Resistance training presents beneficial effects on bone development of adolescents engaged in swimming but not in impact sports: ABCD Growth Study

BACKGROUND

Sports practice during adolescence is important to enhance bone development, although it may provide different effects depending on the mechanical impact present in the sport. Besides, resistance training (RT) may also induce bone changes directly (via muscle contractions) and indirectly (via myokines). However, there have been no studies analyzing the longitudinal influence of engaging in sport with and without added mechanical load. Thus, this study aims to analyze the combined effects of sports participation and resistance training on areal bone mineral density (aBMD) accrual in adolescent athletes participating in swimming and impact sports for 12-months.

METHODS

This was a 12-month longitudinal study. The sample comprised 91 adolescents (21 females) aged 10 to 18 years, engaged in impact sports (basketball, tennis, track & field, baseball and gymnastics, n = 66) and non-impact sport (swimming, n = 25). The sample was divided according to resistance training participation: impact sports only (n = 45), impact sports + resistance training (n = 21), swimming-only (n = 17) and swimming + resistance training (n = 8). aBMD and soft tissues were measured using dual-energy X-ray absorptiometry. Generalized linear models analysis was used for the resistance training (RT) x type of sport interaction in predicting aBMD changes overtime, adjusting for maturation, sex and baseline aBMD.

RESULTS

After 12-months, all groups showed a significant increase in aBMD, except for the swimming groups (regardless of resistant training), which showed a significant loss in spine aBMD (-0.045 [-0.085 to -0.004] g/cm2 in swimming-only and - 0.047 [-0.073 to -0.021] g/cm2 in swimming + RT). In comparisons between groups, only swimming + RT group, compared with swimming-only group presented higher upper limbs aBMD (0.096 g/cm2 [0.074 to 0.118] in swimming + RT vs. 0.046 [0.032 to 0.060] g/cm2 in swimming only; p < 0.05) and whole body less head (WBLH) aBMD (0.039 [0.024 to 0.054] g/cm2 in swimming + RT vs. 0.017 [0.007 to 0.027] g/cm2 swimming-only; p < 0.05).

CONCLUSION

Despite the significant gain in aBMD in all groups and body sites after 12-months, except for the spine site of swimmers, the results indicate that participation in RT seems to improve aBMD accrual in swimmers at the upper limbs and WBLH.

Every Move Counts to Improve Bone Health at Clinical Sites in Young Pediatric Cancer Survivors: The iBoneFIT Project

PURPOSE

We aimed to examine the associations of 24-hour movement behaviors (moderate-to-vigorous physical activity [MVPA], light physical activity [LPA], sedentary behavior [SB] and sleep) with age-, sex- and race-specific areal bone mineral density (aBMD) Z-score parameters at clinical sites in young pediatric cancer survivors.

METHODS

This cross-sectional multicenter study was carried out within the iBoneFIT framework in which 116 young pediatric cancer survivors (12.1 ± 3.3 years old; 42% female) were recruited. We obtained anthropometric and body composition data (i.e., body mass, stature, body mass index and region-specific lean mass), time spent in movement behaviors over at least seven consecutive 24-hour periods (wGT3x-BT accelerometer, ActiGraph) and aBMD Z-score parameters (age-, sex- and race-specific total at the body, total hip, femoral neck and lumbar spine). Survivors were classified according to somatic maturity (pre or peri/post-pubertal depending on the estimated years from peak height velocity). The adjusted models' coefficients were used to predict the effect of reallocating time proportionally across behaviors on the outcomes.

RESULTS

In pre-pubertal young pediatric cancer survivors, reallocating time to MVPA from LPA, SB and sleep was significantly associated with higher aBMD at total body (B = 1.765, P = .005), total hip (B = 1.709, P = .003) and lumbar spine (B = 2.093, P = .001). In peri/post-pubertal survivors, reallocating time to LPA from MVPA, SB and sleep was significantly associated with higher aBMD at all sites (B = 2.090 to 2.609, P = .003 to .038). Reallocating time to SB from MVPA or LPA was significantly associated with lower aBMD at most sites in pre-pubertal and peri/post-pubertal survivors, respectively. Finally, reallocating time to sleep from MVPA, LPA and SB was significantly associated with lower aBMD at total body (B = -2.572, P = .036) and total hip (B = -3.371, P = .015).

CONCLUSIONS

These findings suggest that every move counts and underline the benefits of increasing MVPA or LPA, when low MVPA levels are present, for bone regeneration following pediatric cancer treatment completion.

Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors: The iBoneFIT project

BACKGROUND

Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density (aBMD). However, the prevalence of muscle strength deficits is not well documented, and the associations of muscle strength with aBMD are unknown in this population. Therefore, this study aimed to investigate the prevalence of upper- and lower-body muscle strength deficits and to examine the associations of upper- and lower-body muscle strength with age-, sex, and race-specific aBMD Z-scores at the total body, total hip, femoral neck, and lumbar spine.

METHODS

This cross-sectional study included 116 pediatric cancer survivors (12.1 ± 3.3 years old, mean ± SD; 42.2% female). Upper- and lower-body muscle strength were assessed by handgrip and standing long jump test, respectively. Dual‑energy X‑ray absorptiometry was used to measure aBMD (g/cm2). Associations between muscle strength and aBMD were evaluated in multivariable linear regression models. Logistic regression was used to evaluate the contribution of muscle strength (1-decile lower) to the odds of having low aBMD (Z-score ≤ 1.0). All analyses were adjusted for time from treatment completion, radiotherapy exposure, and body mass index.

