadets in Poland

A professional soldier should be characterized not only by high physical fitness but also by high intellectual and cognitive skills. Therefore, it is important to focus on the future commanding cadre-cadets that are educated in military academies. The aim of the study was to look for correlations between the level of physical fitness and attention and academic achievements (AA) in different subjects among cadets studying at military academies. The research group consisted of students of a military academy in Poland, i.e., 228 cadets, including 31 women and 197 men. Correlations between explained and explanatory variables were assessed using Pearson’s correlation. Correlations between AA and somatic parameters and motor components were analysed using optimal regression, using the best subset method. A statistical difference was found between men and women in terms of the level of somatic and motor development; men also performed significantly better in practical military subjects. In the female group, dominant hand strength is a significant determinant of AA in civilian and theoretical military subjects. The findings suggest the need for specialized training aimed at bridging the major differences in physical fitness between men and women by placing greater emphasis on muscle strength development.

Relationship Between Strength, Athletic Performance, and Movement Skill in Adolescent Girls

Sommerfield, LM, Harrison, CB, Whatman, CS, and Maulder, PS. Relationship between strength, athletic performance, and movement skill in adolescent girls. J Strength Cond Res XX(X): 000-000, 2019-Muscular strength in youth has been linked to health and physical benefits, enhanced movement skill, and an active lifestyle in adulthood. However, the relationship between maximum strength, athletic performance, and movement skill in youth females remains unclear. The purpose was to examine the relationship between maximum strength, athletic performance, and movement skill and determine whether differences exist between strong girls (SGs), average girls (AGs), and weak girls (WGs). One hundred four girls (age 14.0 ± 0.6 years, height 162.6 ± 5.9 cm, body mass 57.3 ± 9.7 cm) from a girls' secondary school performed an isometric midthigh pull (IMTP), double- and single-leg (right leg = R, left leg = L) countermovement jump, 10- and 20-m sprints, a drop vertical jump ,and the back squat assessment. Significance was set at p < 0.01 for correlations and p < 0.05 for one-way analysis of variance. Correlations revealed IMTP had significant small to large relationships with all performance variables (r = 0.27-0.62) except right-leg countermovement jump and left-leg countermovement jump height (r = 0.17-0.23). Relative IMTP had significant moderate to large relationships with all performance variables (r = 0.32-0.60). There were significant differences between strength groups for all performance measures. Strong girls had significantly faster sprint times than AGs. In addition, SGs and AGs performed significantly better than WGs in all assessments. The results of this study demonstrate the importance of strength for athletic performance and movement skill in adolescent girls.

Skeletal loading score is associated with bone microarchitecture in young adults

Physical activity that involves high strain magnitudes and high rates of loading is reported to be most effective in eliciting an osteogenic bone response. Whether a history of participation in osteogenic activities during youth, as well as current participation in osteogenic activities, contributes to young adult bone microarchitecture and strength is unknown.

PURPOSE

We determined the association between a new skeletal loading (SkL) score reflecting physical activity from age 11 to adulthood, the bone specific physical activity questionnaire (BPAQ) and bone microarchitecture in young Black and White men and women.

METHODS

We conducted a cross-sectional study of young ([mean ± SD] 23.7 ± 3.3 years) Black (n = 51 women, n = 31 men) and White (n = 50 women, n = 49 men) adults. Microarchitecture and estimated bone strength (by micro-finite element analysis) were assessed at the ultradistal tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT). Physical activity questionnaires were administered and a SkL score was derived based on ground reaction force, rate of loading, frequency, duration, and life period of participation per activity from age 11 onwards. BPAQ score was also calculated. We used multiple linear regression to determine associations between both SkL score and BPAQ score and bone outcomes, adjusting for age, height, weight, sex, and race.

RESULTS

We found that SkL score, which accounts for current and historical physical activity, was significantly associated with most cortical bone parameters at the tibia including area, area fraction, porosity, thickness, and tissue mineral density (R² = 0.27-0.55, all p < 0.01). Further, trabecular thickness, separation, number, and bone mineral density (R² = 0.22-0.32, all p < 0.01), as well as stiffness and failure load (R² = 0.63-0.65, all p < 0.01), were associated with the SkL score. The BPAQ was also significantly associated with most bone parameters, but to a lesser degree than SkL score.

CONCLUSION

These findings suggest that among young adults, greater amounts of osteogenic physical activity, as assessed by the SkL score and BPAQ are associated with improved bone microarchitecture and strength. With the potential to predict bone parameters in young adults, these scores may ultimately serve to identify those most vulnerable to fracture.

A systematic review on the effects of resistance and plyometric training on physical fitness in youth- What do comparative studies tell us?

INTRODUCTION

To date, several meta-analyses clearly demonstrated that resistance and plyometric training are effective to improve physical fitness in children and adolescents. However, a methodological limitation of meta-analyses is that they synthesize results from different studies and hence ignore important differences across studies (i.e., mixing apples and oranges). Therefore, we aimed at examining comparative intervention studies that assessed the effects of age, sex, maturation, and resistance or plyometric training descriptors (e.g., training intensity, volume etc.) on measures of physical fitness while holding other variables constant.

METHODS

To identify relevant studies, we systematically searched multiple electronic databases (e.g., PubMed) from inception to March 2018. We included resistance and plyometric training studies in healthy young athletes and non-athletes aged 6 to 18 years that investigated the effects of moderator variables (e.g., age, maturity, sex, etc.) on components of physical fitness (i.e., muscle strength and power).

RESULTS

Our systematic literature search revealed a total of 75 eligible resistance and plyometric training studies, including 5,138 participants. Mean duration of resistance and plyometric training programs amounted to 8.9 ± 3.6 weeks and 7.1±1.4 weeks, respectively. Our findings showed that maturation affects plyometric and resistance training outcomes differently, with the former eliciting greater adaptations pre-peak height velocity (PHV) and the latter around- and post-PHV. Sex has no major impact on resistance training related outcomes (e.g., maximal strength, 10 repetition maximum). In terms of plyometric training, around-PHV boys appear to respond with larger performance improvements (e.g., jump height, jump distance) compared with girls. Different types of resistance training (e.g., body weight, free weights) are effective in improving measures of muscle strength (e.g., maximum voluntary contraction) in untrained children and adolescents. Effects of plyometric training in untrained youth primarily follow the principle of training specificity. Despite the fact that only 6 out of 75 comparative studies investigated resistance or plyometric training in trained individuals, positive effects were reported in all 6 studies (e.g., maximum strength and vertical jump height, respectively).

CONCLUSIONS

The present review article identified research gaps (e.g., training descriptors, modern alternative training modalities) that should be addressed in future comparative studies.

Bone health, activity and sedentariness at age 11-12 years: Cross-sectional Australian population-derived study

AIM

To examine cross-sectional associations of children's bone health (size, density, strength) with moderate-vigorous physical activity (MVPA) and sedentary behaviour by considering: (1) duration of activity, (2) fragmentation, and (3) duration/fragmentation combined.

METHODS

Design: Population-based cross-sectional study.

PARTICIPANTS

11-12 year-olds in the Longitudinal Study of Australian Children's Child Health CheckPoint. Exposures: MVPA and sedentary behaviour (7-day accelerometry), yielding (1) daily average durations (min/day) and (2) fragmentations (the parameter alpha, representing the relationship between activity bout frequency and bout length).

OUTCOMES

Tibial peripheral quantitative computed tomography (bone density, geometry, strength).

ANALYSIS

Multivariable regression models including activity durations and fragmentations separately and combined.

RESULTS

Of 1357 children attending the CheckPoint, 864 (64%) provided both bone and accelerometry data (mean age 11.4 years (standard deviation (SD) 0.5); 49% male). Mean daily MVPA and sedentary behaviour durations were 34.4 min/day (SD 28.3) and 667.9 min/day (SD 71.9) respectively for boys and girls combined. Each additional daily hour of MVPA was associated with small bone health benefits comprising greater periosteal and endosteal circumference (standardised effect sizes 0.25, 95% CI 0.10 to 0.40 and 0.21, 95% CI 0.03 to 0.39, respectively) and bone strength (0.26, 95% CI 0.14 to 0.38). Sedentary duration and fragmentation of either MVPA or sedentary behaviour showed little association with bone health.

CONCLUSIONS

In early adolescence, MVPA duration showed associations with better bone health that, while modest, could be of population-level importance. MVPA fragmentation and sedentary behaviour duration and fragmentation seemed less important.

Are consumption of dairy products and physical activity independently related to bone mineral density of 6-year-old children? Longitudinal and cross-sectional analyses in a birth cohort from Brazil

OBJECTIVE

To evaluate cross-sectional and longitudinal associations of consumption of dairy products and physical activity (PA) with bone mineral density (BMD).

DESIGN

Cohort study with children from the 2004 Pelotas (Brazil) Birth Cohort.

SETTING

Pelotas, a medium-sized Brazilian city.

SUBJECTS

The study started in 2004 and mothers/children were interviewed/measured periodically from birth to age 6 years. PA was measured by maternal proxy at 4 and 6 years and by accelerometry at 6 years. Consumption of dairy products was measured using 24 h food recall (at 4 years) and FFQ (at 6 years). Total-body and lumbar-spine BMD (g/cm2) were measured by dual-energy X-ray absorptiometry.

RESULTS

At 6 years, BMD was measured in 3444 children and 2636 children provided data on objectively measured PA by accelerometry. Consumption of dairy products at 4 years was associated with higher lumbar-spine BMD at 6 years in boys, while current consumption was positively associated with BMD in both sexes (P < 0·001). PA assessed by maternal report at 4 and 6 years of age was associated with higher BMD at 6 years in boys. PA assessed by accelerometry was positively related to total-body and lumbar-spine BMD in boys and lumbar-spine BMD in girls. We did not find evidence for an interaction between PA and consumption of dairy products on BMD.

CONCLUSIONS

We observed positive and independent longitudinal and cross-sectional associations between consumption of dairy products and PA with BMD in the total body and at the lumbar spine in young children.

Rearing system affects prevalence of keel-bone damage in laying hens: a longitudinal study of four consecutive flocks

High flock-level prevalence of keel-bone fractures and deviations in laying hens are commonly reported across various housing systems; however, few longitudinal studies exist, especially for furnished and conventional cage systems. Load-bearing exercise improves bone strength and mineral composition in laying hens and has the potential to reduce keel-bone damage, especially if exercise is allowed during critical periods of bone growth throughout the pullet rearing phase. The objective of this study was to determine the prevalence of keel-bone damage in laying hens housed in furnished and conventional cages, and assess whether opportunities for exercise during the pullet rearing phase influenced the prevalence of keel-bone damage throughout the laying period. Four flock replicates of 588 Lohmann Selected Leghorn-Lite pullets/flock were reared in either conventional cages (Conv) or an aviary rearing system (Avi) and placed into conventional cages (CC), 30-bird furnished cages (FC-S) or 60-bird furnished cages (FC-L) for adult housing. Keel-bone status was determined by palpation at 30, 50, and 70 wk of age. Age (P < 0.001) and rearing system (P < 0.001) had an effect on the presence of keel-bone fractures. The presence of fractures increased with age, and hens raised in the Avi system had a lower percentage of fractures (41.6% ± 2.8 SE) compared to hens reared in the Conv system (60.3% ± 2.9 SE). Adult housing system did not have an effect on the percentage of keel fractures (P = 0.223). Age had an effect on the presence of deviations (P < 0.001), with deviations increasing with age. Rearing system (P = 0.218) and adult housing system (P = 0.539) did not affect the presence of deviations. Keel fractures and deviations were strongly associated with each other at all ages: 30 wk: (P < 0.001); 50 wk: (P < 0.001); and 70 wk: (P < 0.001). Increased opportunities for exercise provided by an aviary rearing system reduced the prevalence of keel-bone fractures through the end-of-lay.

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.

Exercise for Bone in Childhood-Hitting the Sweet Spot

PURPOSE

The goal of the current work is to challenge the enduring notion that prepuberty is the optimum timing for maximum bone response to exercise in childhood and to present the evidence that early puberty is a more potently receptive period.