RESULTS

More than one-half of survivors were within the 2 lowest deciles for upper- (56.9%) and lower- body muscle strength (60.0%) in comparison to age- and sex-specific reference values. Muscle strength deficits were associated with lower aBMD Z-scores at all sites (B : 0.133-0.258, p : 0.001-0.032). Each 1-decile lower in upper-body muscle strength was associated with 30%-95% higher odds of having low aBMD Z-scores at all sites. Each 1-decile lower in lower-body muscle strength was associated with 35%-70% higher odds of having low aBMD Z-scores at total body, total hip, and femoral neck.

CONCLUSION

Muscle strength deficits are prevalent in young pediatric cancer survivors, and such deficits are associated with lower aBMD Z-scores at all sites. These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.

A 20-week exercise program improved total body and legs bone mineral density in children with overweight or obesity: The ActiveBrains randomized controlled trial

OBJECTIVES

The aim of this study was to investigate the effect of a 20-week exercise program on bone mineral parameters in children with overweight or obesity.

DESIGN

Randomized controlled trial.

METHODS

This study took part from November 21, 2014, to June 30, 2016, in Granada, Spain. A secondary analysis of this parallel-group randomized controlled trial was performed with 77 children with overweight or obesity (9.9 ± 1.2, 65 % boys) who were randomly allocated to exercise or control group. All participants received lifestyle recommendations. The control group continued their usual routines, whereas the exercise group attended a minimum of 3 supervised 90-minute sessions/week of aerobic plus resistance training for 20 weeks. A whole-body scan by dual-energy X-ray absorptiometry was carried out to obtain body composition at total body less head, arms, lumbar spine, pelvis, and legs.

RESULTS

Participants in the exercise group acquired significantly higher total body aBMD (mean z-score [95 % confidence intervals, CI], 0.607 [0.522-0.692]) compared with the participants in the control group (mean z-score, 0.472 [0.388-0.556]); difference between groups, 0.135 standard deviations [95 % CI 0.015-0.255], and legs aBMD (mean z-score, 0.629 [0.550-0.708]); control group (mean z-score, 0.518 [0.440-0.596]); difference between groups, 0.111 [0.001-0.222]; all p < 0.05. There were no significant differences between exercise group and control group at the remaining evaluated regions (p > 0.05).

CONCLUSIONS

A 20-week non-specifically bone-targeted exercise program induced a small, yet significant, improvement on total body and legs aBMD in children with overweight or obesity. Future studies should investigate the interaction of weight status in the bone response to exercise programs.

TRIAL REGISTRATION

Prospectively registered in ClinicalTrials.gov Identifier: NCT02295072.

Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis

BACKGROUND

The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment.

METHODS

MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains.

RESULTS

In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires.

CONCLUSION

Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.

Determinants of bone parameters in young paediatric cancer survivors: the iBoneFIT project

BACKGROUND

Bone health is remarkably affected by endocrine side effects due to paediatric cancer treatments and the disease itself. We aimed to provide novel insights into the contribution of independent predictors of bone health in young paediatric cancer survivors.

METHODS

This cross-sectional multicentre study was carried out within the iBoneFIT framework in which 116 young paediatric cancer survivors (12.1 ± 3.3 years old; 43% female) were recruited. The independent predictors were sex, years from peak height velocity (PHV), time from treatment completion, radiotherapy exposure, region-specific lean and fat mass, musculoskeletal fitness, moderate-vigorous physical activity and past bone-specific physical activity.

RESULTS

Region-specific lean mass was the strongest significant predictor of most areal bone mineral density (aBMD), all hip geometry parameters and Trabecular Bone Score (β = 0.400-0.775, p ≤ 0.05). Years from PHV was positively associated with total body less head, legs and arms aBMD, and time from treatment completion was also positively associated with total hip and femoral neck aBMD parameters and narrow neck cross-sectional area (β = 0.327-0.398, p ≤ 0.05; β = 0.135-0.221, p ≤ 0.05), respectively.

CONCLUSION

Region-specific lean mass was consistently the most important positive determinant of all bone parameters, except for total hip aBMD, all Hip Structural Analysis parameters and Trabecular Bone Score.

IMPACT

The findings of this study indicate that region-specific lean mass is consistently the most important positive determinant of bone health in young paediatric cancer survivors. Randomised clinical trials focused on improving bone parameters of this population should target at region-specific lean mass due to the site-specific adaptations of the skeleton to external loading following paediatric cancer treatment. After paediatric cancer diagnosis, years from peak height velocity (somatic maturity) is critical for bone development.

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

Is higher physical fitness associated with better psychological health in young pediatric cancer survivors? A cross-sectional study from the iBoneFIT project

OBJECTIVE

To examine the associations of self-perceived and objectively-measured physical fitness with psychological well-being and distress indicators in young pediatric cancer survivors.

MATERIALS AND METHODS

A total of 116 participants (12.1 ± 3.3 years, 56.9% boys) from the iBoneFIT project participated in this cross-sectional study. Objectively-measured physical fitness (muscular fitness) was obtained by handgrip strength and standing long jump tests for the upper and lower body, respectively. Self-perceived physical fitness was obtained by the International Fitness Scale (IFIS). Positive and negative affect were assessed by the positive affect schedule for children (PANAS-C), happiness by Subjective Happiness Scale (SHS), optimism by Life Orientation Test-Revised (LOT-R), self-esteem by the Rosenberg Self-Esteem Scale (RSE), anxiety by State-Trait Anxiety Inventory for Children (STAIC-R), and depression by Children Depression Inventory (CDI). Multiple linear regressions adjusted by key covariates were performed to analyze associations.

RESULTS

No associations were found between objectively-measured muscular fitness and any of the psychological well-being and distress indicators (p > 0.05). Self-perceived overall fitness and flexibility were positively associated with positive affect (β ≥ 0.258, p < 0.05). Self-perceived cardiorespiratory fitness, speed/agility, and flexibility were negatively associated with depression (β ≥ -0.222, p < 0.05). Finally, self-perceived cardiorespiratory fitness was also negatively associated with anxiety and negative affect (β ≥ -0.264, p < 0.05).

CONCLUSIONS

Perceived physical fitness, but not objectively physical fitness, seems to be inversely related to psychological distress variables and to less extent positively related to psychological well-being. The findings from this study highlight the importance of promoting self-perceived fitness in the pediatric oncology population.

Sweetened beverages are associated with a higher risk of differentiated thyroid cancer in the EPIC cohort: a dietary pattern approach

BACKGROUND

Dietary pattern analysis has gained particular interest, because it reflects the complexity of dietary intake. The aim of this study was to explore the associations between a posteriori dietary patterns, derived using a data-driven approach, and the risk of differentiated thyroid cancer (TC) in Europe.

METHODS

This investigation included 450,064 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Dietary intake was assessed using validated country-specific dietary questionnaires. A posteriori dietary patterns were computed using principal component analyses. Cox regression was used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

After a mean follow-up time of 14 years, 712 first differentiated TCs were diagnosed. In the fully adjusted model, a dietary pattern characterized by alcohol consumption (basically beer and wine) was negatively associated with differentiated TC risk (HRQ4vs.Q1 = 0.75; 95% CI:0.60-0.94, P-trend = 0.005), while a dietary pattern rich in sweetened beverages was positively associated with differentiated TC risk (HRQ4vs.Q1 = 1.26; 95% CI:0.99-1.61; P-trend = 0.07). The remaining 8 dietary patterns were not related to differentiated TC risk. The intake of sweetened beverages was positively associated with differentiated TC risk (HR100mL/d = 1.05; 95% CI:1.00-1.11), especially with papillary TC risk (HR100mL/d = 1.07; 95% CI:1.01-1.13). Similar results were observed with sugary and artificially sweetened beverages.

CONCLUSIONS

The investigation of dietary patterns detected that the consumption of sweetened beverages was associated with a higher risk of differentiated thyroid cancer. Our results are in line with the general dietary recommendations of reducing the consumption of sweetened beverages.

Body shape phenotypes of multiple anthropometric traits and cancer risk: a multi-national cohort study

BACKGROUND

Classical anthropometric traits may fail to fully represent the relationship of weight, adiposity, and height with cancer risk. We investigated the associations of body shape phenotypes with the risk of overall and site-specific cancers.

METHODS

We derived four distinct body shape phenotypes from principal component (PC) analysis on height, weight, body mass index (BMI), waist (WC) and hip circumferences (HC), and waist-to-hip ratio (WHR). The study included 340,152 men and women from 9 European countries, aged mostly 35-65 years at recruitment (1990-2000) in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

After a median follow-up of 15.3 years, 47,110 incident cancer cases were recorded. PC1 (overall adiposity) was positively associated with the risk of overall cancer, with a HR per 1 standard deviation (SD) increment equal to 1.07 (95% confidence interval 1.05 to 1.08). Positive associations were observed with 10 cancer types, with HRs (per 1 SD) ranging from 1.36 (1.30-1.42) for endometrial cancer to 1.08 (1.03-1.13) for rectal cancer. PC2 (tall stature with low WHR) was positively associated with the risk of overall cancer (1.03; 1.02-1.04) and five cancer types which were not associated with PC1. PC3 (tall stature with high WHR) was positively associated with the risk of overall cancer (1.04; 1.03-1.05) and 12 cancer types. PC4 (high BMI and weight with low WC and HC) was not associated with overall risk of cancer (1.00; 0.99-1.01).

CONCLUSIONS

In this multi-national study, distinct body shape phenotypes were positively associated with the incidence of 17 different cancers and overall cancer.

Sprint and upper limbs power field tests for the screening of low bone mineral density in children

Background: The possibility of carrying out screening, with acceptable accuracy, of a child's bone mass status based on a physical fitness test can advance the concept of health-related physical fitness. In addition, the relevance of the applicability of this type of screening in educational environments is mainly due to the difficulty of direct assessments of bone health indicators. This study aimed to propose cut-off points for physical fitness tests based on children's bone health indicators. Methods: This is a two-phase cross-sectional study. Phase-1: 160 children (6-11 years-old) performed the 20-m sprint test (20-mST) and the 2 kg medicine ball throw test (2 kgMBTT). Areal bone mineral density (aBMD) and content was assessed by DXA. The area under the ROC curve greater than 70% was considered valid. Phase-2: It was carried out a secondary analysis in a sample with 8,750 Brazilians (6-11 years-old). The percentile values (identified in phase-1) were used to identify the values of the cut-off points in the unit of measurement of the tests. The validation of the cut-off points found was by odds ratio values and p ≤ 0.05. Results: Phase 1: The areas under the ROC curve were 0.710, 0.712 (boys and girls-20-mST), 0.703, and 0.806 (boys and girls-2 kgMBTT) with total spine and pelvis aBMD as the outcome. Phase 2: From percentile values, we find valid cut-off points in the Brazilian sample (OR > 3.00; p < 0.001) for boys and girls. Values ranged between 5.22 s-4.00 s to 20-mST and between 125.0 cm-160.0 cm to 2 kgMBTT. Conclusion. The 20-mST and the 2 kgMBTT presented sufficient accuracy for the screening of children aged between 6 and 11 years with greater chances of having low aBMD in the total spine and pelvis, with valid cut-off points.