METHOD

The relevant literature is reviewed and the causes of the misconception are addressed in detail.

RESULTS

Contrary to prevailing opinion, ample evidence exists to suggest that the peripubertal years represent the developmental period during which bone is likely to respond most robustly to exercise intervention.

CONCLUSION

Public health initiatives that target bone-specific exercise interventions during the pubertal years are likely to be the most effective strategy to harness the increased receptiveness of the growing skeleton to mechanical loading.

Overweight and obesity and their associated factors among early adolescence school children in urban and rural Portugal

BACKGROUND

Obesity is defined as an abnormal or excessive accumulation of body fat and it is currently one of the most concerning public health issues, as it is related to a wide range of serious diseases and disorders. The study of the causes of obesity is multifactorial, and its diagnosis requires specific methods. Its management is complex, and it is crucial that it is handled appropriately, and its primary focus should be on prevention through lifestyle changes.The objectives of this study are to determine the prevalence of overweight/obesity in adolescents of both genders, aged 10 to 12 years, from different geographical environments (rural and urban), as well as to identify the underlying risk factors related to the respective obesity rates, namely: family environment, eating habits, and physical exercise.

METHODS

An observational, cross-sectional study in a sample of 129 adolescents aged 10 to 12 years was conducted. Participants of both genders from rural and urban environments were included in this study. A questionnaire was completed on eating habits and physical activity, focusing on the number of daily meals, meal composition, and sedentary lifestyle habits. An anthropometric assessment was also performed, including weight, height, skinfolds, waist circumference, arm circumference, and percentage of lean mass and body fat, using bioelectrical impedance analysis.

RESULTS

In the rural environment, the obesity rate was 16.9%, with 26.8% being either overweight or obese; whereas in the urban environment, these rates were respectively 16.7% and 33.4%. Living in a rural environment was not an independent predictor of being overweight or obesity, p = 0.581, or for increased percentage of body fat, p = 0.790. In contrast, being 12 years old, eating high-calorie foods four times a week or less, and having at least one obese parent were predictors of being overweight or obesity. Being 12 years old was also a predictor of gaining moderate to high body fat.

CONCLUSIONS

Adolescents' residence in a rural or urban environment does not affect the occurrence of being overweight, obesity or high body fat. Paternal obesity was an important predictor of obesity in children. Obese fathers tended to serve higher calorie meals to their children.

National Strength and Conditioning Association Position Statement on Long-Term Athletic Development

There has recently been a growing interest in long-term athletic development for youth. Because of their unique physical, psychological, and social differences, children and adolescents should engage in appropriately prescribed exercise programs that promote physical development to prevent injury and enhance fitness behaviors that can be retained later in life. Irrespective of whether a child is involved in organized sport or engages in recreational physical activity, there remains a need to adopt a structured, logical, and evidence-based approach to the long-term development of athleticism. This is of particular importance considering the alarmingly high number of youth who fail to meet global physical activity recommendations and consequently present with negative health profiles. However, appropriate exercise prescription is also crucial for those young athletes who are physically underprepared and at risk of overuse injury because of high volumes of competition and an absence of preparatory conditioning. Whether the child accumulates insufficient or excessive amounts of exercise, or falls somewhere between these opposing ends of the spectrum, it is generally accepted that the young bodies of modern day youth are often ill-prepared to tolerate the rigors of sports or physical activity. All youth should engage in regular physical activity and thus should be viewed as "athletes" and afforded the opportunity to enhance athleticism in an individualized, holistic, and child-centered manner. Because of emerging interest in long-term athletic development, an authorship team was tasked on behalf of the National Strength and Conditioning Association (NSCA) to critically synthesize existing literature and current practices within the field and to compose a relevant position statement. This document was subsequently reviewed and formally ratified by the NSCA Board of Directors. A list of 10 pillars of successful long-term athletic development are presented, which summarize the key recommendations detailed within the position statement. With these pillars in place, it is believed that the NSCA can (a) help foster a more unified and holistic approach to long-term athletic development, (b) promote the benefits of a lifetime of healthy physical activity, and

State of the Art Reviews: Resistance Training for Children and Adolescents

Although much of what we understand about the stimulus of resistance exercise has been gained by exploring the responses of adults to various training protocols, research into the effects of resistance exercise on children and adolescents has increased over the past decade. Despite outdated concerns that resistance training was ineffective or unsafe for youth, research increasingly suggests that resistance training can be a safe and effective method of exercise for children and adolescents provided that appropriate training guidelines are followed. In addition to enhancing motor skills and sports performance, regular participation in a youth resistance training program has the potential to positively influence several measurable indices of health. It helps strengthen bone, facilitate weight control, enhance psychosocial well-being, and improve one's cardiovascular risk profile. Furthermore, a stronger musculoskeletal system will enable boys and girls to perform life's daily activities with more energy and vigor and may increase a young athlete's resistance to sports-related injuries. Along with other types of physical activity, a properly designed youth resistance training program can offer observable health value to children and adolescents when appropriately prescribed and supervised.

A longitudinal study of bone area, content, density, and strength development at the radius and tibia in children 4-12 years of age exposed to recreational gymnastics

This study investigated the long-term relationship between the exposure to childhood recreational gymnastics and bone measures and bone strength parameters at the radius and tibia. It was observed that individuals exposed to recreational gymnastics had significantly greater total bone content and area at the distal radius. No differences were observed at the tibia.

INTRODUCTION

This study investigated the relationship between exposure to early childhood recreational gymnastics with bone measures and bone strength development at the radius and tibia.

METHODS

One hundred twenty seven children (59 male, 68 female) involved in either recreational gymnastics (gymnasts) or other recreational sports (non-gymnasts) between 4 and 6 years of age were recruited. Peripheral quantitative computed tomography (pQCT) scans of their distal and shaft sites of the forearm and leg were obtained over 3 years, covering the ages of 4-12 years at study completion. Multilevel random effects models were constructed to assess differences in the development of bone measures and bone strength measures between those exposed and not exposed to gymnastics while controlling for age, limb length, weight, physical activity, muscle area, sex, and hours of training.