Leptin levels were negatively associated with lumbar spine bone mineral content in children with overweight or obesity

AIM

Adipokines seem to play a role in bone morphogenesis, although this also depends on the mechanical forces applied to the skeleton. The aim was to assess the relationships of resting leptin and adiponectin with bone parameters and whether high muscular fitness levels affect these relationships in children with overweight or obesity.

METHODS

This cross-sectional study took part from 2014 to 2016 in Granada, Spain. Participants were recruited from University Hospitals, and we also used advertisements in local media and school contacts in the city. Adipokines were analysed in plasma. Muscular fitness was assessed by 1 repetition maximum in bench and leg press tests. Dual-energy X-ray absorptiometry was used to measure bone parameters.

RESULTS

We included 84 children (10.0±1.2y; 63% boys) in this analysis. Leptin was negatively associated with lumbar spine bone mineral content (β=-0.162, p=0.053). No significant interaction was found for muscular fitness. Simple slope estimates suggested that children performing more than 133.3kg in leg press test ameliorated the negative association between leptin and lumbar spine bone mineral content.

CONCLUSION

Leptin levels were negatively associated with lumbar spine bone mineral content in children with overweight or obesity. A high muscular fitness at the lower body could counteract this association.

Do patients with type 2 diabetes have impaired hip bone microstructure? A study using 3D modeling of hip dual-energy X-ray absorptiometry

AIM

Patients with type 2 diabetes (T2DM) have more risk of bone fractures. However, areal bone mineral density (aBMD) by conventional dual-energy x-ray absorptiometry (DXA) is not useful for identifying this risk. This study aims to evaluate 3D-DXA parameters determining the cortical and trabecular compartments in patients with T2DM compared to non-diabetic subjects and to identify their determinants.

MATERIALS AND METHODS

Case-control study in 111 T2DM patients (65.4 ± 7.6 years old) and 134 non-diabetic controls (64.7 ± 8.6-year-old). DXA, 3D-DXA modelling via 3D-Shaper software and trabecular bone score (TBS) were used to obtain aBMD, cortical and trabecular parameters, and lumbar spine microarchitecture, respectively. In addition, biochemical markers as 25-hydroxyvitamin d, type I procollagen N-terminal propeptide (P1NP), C-terminal telopeptide of type I collagen (CTX), and glycated haemoglobin (HbA1c) were analysed.

RESULTS

Mean-adjusted values showed higher aBMD (5.4%-7.7%, ES: 0.33-0.53) and 3D-DXA parameters (4.1%-10.3%, ES: 0.42-0.68) in the T2DM group compared with the control group. However, TBS was lower in the T2DM group compared to the control group (-14.7%, ES: 1.18). In addition, sex (β = 0.272 to 0.316) and body mass index (BMI) (β = 0.236 to 0.455) were the most consistent and positive predictors of aBMD (p ≤ 0.01). BMI and P1NP were negative predictors of TBS (β = -0.530 and -0.254, respectively, p ≤ 0.01), while CTX was a positive one (β = 0.226, p=0.02). Finally, BMI was consistently the strongest positive predictor of 3D-DXA parameters (β = 0.240 to 0.442, p<0.05).

CONCLUSION

Patients with T2DM present higher bone mass measured both by conventional DXA and 3D-DXA, suggesting that 3D-DXA technology is not capable of identifying alterations in bone structure in this population. Moreover, BMI was the most consistent determinant in all bone outcomes.

Evidence Update on the Relationship between Diet and the Most Common Cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: A Systematic Review

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a multicentre prospective study conducted in 23 centres in 10 European countries. Here we review the findings from EPIC on the relationship between diet-related exposures and incidence or mortality from the four most frequent cancers in the European population: colorectal, breast, lung, and prostate cancer. We conducted a systematic review following PRISMA guidelines and identified 110 high-quality studies based on the EPIC cohort. Fruit and vegetable consumption had a protective effect against colorectal, breast, and lung cancer, whereas only fruit had a protective effect against prostate cancer. A higher consumption of fish and lower consumption of red and processed meat were related with a lower risk of colorectal cancer; and higher consumption of fatty fish with lower risk of breast cancer. Calcium and yogurt intake were found to protect against colorectal and prostate cancer. Alcohol consumption increased the risk for colorectal and breast cancer. Finally, adherence to the Mediterranean diet emerged as a protective factor for colorectal and breast cancer. The EPIC study results are in agreement with the latest evidence from leading authorities on cancer prevention and help to inform public prevention policies and strategies.

The Impact of Childhood Obesity on Joint Alignment: A Systematic Review and Meta-Analysis

OBJECTIVE

It has been suggested that overweight/obesity (OW/OB) impairs the normal alignment of children and adolescents' musculoskeletal system. However, to date, no study has systematically reviewed or quantified the effect of OW/OB on the development of joint malalignments in children and adolescents. The purpose of this study was to systematically review the association between OW/OB and joint alignment in children and adolescents and to quantify the evidence on whether children and adolescents with OW/OB have a higher risk of developing joint malalignments than their peers of normal weight.

METHODS

PubMed and Web of Science databases were systematically searched from inception to March 9, 2020. Studies investigating the association between OW/OB and joint alignment in children and adolescents were selected. Nonoriginal articles, participants with movement pattern diseases, and adolescents studied while pregnant were excluded. Two independent reviewers conducted the study selection and data extraction. Qualitative synthesis of evidence and random effect meta-analyses (risk ratio [RR]) were performed.

RESULTS

Seventy-three studies (5 longitudinal and 68 cross-sectional) met the inclusion criteria involving 1,757,107 children and adolescents. There was consistent evidence supporting associations of OW/OB with rounded shoulder, lumbar hyperlordosis, genu valgum, and flatfoot. Our meta-analysis showed that children and adolescents with OW/OB had a significantly higher risk of lumbar hyperlordosis (RR = 1.41), genu valgum (RR = 5.92), flatfoot (RR = 1.49), and any joint malalignment (RR = 1.68) when compared with their peers of normal weight. The presence of genu valgum and flatfoot were the most robust results.

CONCLUSION

Based on these findings, OW/OB is associated with the presence of joint malalignments in children and adolescents.

IMPACT

This is the first study that has systematically reviewed the effect of OW/OB on the development of joint malalignments in children and adolescents.

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.

Muscular and Physical Response to an Agility and Repeated Sprint Tests According to the Level of Competition in Futsal Players

The aim of this study was to evaluate the neuromuscular response to an agility and repeated sprint ability (RSA) test according to the level of competition in futsal players. A total of 33 players from two elite teams and one amateur team participated in the study. The participants completed an agility t-test, a 30 m-speed test, and a RSA test. A countermovement jump (CMJ) test and a tensiomyography test of the rectus femoris (RF) and biceps femoris (BF) of both legs were carried out before and after the tests. RSA test revealed better sprint times in elite players compared to amateurs in the seven bouts, as well as in the 30 m sprint and in the agility test (p < 0.05). Before the tests, elite players showed higher sustain time (Ts) in RF (+31.03 ms; ES: 0.76) and BF (+28.73 ms; ES: 0.73), higher half-relaxation time (Tr) in BF (+20.79 ms; ES: 0.94), and lower delay time (Td) in BF (−2 ms; ES: 1.19) compared to amateur players. However, post-test values did not present any significant differences (p > 0.05). In conclusion, elite players showed greater performance in the RSA test, in the 30 m tests and in the agility test compared to amateur players. The contractile properties were not a key factor in the RSA performance of the futsal players.

Hybrid neuromuscular training promotes musculoskeletal adaptations in inactive overweight and obese women: A training-detraining randomized controlled trial

This study investigated the effects of a 10-month high-intensity interval-type neuromuscular training programme on musculoskeletal fitness in overweight and obese women. Forty-nine inactive females (36.4 ± 4.4 yrs) were randomly assigned to either a control (N = 21), a training (N = 14, 10 months) or a training-detraining group (N = 14, 5 months training followed by 5 months detraining). Training used progressive loaded fundamental movement patterns with prescribed work-to-rest intervals (1:2, 1:1, 2:1) in a circuit fashion (2-3 rounds). Muscular strength and endurance, flexibility, passive range of motion (PRoM), static balance, functional movement screen (FMS) and bone mass density (BMD) and content (BMC) were measured at pre-, mid-, and post-intervention. Ten months of training induced greater changes than the controls in (i) BMD (+1.9%, p < 0.001) and BMC (+1.5%, p = 0.023) ii) muscular strength (25%-53%, p = 0.001-0.005); iii) muscular endurance (103%-195%, p < 0.001); and iv) mobility (flexibility: 40%, p < 0.001; PRoM [24%-53%, p = 0.001-0.05;]; balance: 175%, p = 0.058; FMS: +58%, p < 0.001). The response rate to training was exceptionally high (86-100%). Five months of detraining reduced but not abolished training-induced adaptations. These results suggest that a hybrid-type exercise approach integrating endurance-based bodyweight drills with resistance-based alternative modes into a real-world gym setting may promote musculoskeletal fitness in overweight and obese women.

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.

Lean mass index is positively associated with white matter volumes in several brain regions in children with overweight/obesity

BACKGROUND

The relationship of obesity with grey and white matter volumes has been examined in several studies, and the results are decidedly mixed.

OBJECTIVE

To investigate the associations of body mass index (BMI), fat mass index (FMI) and lean mass index (LMI) with total and regional grey and white matter volumes.

METHODS

This is a cross-sectional study involving 100 children (60% boys) with overweight/obesity. T1-weighted images were acquired using magnetic resonance imaging. Dual energy X-ray absorptiometry was used to measure body composition. Separate hierarchical regression analyses were performed between predictor variables (BMI, FMI and LMI) and the total brain volumes including sex, years from peak height velocity and parental education as covariates. In addition, FMI was added as a covariate when LMI was the predictor and vice versa. Statistical analyses of imaging data were performed using three whole-brain voxel-wise multiple regression models and adjusted by the same covariates.

RESULTS

LMI was positively associated with white matter in numerous regions and to a lower extent, with grey matter regions. Further, the relationship between LMI, and grey and white matter regions was independent of FMI levels.