RESULTS

Once age, limb length, weight, muscle area, physical activity, sex, and hours of training effects were controlled, it was observed that individuals exposed to recreational gymnastics had significantly greater total bone area (18.0 ± 7.5 mm(2)) and total bone content (6.0 ± 3.0 mg/mm) at the distal radius (p < 0.05). This represents an 8-21 % benefit in ToA and 8-15 % benefit to ToC from 4 to 12 years of age. Exposure to recreational gymnastics had no significant effect on bone measures at the radius shaft or at the tibia (p > 0.05).

CONCLUSIONS

Exposure to early life recreational gymnastics provides skeletal benefits to distal radius bone content and area. Thus, childhood recreational gymnastics exposure may be advantageous to bone development at the wrist.

Prediction of bone mineral density and content from measures of physical activity and sedentary behavior in younger and older females

BACKGROUND

Little is known regarding the extent to which physical activity (PA) and sedentary behavior (SB) influence bone mineral content (BMC) and bone mineral density (BMD) in females across the lifespan.

METHODS

Data from 2232 females aged 12 years and older collected as part of the 2007-2008 National Health and Nutrition Examination Survey were analyzed. Categories of PA and SB were used to predict femoral and spinal BMD and BMC in four age groups (G1: 12-17; G2: 18-39; G3: 40-64; G4: ≥ 65 years). Self-reported PA categories included sufficient moderate-to-vigorous recreational PA (S-MVRPA) and insufficient MVRPA (I-MVRPA).

RESULTS

G1 females who accumulated S-MVRPA displayed greater femoral and spinal BMC and BMD compared to G1 females who displayed I-MVRPA. For G4 females, higher levels of SB were associated with lower femoral BMC and BMD.

CONCLUSIONS

These findings highlight the importance of engaging in sufficient moderate-to-vigorous physical activity during adolescence and reducing sedentary behavior in older adults to improve bone health in females.

Pelvis width associated with bone mass distribution at the proximal femur in children 10-11 years old

Differences in skeletal geometry may generate different patterns of mechanical loading to bone. Impact and muscle loading during physical activity have been shown to influence skeletal geometry. The purpose of this study was to compare geometric measures of the pelvis and proximal femur (PF) of young children and to analyze the contribution and potential interaction of these geometric measures with physical activity on PF bone mass distribution. Participants were 149 girls and 145 boys, aged 10-11 years. Total body and left hip DXA scans were used to derive pelvic and PF geometric measures and PF bone mineral density (BMD) at the femoral neck (FN), trochanter (TR), and intertrochanter (IT). These subregions were used to represent bone mass distribution via three BMD ratios: FN:PF, TR:PF, and IT:PF. Physical activity was objectively measured using accelerometry, and maturity was estimated as the years of distance from peak height velocity. When compared to boys, girls had a wider pelvic diameter and greater interacetabular distances (p < 0.001), lower BMD at FN, TR, and IT (p < 0.05), and higher TR:PF (p < 0.001). After controlling for maturity, body height, and lean body mass, the interacetabular distance in girls explained 21.1 % (β = 0.713, p < 0.001) in TR:PF and 2.9 % (β = -0.179, p = 0.031) in the IT:PF. Neck-shaft angle explained 5.6 % (β = -0.265, p = 0.001) of the IT:PF and 3.1 % (β = 0.194, p = 0.018) of the FN:PF. In boys, FN axis length explained 2.9 % (β = 0.195, p = 0.040) of TR:PF. There was no main effect of physical activity or interaction effect with pelvic geometry in explaining BMD differences among the subregions of the PF. Even before sexual dimorphism, girls have a wider pelvis than boys, which accounted for proportionally greater BMD of the TR than other subregions of the PF.

Lack of exercise is a major cause of chronic diseases

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.

Bone mass and density in preadolescent boys with and without Down syndrome

Preadolescent boys with Down syndrome at 7-10 years of age have lower bone mass and density in the pelvis than age-matched children without Down syndrome. However, bone mass and density of total body less head and lumbar spine are not different between these two groups.

INTRODUCTION

This study aimed to assess bone mineral content (BMC) and density (BMD) in preadolescent boys with and without Down syndrome (DS) at 7-10 years of age.

METHODS

Eleven preadolescent boys with DS and eleven age-matched children without DS participated in this study. Dual-energy X-ray absorptiometry was used to measure BMC and BMD in whole body and lumbar spine. Both BMC and BMD of total body less head (TBLH) and lumbar spine (vertebrae L2-L4) were compared between the two groups, with and without adjusting for physical characteristics such as bone area, body height, and total lean mass. Two bone mineral apparent density (BMAD) variables were calculated to estimate volumetric BMD in the lumbar spine.

RESULTS

Both BMC and BMD in the pelvis were lower in the DS group, after adjusting for physical characteristics. However, with and without adjusting for physical characteristics, the two groups were not different in BMC and BMD of the arms, legs, and TBLH from the whole body scan and in BMC, BMD, and BMAD of the lumbar spine from the lumbar spine scan.

CONCLUSIONS

These findings indicate that the pelvis may be the first site to show the significant difference in BMC and BMD between preadolescent boys with and without DS. It also suggests that significantly lower BMC and BMD in whole body and lumbar spine, which is usually observed in young adults with DS, may not occur before adolescence.

Can physical activity improve peak bone mass?

The pediatric origin of osteoporosis has led many investigators to focus on determining factors that influence bone gain during growth and methods for optimizing this gain. Bone responds to bone loading activities by increasing mass or size. Overall, pediatric studies have found a positive effect of bone loading on bone size and accrual, but the types of loads necessary for a bone response have only recently been investigated in human studies. Findings indicate that responses vary by sex, maturational status, and are site-specific. Estrogen status, body composition, and nutritional status also may influence the bone response to loading. Despite the complex interrelationships among these various factors, it is prudent to conclude that increased physical activity throughout life is likely to optimize bone health.

Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children

The results of physical activity (PA) intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN) is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD) of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR) and intertrochanter (IT) regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs) and 164 boys (age: 9.7±0.3 yrs). PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status) revealed that vigorous PA explained 3–5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (p<0.05) and a ∼2% higher IT and TR BMD in girls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys.