CONCLUSIONS

LMI seems to be a positive predictor of regional white matter volumes in children with overweight/obesity.

Validity of Slaughter Equations and Bioelectrical Impedance Against Dual-Energy X-Ray Absorptiometry in Children

OBJECTIVE

This study aimed to 1) analyze the criterion validity of the Slaughter equations (Slg-Eq) and bioelectrical impedance analysis (BIA) to estimate body fat percentage (BFP) and fat mass index (FMI) at different degrees of obesity in children compared with dual-energy x-ray absorptiometry (DXA) and 2) determine their agreement over time.

METHODS

Ninety-two children with overweight or obesity (10.0 [SD 1.2] years; 34.8% girls) participated in this 20-week study. Anthropometric, BIA, and DXA measurements were performed.

RESULTS

Both Slg-Eq and BIA methods underestimated BFP and FMI against DXA, and the bias was markedly larger with BIA (mean absolute percentage error = 11% for Slg-Eq vs. 18%-21% for BIA); a larger underestimation was observed in girls compared with boys for Slg-Eq (P ≤ 0.001), and the observed underestimation in adiposity was reduced as weight status increased. Systematic errors were kept constant over time, so no large differences between methods were observed in the change in adiposity.

CONCLUSIONS

At the group level, Slg-Eq provides a more valid estimation of BFP and FMI than BIA. At the individual level, Slg-Eq shows larger estimation errors. The validity of these methods might differ in sex and weight status. Nevertheless, both methods seem to be valid for monitoring changes in adiposity.

Correction: Inflammatory markers and bone mass in children with overweight/obesity: the role of muscular fitness

A correction to this paper has been published and can be accessed via a link at the top of the paper.

Analysis of Bone Impairment by 3D DXA Hip Measures in Patients With Primary Hyperparathyroidism: A Pilot Study

CONTEXT

Primary hyperparathyroidism (PHPT) has been related to bone loss. Dual-energy x-ray absorptiometry (DXA) cannot distinguish between trabecular and cortical bone compartments but the recently developed three-dimensional (3D)-DXA software might overcome this issue.

OBJECTIVE

To examine the differences in DXA-derived areal bone mineral density (aBMD) and 3D-DXA parameters at the hip site between patients with PHPT and a healthy control group.

DESIGN

Cross-sectional pilot study.

SETTING

Hospital.

PATIENTS

80 adults (59.5 ± 9.1 yrs), 40 with PHPT and 40 age- and sex-matched healthy controls.

MEASURES

aBMD (g/cm2) of the femoral neck, trochanter, shaft, and total hip was assessed using DXA. Cortical surface (sBMD, mg/cm2), cortical volumetric BMD (vBMD, mg/cm3), trabecular vBMD (mg/cm3), integral vBMD (mg/cm3) and cortical thickness (mm) was assessed using 3D-DXA software.

RESULTS

Mean-adjusted values showed lower aBMD (7.5%-12.2%, effect size: 0.51-1.01) in the PHPT group compared with the control group (all P < 0.05). 3D-DXA revealed bone impairment (3.7%-8.5%, effect size: 0.47-0.65) in patients with PHPT, mainly in cortical parameters (all P < 0.05). However, differences in trabecular vBMD were not statistically significant (P = 0.055). The 3D mapping showed lower cortical sBMD, cortical vBMD, and cortical thickness at the trochanter and diaphysis in the PHPT group (P < 0.05) compared with the control group. In both groups, the presence of osteopenia or osteoporosis is related to lower cortical bone.

CONCLUSIONS

aBMD and cortical 3D parameters are impaired in patients with PHPT versus healthy controls. The vBMD of the trabecular compartment seems to be affected, although to a lesser extent.

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.

Effect of different types of exercise on health-related quality of life during and after cancer treatment: a protocol for a systematic review and network meta-analysis

INTRODUCTION

Cancer (and survival) is known to affect the quality of life. Strategies as physical activity and exercise during and after cancer may improve health-related qualify of life (HRQOL) outcomes and are, therefore, of clinical and public health importance. To the best of our knowledge, comparative evidence of the effect of the different types of exercise on improving HRQOL in cancer patients has not been synthesised thus far. We aim to conduct a systematic review and network meta-analysis in order to synthesise all available evidence regarding the effect of different types of exercise interventions on HRQOL during and after cancer treatment.

METHODS AND ANALYSIS

MEDLINE (via PubMed), Web of Science, Embase, The Cochrane Library and SPORTDiscus will be searched from inception to December 2018 for relevant randomised controlled trials (RCTs) and non-RCTs. Studies assessing physical activity and exercise interventions in cancer patients (during treatment) and survivors (after treatment) will be selected. Two independent reviewers will identify eligible studies. After quality appraisal and data extraction, we will conduct meta-analyses for outcomes of interest, including data from mental and physical dimensions of cancer-specific and/or generic HRQOL questionnaires. Risk of bias assessments will be completed using the Quality Assessment Tool for Quantitative Studies. Study heterogeneity will be measured by the I² statistic. Bayesian (and traditional approach) network meta-analysis will be performed when possible to determine the comparative effect of the different physical activity or exercise interventions.

ETHICS AND DISSEMINATION

This systematic review and network meta-analysis will synthesise evidence on the effect of different types of exercise interventions on HRQOL during and after cancer treatment. The results will be disseminated by publication in a peer-reviewed journal and through scientific conferences and symposia. Ethical approval will not be required because the data used for this work will be exclusively extracted from published studies.

PROSPERO REGISTRATION NUMBER

CRD42019125028.

A 9-Month Jumping Intervention to Improve Bone Geometry in Adolescent Male Athletes

PURPOSE

Sports have different effects on bone development and effective interventions to improve bone health of adolescent athletes are needed. The purpose of the study was to investigate the effect of a 9-month jumping intervention on bone geometry and metabolism in adolescent male athletes.

METHODS

Ninety-three adolescent (14.1 yr old) male swimmers (SWI), footballers (FOO), and cyclists (CYC) were randomized to intervention and sport (INT-SWI = 19, INT-FOO = 15, and INT-CYC = 14) or sport only (CON-SWI = 18, CON-FOO = 15, and CON-CYC = 12) groups. Cross-sectional area, cross-sectional moment of inertia (CSMI), and section modulus (Z) at the femoral neck were assessed using hip structural analysis and trabecular texture of the lumbar spine using trabecular bone score. Bone mineral content (BMC) at femoral neck and lumbar spine was assessed using dual-energy x-ray absorptiometry. Serum N-terminal propeptide of procollagen type I, isomer of the carboxy-terminal telopeptide of type 1 collagen, total serum calcium, and 25-hydroxyvitamin D were analyzed.

RESULTS

INT-CYC acquired significantly higher lumbar spine BMC (4.6%) and femoral neck BMC (9.8%) than CON-CYC. INT-CYC acquired significantly higher cross-sectional area (11.0%), CSMI (10.1%), and trabecular bone score (4.4%) than CON-CYC. INT-SWI acquired significantly higher femoral neck BMC (6.0%) and CSMI (10.9%) than CON-SWI. There were no significant differences between INT-FOO and CON-FOO in any bone outcomes. N-terminal propeptide of procollagen type I significantly decreased in CON-SWI, INT-FOO, CON-FOO, and CON-CYC. Carboxy-terminal telopeptide of type 1 collagen significantly decreased in CON-SWI and CON-CYC. The 25-hydroxyvitamin D significantly increased in INT-CYC, CON-CYC, INT-FOO, and CON-FOO.

CONCLUSIONS

A 9-month jumping intervention improved bone outcomes in adolescent swimmers and cyclists, but not in footballers. This intervention might be used by sports clubs to improve bone health of adolescent athletes.

Effect of a Repeated Sprint Ability test on the muscle contractile properties in elite futsal players

The aim of this study was to evaluate the effect of a repeated sprint ability (RSA) test on the contractile properties of the muscles in elite futsal players. A total of 20 elite players completed the RSA test (7 × 30 m), and the contractile response from the rectus femoris (RF) and biceps femoris (BF) of both legs were analysed pre and post through tensiomyography. There was a significant increment in 30-m times from the third sprint onwards (p < 0.05). The percent decrement in sprint ability (RSA_DEC) with respect to the first sprint was significantly higher in the last sprint. The players did not show evidence of lateral asymmetry in any of the muscle groups analysed after the RSA test (p > 0.05). Following the RSA test there was a significant reduction in the delay time (Td) in RF, a significant decrement in half-relaxation time (Tr) in the RF, and a significant reduction in sustain time (Ts) in the RF and BF of both legs. The maximum radial displacement of the muscle belly (Dm) increased (1.6 mm; effect size = 0.75; p < 0.05) in the RF after the RSA test, indicating reduced muscle stiffness and the ability to generate strength rapidly. The decrement in performance during the RSA test was significantly correlated with changes in contraction time (Tc) in RF and BF, Td in BF, and Dm in RF (p < 0.05). The RSA test generated alterations in the contractile properties of the RF and BF in elite players. However, futsal players did not present asymmetries in any muscular parameters. The baseline contractile muscle parameters could be an important factor related to performance of players during repeated high-intensity actions.

Impact of Futsal and Swimming Participation on Bone Health in Young Athletes

Physical activity plays a crucial role in bone mass acquisition during childhood and adolescence, with weightbearing and high-impact sport activities being more beneficial. This study sought to evaluate the impact of different sports activities on bone mineral density and content in male Portuguese athletes. Seventy adolescent boys (aged 12-15 years) including 28 futsal players (FG), 20 swimmers (SG) and 22 non-athletic adolescents used as control subjects (CG), participated in the current study. Areal bone mineral density (aBMD) and areal bone mineral content (aBMC) were measured by dual energy x-ray absorptiometry (DEXA). Futsal players had significantly higher aBMD (lumbar spine - FG: 0.95 ± 0.18, SG: 0.80 ± 0.13, CG: 0.79 ± 0.13 g/cm2, p = 0.001; pelvis - FG: 1.17 ± 0.21, SG: 0.91 ± 0.12, CG: 0.98 ± 0.10 g/cm2, p < 0.001; lower limbs - FG: 1.21 ± 0.19, SG: 0.97 ± 0.10, CG: 0.99 ± 0.09 g/cm2, p < 0.001) and aBMC (lumbar spine - FG: 51.07 ± 16.53, SG: 40.19 ± 12.47, CG: 40.50 ± 10.53 g, p = 0.013; pelvis - FG: 299.5 ± 110.61, SG: 170.02 ± 55.82, CG: 183.11 ± 46.78 g, p < 0.001; lower limbs - FG: 427.21 ± 117.11, SG: 300.13 ± 76.42, CG: 312.26 ± 61.86 g/cm2, p < 0.001) than swimmers and control subjects. Data suggest that futsal, as a weightbearing and high or odd-impact sport, may improve bone mass during childhood and adolescence.