Skeletal adaptations associated with pre-pubertal gymnastics participation as determined by DXA and pQCT: a systematic review and meta-analysis

Participation in gymnastics prior to puberty offers an intriguing and unique model, particularly in girls. The individuality comes from both upper and lower limbs being exposed to high mechanical loading through year long intensive training programs, initiated at a young age. Studying this unique model and the associated changes in musculoskeletal health during growth is an area of specific interest. Previous reviews on gymnastics participation and bone health have been broad; and not limited to a particular maturation period, such as pre-puberty.

OBJECTIVES

To determine the difference in skeletal health between pre-pubertal girls participating in gymnastics compared with non-gymnasts.

DESIGN

Meta-analysis.

METHODS

Following a systematic search, 17 studies were included in this meta-analysis. All studies used dual-energy X-ray absorptiometry to assess bone mineral density and bone mineral content. In addition, two studies included peripheral quantitative computed tomography.

RESULTS

Following the implementation of a random effects model, gymnasts were found to have greater bone properties than non-gymnasts. The largest difference in bone health between gymnasts and non-gymnasts was observed in peripheral quantitative computed tomography-derived volumetric bone mineral density at the distal radius (d=1.06).

CONCLUSIONS

Participation in gymnastics during pre-pubertal growth was associated with skeletal health benefits, particularly to the upper body.

Mid-thigh cortical bone structural parameters, muscle mass and strength, and association with lower limb fractures in older men and women (AGES-Reykjavik Study)

In a cross-sectional study we investigated the relationship between muscle and bone parameters in the mid-thigh in older people using data from a single axial computed tomographic section through the mid-thigh. Additionally, we studied the association of these variables with incident low-trauma lower limb fractures. A total of 3,762 older individuals (1,838 men and 1,924 women), aged 66-96 years, participants in the AGES-Reykjavik study, were studied. The total cross-sectional muscular area and knee extensor strength declined with age similarly in both sexes. Muscle parameters correlated most strongly with cortical area and total shaft area (adjusted for age, height, and weight) but explained <10 % of variability in those bone parameters. The increment in medullary area (MA) and buckling ratio (BR) with age was almost fourfold greater in women than men. The association between MA and muscle parameters was nonsignificant. During a median follow-up of 5.3 years, 113 women and 66 men sustained incident lower limb fractures. Small muscular area, low knee extensor strength, large MA, low cortical thickness, and high BR were significantly associated with fractures in both sexes. Our results show that bone and muscle loss proceed at different rates and with different gender patterns.

Calcium and vitamin-D supplementation on bone structural properties in peripubertal female identical twins: a randomised controlled trial

A randomised controlled trial was used in assessing the impact of 6 months of daily calcium and vitamin-D supplementation on trabecular and cortical bone acquisition at distal tibial and radial sites using peripheral quantitative computed tomography (pQCT). Daily supplementation was associated with increased bone density and bone strength at the distal tibia and radius.

INTRODUCTION

pQCT has not been used to assess bone responses to calcium and vitamin-D supplementation on peripubertal children. This randomised controlled trial aimed to assess the impact of a 6-month daily calcium and vitamin-D supplementation on trabecular and cortical bone acquisition at distal tibial and radial sites using pQCT.

METHODS

Twenty pairs of peripubertal female identical twins, aged 9 to 13 years, were randomly assigned to receive either 800 mg of calcium and 400 IU of vitamin D3, or a matched placebo. Bone structural properties at the distal tibia and distal radius were acquired at baseline and 6 months.

RESULTS

The calcium-supplemented group showed greater gains in trabecular density, trabecular area and strength strain index at the 4% of distal tibial and radial sites compared with the placebo group (p=0.001). Greater gains in cortical area at the 38% and 66% of tibial sites were also found in twins receiving the calcium supplement (p=0.001).

CONCLUSIONS

Daily supplementation for a period of 6 months was associated with increased trabecular area, trabecular density and strength strain index at the ultra-distal tibia and radius and increased cortical area at tibial mid-shaft.

Youth resistance training: updated position statement paper from the national strength and conditioning association

Faigenbaum, AD, Kraemer, WJ, Blimkie, CJR, Jeffreys, I, Micheli, LJ, Nitka, M, and Rowland, TW. Youth resistance training: Updated position statement paper from the National Strength and Conditioning Association. J Strength Cond Res 23(5): S60-S79, 2009-Current recommendations suggest that school-aged youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate and enjoyable and involves a variety of activities (). Not only is regular physical activity essential for normal growth and development, but also a physically active lifestyle during the pediatric years may help to reduce the risk of developing some chronic diseases later in life (). In addition to aerobic activities such as swimming and bicycling, research increasingly indicates that resistance training can offer unique benefits for children and adolescents when appropriately prescribed and supervised (). The qualified acceptance of youth resistance training by medical, fitness, and sport organizations is becoming universal ().Nowadays, comprehensive school-based programs are specifically designed to enhance health-related components of physical fitness, which include muscular strength (). In addition, the health club and sport conditioning industry is getting more involved in the youth fitness market. In the U.S.A., the number of health club members between the ages of 6 and 17 years continues to increase () and a growing number of private sport conditioning centers now cater to young athletes. Thus, as more children and adolescents resistance train in schools, health clubs, and sport training centers, it is imperative to determine safe, effective, and enjoyable practices by which resistance training can improve the health, fitness, and sports performance of younger populations.The National Strength and Conditioning Association (NSCA) recognizes and supports the premise that many of the benefits associated with adult resistance training programs are attainable by children and adolescents who follow age-specific resistance training guidelines. The NSCA published the first position statement paper on youth resistance training in 1985 () and revised this statement in 1996 (). The purpose of the present report is to update and clarify the 1996 recommendations on 4 major areas of importance. These topics include (a) the potential risks and concerns associated with youth resistance training, (b) the potential health and fitness benefits of youth resistance training, (c) the types and amount of resistance training needed by healthy children and adolescents, and (d) program design considerations for optimizing long-term training adaptations. The NSCA based this position statement paper on a comprehensive analysis of the pertinent scientific evidence regarding the anatomical, physiological, and psychosocial effects of youth resistance training. An expert panel of exercise scientists, physicians, and health/physical education teachers with clinical, practical, and research expertise regarding issues related to pediatric exercise science, sports medicine, and resistance training contributed to this statement. The NSCA Research Committee reviewed this report before the formal endorsement by the NSCA.For the purpose of this article, the term children refers to boys and girls who have not yet developed secondary sex characteristics (approximately up to the age of 11 years in girls and 13 years in boys; Tanner stages 1 and 2 of sexual maturation). This period of development is referred to as preadolescence. The term adolescence refers to a period between childhood and adulthood and includes girls aged 12-18 years and boys aged 14-18 years (Tanner stages 3 and 4 of sexual maturation). The terms youth and young athletes are broadly defined in this report to include both children and adolescents.By definition, the term resistance training refers to a specialized method of conditioning, which involves the progressive use of a wide range of resistive loads and a variety of training modalities designed to enhance health, fitness, and sports performance. Although the term resistance training, strength training, and weight training are sometimes used synonymously, the term resistance training encompasses a broader range of training modalities and a wider variety of training goals. The term weightlifting refers to a competitive sport that involves the performance of the snatch and clean and jerk lifts.This article builds on previous recommendations from the NSCA and should serve as the prevailing statement regarding youth resistance training. It is the current position of the NSCA that:

Tracking of bone mass from childhood to adolescence and factors that predict deviation from tracking

It has been hypothesized that bone density tracks but long term studies in children are lacking. As such, the aim of this study was to describe tracking of dual X-ray absorptiometry measures from age 8 to age 16 years, whether this was independent of change in body size and whether deviation from tracking could be predicted. 116 males and 67 females had anthropometric (height and weight), questionnaire (medication use, sports, breastfeeding), fitness (PWC(170)) and DXA measures (bone free lean mass [LM], fat mass [FM] and bone mass) at baseline and follow-up. BMC and aBMD were assessed at the spine and hip and total body and bone mineral apparent density (BMAD) at the spine and hip. We found all DXA measures tracked significantly after adjustment for change in height and change in weight (males: R(2): BMC 24-62%; aBMD 41-48%; BMAD 30-37%, females: R(2): BMC 45-72%; aBMD 36-56%; BMAD 30-48%). Factors that predicted subjects would deviate positively, that is improve in tertile or remain in the highest tertile of spine and hip aBMD included having been breastfed, increase in LM, PWC(170) at age 8 and sport participation in males. LM at age 8 was beneficial in males while in females; FM at age 8 predicted subjects would deviate positively. Boys who gained absolute and percent FM and girls who gained percent FM, were more likely to deviate negatively, that is, decrease in tertile or remain in the lowest tertile of spine and hip aBMD. ICS use at age 8 also predicted subjects, particularly males would not improve in bone mass relative to their peers. In conclusion, DXA measures track moderately to strongly from childhood to adolescence. This was independent of linear growth and sex indicating bone development and physical growth are under largely separate mechanistic control. Body composition was the main predictor of altered tracking but environmental factors also appear important.

Canadian Society for Exercise Physiology position paper: resistance training in children and adolescents

Many position stands and review papers have refuted the myths associated with resistance training (RT) in children and adolescents. With proper training methods, RT for children and adolescents can be relatively safe and improve overall health. The objective of this position paper and review is to highlight research and provide recommendations in aspects of RT that have not been extensively reported in the pediatric literature. In addition to the well-documented increases in muscular strength and endurance, RT has been used to improve function in pediatric patients with cystic fibrosis and cerebral palsy, as well as pediatric burn victims. Increases in children's muscular strength have been attributed primarily to neurological adaptations due to the disproportionately higher increase in muscle strength than in muscle size. Although most studies using anthropometric measures have not shown significant muscle hypertrophy in children, more sensitive measures such as magnetic resonance imaging and ultrasound have suggested hypertrophy may occur. There is no minimum age for RT for children. However, the training and instruction must be appropriate for children and adolescents, involving a proper warm-up, cool-down, and appropriate choice of exercises. It is recommended that low- to moderate-intensity resistance exercise should be done 2-3 times/week on non-consecutive days, with 1-2 sets initially, progressing to 4 sets of 8-15 repetitions for 8-12 exercises. These exercises can include more advanced movements such as Olympic-style lifting, plyometrics, and balance training, which can enhance strength, power, co-ordination, and balance. However, specific guidelines for these more advanced techniques need to be established for youth. In conclusion, an RT program that is within a child's or adolescent's capacity and involves gradual progression under qualified instruction and supervision with appropriately sized equipment can involve more advanced or intense RT exercises, which can lead to functional (i.e., muscular strength, endurance, power, balance, and co-ordination) and health benefits.

Bone mineral density of young boy soccer players at different pubertal stages: relationships with hormonal concentration

OBJECTIVES

To examine the effects of soccer in relation with the hormonal concentration, on the bone mass of young Tunisian players at different pubertal stages.

METHODS

Two groups of 152 young boys (age: 13.3+/-0.9 years) participated in this study: (1) 91 soccer players, and (2) 61 non-athletic boys used as control subjects. The bone mineral density (BMD) and the bone mineral content (BMC) were measured by dual-energy X-ray absorptiometry (DXA). Pubertal stages were assessed, and serum concentrations of insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP-3), growth hormone (GH) and the total testosterone were measured.

RESULTS

The BMD and BMC for whole body, lumbar spine, femoral neck, pelvis and lower limbs were higher in soccer players than in controls (p<0.001). In early puberty, the soccer players also exhibited significantly greater BMD and BMC in the whole body and in weight-bearing bones compared with the controls (p<0.001). However, there was no intersubject variability due to puberty in either BMD or BMC. The pubescent soccer players had significantly higher hormonal concentrations of IGF-1 and IGFBP-3 than their counterpart controls (p<0.05). Moreover, the whole body BMD was significantly (p<0.001) correlated with GH, IGF-1 and IGFBP-3 but not with the testosterone concentrations.

CONCLUSION

The soccer participation of boys is generally associated with the improvement of their bone mass which is mainly marked at early and late puberty. The relationships between somatotropic axis hormones and BMD of the players may be linked to the parallel development of these two parameters during puberty.

Bone density and young athletic women. An update

High-school girls and collegiate women have tremendous opportunities to participate in athletic teams. Young girls are also playing in club and select teams at an early age and often, year-round. There are many benefits for participating in sport and physical activity on both the physical and mental health of girls and women. Decreased risk for heart disease and diabetes mellitus, along with improved self-esteem and body-image, were among the first reported benefits of regular physical activity. In addition, sport participation and physical activity is also associated with bone health. Athletes have a greater bone mineral density compared with non-active and physically active females. The increase in bone mass should reduce the risk of fragility fractures in later life. There appears to be a window of opportunity during the development of peak bone mass in which the bone is especially responsive to weight-bearing physical activity. Impact loading sports such as gymnastics, rugby or volleyball tend to produce a better overall osteogenic response than sports without impact loading such as cycling, rowing and swimming. Relatively little is known about the impact of retiring from athletics on bone density. It appears that former athletes continue to have a higher bone density than non-athletes; however, the rate of bone loss appears to be similar in the femoral neck. The positive impact of sports participation on bone mass can be tempered by nutritional and hormonal status. It is not known whether female athletes need additional calcium compared with the general female population. Due to the increased energy expenditure of exercise and/or the pressure to obtain an optimal training bodyweight, some female athletes may develop low energy availability or an eating disorder and subsequently amenorrhoea and a loss of bone mineral density. The three inter-related clinical disorders are referred to as the 'female athlete triad'. This article presents a review of the relationship between sports training and bone health, specifically bone mineral density, in young athletic women.

State of the Art Reviews: Development of Fitness in Children: The Influence of Gender and Physical Activity

The influences of gender and physical activity on the development of fitness are reviewed from early childhood to late adolescence. Changes in parameters of fitness prior to puberty are driven predominantly by neuroendocrine-mediated factors, although physical activity level may be influenced largely by sociocultural factors prior to and following puberty. Thus, it is still unclear to what extent environment versus genetics accounts for gender differences in fitness. Future studies need to account for all factors known to explain gender differences in fitness to better differentiate intrinsic versus environmental causes. Consequently, one must consider if and to what extent a gender comparison study actually reveals true, inherent gender differences compared with sociocultural and/or cultural influences. Nevertheless, differences in fitness between girls and boys that are influenced by sociocultural factors should be considered when devising programs to promote physical activity and enhance fitness in youth. Fundamentally, the role of parents and primary caregivers in modeling physical activity and influencing the fitness level of their child cannot be overestimated.

Influence of sports participation and menarche on bone mineral density of female high school athletes

Weight-bearing exercise during adolescence may enhance peak bone mineral density (BMD) and reduce osteoporosis risk. The association of sports participation before and after menarche with areal BMD (by central DXA) was investigated in 99 female high school athletes (age 15.5+/-1.3 year). The frequency and duration of structured sports (school-based or other organized team) were assessed using an interviewer-assisted questionnaire. Overall, the average number of years of weight-bearing sport participation was 7.4+/-3.4 years; 72% of the athletes began sport participation before menarche. Training patterns and BMD were examined by tertiles of yearly weight-bearing sport participation (hours/year) before (WBpre), after (WBpost) menarche, and in total (WBtotal). After adjusting for chronological age, gynecological age, and BMI, compared to athletes in the WBtotal low tertile, athletes in the WBtotal high tertile had significantly greater BMD at the spine (p=0.009), total hip (p=0.03), trochanter (p=0.03), and total body (p=0.009). Similar patterns were found by WBpre or WBpost status, separately, with the exception of spine BMD which was significantly different across tertiles in WBpost only (p<0.01). While the number of years of participation was similar across tertiles of WBtotal, the number of months/year was significantly greater among athletes in the high tertile than athletes in the low tertile (9.2+/-3.4 month/year versus 5.0+/-2.9 month/year, respectively (p<0.001)). These results indicate that near year-round participation in structured weight-bearing sports during early adolescence may help young girls optimize bone mineral accrual during these critical years, and may decrease their risk of osteoporosis with advancing age.

Physical activity-key issues in treatment of childhood obesity

Changes in physical activity with the aim of increasing energy expenditure are usually an important component of childhood obesity treatment. Physical activity also has several other aspects that are positive for the obese child's health, such as improving the metabolic profile and psychological well being. The aim of this paper is to give a short review of what we know about physical activity in paediatric obesity treatment. In addition, practical recommendations will be presented which a health care provider can suggest to obese children and their families with a special focus on daily activity, participation in physical education classes and sports, sedentary behaviours, active commuting to school and how to get family and friends involved in supporting the child.

Bone mass in Chinese premenarcheal girls: the roles of body composition, calcium intake and physical activity

The association of growth and anthropometric characteristics and lifestyle factors with bone mass and second metacarpal radiogrammetry parameters was evaluated in 373 healthy Chinese premenarcheal girls aged 9–11 years. Bone mineral content (BMC) and density (BMD) and bone area (BA) of distal forearm, proximal forearm and total body, bone mineral-free lean (BMFL) mass and fat mass were measured by dual-energy X-ray absorptiometry. Metacarpal bone periosteal and medullary diameters were measured. Dietary intakes were assessed by 7d food record and physical activity (PA) by questionnaire. BMFL and fat mass together explained 6·3 and 51·6% of the variation in total body BMC and BMD, respectively. BMFL mass contributed to a substantial proportion of the variation in forearm BMC and BMD and periosteal diameter (10·4–41·0%). The corresponding BA explained 14·8–80·4% of the variation in BMC. Other minor but significant predictors of total body bone mass were Ca intake, height, age and PA score (BMD only), and of forearm bone mass were PA score, bone age, height and fat mass. Nevertheless, after adjusting for bone and body size and for age or bone age, subjects with Ca intake above the median (417mg/d) had 1·8% greater total body BMC (P<0·001), and subjects with PA scores above the median had 2·4–2·5% greater distal and proximal forearm BMC (P<0·05) than those below. Vitamin D intake negatively associated with medullary diameter (partialR21·7%). The results indicate that premenarcheal girls should be encouraged to optimise nutrition and Ca intake and exercise regularly to achieve maximum peak bone mass.

Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials

INTRODUCTION

Osteoporosis is a serious skeletal disease and as there is currently no cure, there is a large emphasis on its prevention, including the optimisation of peak bone mass. There is increasing evidence that regular weight-bearing exercise is an effective strategy for enhancing bone status during growth. This systematic review evaluates randomised and non-randomised controlled trials to date, on the effects of exercise on bone mineral accrual in children and adolescents.

METHODS

An online search of Medline and the Cochrane database enabled the identification of studies. Those that met the inclusion criteria were included in the review and graded according to risk for bias.

RESULTS

Twenty-two trials were reviewed. Nine were conducted in prepubertal children (Tanner I), 8 in early pubertal (Tanner II-III) and 5 in pubertal (Tanner IV-V). Sample sizes ranged from n=10 to 65 per group. Exercise interventions included games, dance, resistance training and jumping exercises, ranging in duration from 3 to 48 months. Approximately half of the trials (n=10) included ground reaction force (GRF) data (2 to 9 times body weight). All trials in early pubertal children, 6 in pre pubertal and 2 in pubertal children, reported positive effects of exercise on bone (P<0.05). Mean increases in bone parameters over 6 months were 0.9-4.9% in prepubertal, 1.1-5.5% in early pubertal and 0.3-1.9% in pubertal exercisers compared to controls (P<0.05).

CONCLUSIONS

Although weight-bearing exercise appears to enhance bone mineral accrual in children, particularly during early puberty; it remains unclear as to what constitutes the optimal exercise programme. Many studies to date have a high risk for bias and only a few have a low risk. Major limitations concerned selection procedures, compliance rates and control of variables. More well designed and controlled investigations are needed. Furthermore, the specific exercise intervention that will provide the optimal stimulus for peak bone mineral accretion is unclear. Future quantitative, dose-response studies using larger sample sizes and interventions that vary in GRF and frequency may characterise the most and least effective exercise programmes for bone mineral accrual in this population. In addition, the measurement of bone quality parameters and volumetric BMD would provide a greater insight into the mechanisms implicated in the adaptation of bone to exercise.

Adaptations to humeral torsion in medieval Britain

Adaptations to the humeral torsion angle have been identified in the professional throwing athlete. This movement pattern increases the humeral torsion angle, and also increases the extent of external rotation movements in the dominant, throwing limb when compared with the nondominant limb. The purpose of this paper is to test the hypothesis that the humeral torsion angle is an adaptation to upper limb use. This project examines the humeral torsion angle in a number of medieval British populations, as well as a modern cadaver-based sample. The results identify significant differences in the humeral torsion angle both between and within male (P < 0.001, ANOVA) and female (P < 0.014, ANOVA) populations, although the results are not consistent with expected behavior patterns. Statistically significant differences between males and females within the same site were identified in 2 of the 5 samples examined. The mean level of bilateral asymmetry does not approach that reported for the professional throwing athlete. However, a number of individuals have high levels of asymmetry in excess of that identified in the professional throwing athlete. This analysis demonstrates the need for individual rather than population-based analyses, as the heterogeneity within population samples obscures individual variation in activity patterns. The diversity within British medieval society and a lack of specific known behaviors prevent further identification of the functional significance of the humeral torsion angle within the archaeological record examined here.

Short-term and long-term site-specific effects of tennis playing on trabecular and cortical bone at the distal radius

Mechanical loading during growth magnifies the normal increase in bone diameter occurring in long bone shafts, but the response to loading in long bone ends remains unclear. The aim of the study was to investigate the effects of tennis playing during growth at the distal radius, comparing the bone response at trabecular and cortical skeletal sites. The influence of training duration was examined by studying bone response in short-term (children) and long-term (young adults) perspectives. Bone area, bone mineral content (BMC), and bone mineral density (BMD) of the radius were measured by DXA in 28 young (11.6 +/- 1.4 years old) and 47 adult tennis players (22.3 +/- 2.7 years old), and 70 age-matched controls (12 children, 58 adults) at three sites: the ultradistal region (trabecular), the mid-distal region, and the third-distal region (cortical). At the ultradistal radius, young and adult tennis players displayed similar side-to-side differences, the asymmetry in BMC reaching 16.3% and 13.8%, respectively (P < 0.0001). At the mid- and third-distal radius, the asymmetry was much greater in adults than in children (P < 0.0001) for all the bone parameters (mid-distal radius, +6.6% versus +15.6%; third-distal radius, +6.9% versus +13.3%, for BMC). Epiphyseal bone enduring longitudinal growth showed a great capacity to respond to mechanical loading in children. Prolonging tennis playing into adulthood was associated with further increase in bone mineralization at diaphyseal skeletal sites. These findings illustrate the benefits of practicing impact-loading sports during growth and maintaining physical activity into adulthood to enhance bone mass accrual and prevent fractures later in life.

Newer Perspectives on Calcium Nutrition and Bone Quality

It is now generally accepted that an adequate calcium intake is important for building and maintaining a skeleton that expresses quantitatively the full genetic program and reduces lifetime fracture risk. In this brief review we focus mainly on a new and growing body of evidence indicating a benefit of adequate calcium intake on qualitative features of the skeleton that, independent of the quantity of bone, themselves influence skeletal strength and fragility. Change in bone mass and size during growth are dependent on both calcium intake and exercise, with the largest differences being observed in prepubertal children who have both high exercise levels and high calcium intakes. Much of this benefit is expressed as increased bone diameter (and hence stiffness). Fracture risk peaks at about the time of puberty and is inversely related to bone mass. However, even prepubertally, children with low calcium intakes have been reported to have a fracture rate 2.7x that of their birth cohort. Bone remodeling triples from age 50 to 65 in typical women and is now recognized to have primarily a homeostatic basis. While remodeling improves bone strength by repairing acquired defects, homeostatic remodeling, while necessary to maintain blood calcium levels, contributes only structural weakness to bone. High calcium intakes in postmenopausal and older women reduce this homeostatic remodeling to approximately pre-menopausal values and improve bone strength immediately, well prior to any appreciable change in bone mass.