Longitudinal determinants of 12-month changes on bone health in adolescent male athletes

We identified the determinants of 12-month changes of areal bone mineral density (aBMD), hip geometry and trabecular bone score (TBS) in adolescent male athletes. Changes in region-specific lean mass and the type of sport are the most consistent determinants in this population.

PURPOSE

This study aims to identify the determinants of 12-month changes of areal bone mineral density (aBMD), hip geometry and trabecular bone score (TBS) in adolescent male athletes.

METHODS

The sample was 104 adolescent males aged 12-14 years at baseline that were followed over 12 months: 39 swimmers, 37 footballers (or soccer players) and 28 cyclists. Dual-energy X-ray absorptiometry measured aBMD at the whole body, lumbar spine and dual hip. Hip geometry estimates at the femoral neck were measured using hip structural analysis. Lumbar spine texture was measured by TBS.

RESULTS

Multivariate regression models significantly explained 38-60% of the variance in the aBMD changes, 36-62% in the hip geometry estimates changes and 45% in the TBS changes. Δregion-specific lean mass was the most consistent predictor of changes in aBMD outcomes (β = 0.591 to 0.696), followed by cycling participation (β = - 0.233 to - 0.262), swimming participation (β = - 0.315 to - 0.336) and ΔMVPA (β = 0.165). Cycling participation was the most consistent predictor of changes in hip geometry estimates (β = - 0.174 to - 0.268), followed by Δregion-specific lean mass (β = 0.587) and Δcardiorespiratory fitness (β = 0.253). Finally, cycling and swimming participation (β = - 0.347 to - 0.453), Δregion-specific lean mass (β = 0.848) and Δstature (β = 0.720) were predictors of change in TBS.

CONCLUSIONS

Changes in region-specific lean mass and the type of sport are the most consistent determinants of 12-month changes in aBMD, hip geometry estimates and TBS in adolescent male athletes.

TRIAL REGISTRATION

ISRCTN17982776.

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.

Longitudinal Adaptations of Bone Mass, Geometry, and Metabolism in Adolescent Male Athletes: The PRO-BONE Study

Adolescence is a crucial period for bone development, and exercise can enhance bone acquisition during this period of life. However, it is not known how the different loading sports practiced can affect bone acquisition in adolescent male athletes. Therefore, the purpose of the present study was to determine the 1-year longitudinal bone acquisition among adolescent males involved in osteogenic (football) and non-osteogenic (swimming and cycling) sports and to compare with active controls. A total of 116 adolescent males aged 12 to 14 years at baseline were followed for 1 year: 37 swimmers, 37 footballers, 28 cyclists, and 14 active controls. Bone mineral content (BMC) was assessed using dual-energy X-ray absorptiometry (DXA); cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), and section modulus (Z) at the femoral neck was assessed using hip structural analysis (HSA); and bone texture of the lumbar spine was assessed using trabecular bone score (TBS). Serum N-terminal propeptide of procollagen type I (PINP), isomer of the Carboxi-terminal telopeptide of type 1 collagen (CTX-I), total serum calcium, and 25 hydroxyvitamin D [25(OH)D] were analyzed. Footballers had significantly higher adjusted BMC at the lumbar spine (7.0%) and femoral neck (5.0%) compared with cyclists, and significantly greater BMC at the lumbar spine (6.9%) compared with swimmers. Footballers presented significantly greater TBS (4.3%) compared with swimmers, and greater CSMI (10.2%), CSA (7.1%), Z (8.9%) and TBS (4.2%) compared with cyclists. No differences were noted between cyclists and swimmers, both groups had similar bone acquisition compared with controls. PINP was significantly higher in footballers and controls compared with cyclists and swimmers (3.3% to 6.0%), and 25(OH)D was significantly higher in footballers and cyclists compared with swimmers and controls (9.9% to 13.1%). These findings suggest that bone acquisition is higher in adolescent male footballers compared with swimmers and cyclists at the femoral neck and lumbar spine sites of the skeleton. © 2017 American Society for Bone and Mineral Research.

Lean mass explains the association between muscular fitness and bone outcomes in 13-year-old boys

AIM

This study investigated the associations between fitness indices and bone outcomes in young males.

METHODS

Data were collected between autumn and winter 2014-2015 on 121 males with a mean age of 13.1 ± 0.1 years: 41 swimmers, 37 footballers, 29 cyclists and 14 nonathletes. Participants were recruited from athletic clubs and schools across South West England. Lean mass, areal bone mineral density and hip structural estimates were measured using dual-energy X-ray absorptiometry. The relationships between bone outcomes and the vertical jump, standing long jump and the 20-m shuttle run test were analysed using three regression models: model 1 was adjusted by age and stature, model 2 added vigorous physical activity and model 3 then added lean mass.

RESULTS

The boys' performance in the vertical jump and standing long jump was positively associated with the majority of bone outcomes in models 1 and 2, but most of these disappeared in model 3. The 20-m shuttle run test was positively associated with most bone outcomes in all three models. Lean mass played a key role in the association between muscular fitness and bone outcomes.

CONCLUSION

Vigorous physical activity did not explain the associations between fitness and bone outcomes, but lean mass did.

The effect of 12-month participation in osteogenic and non-osteogenic sports on bone development in adolescent male athletes. The PRO-BONE study

OBJECTIVES

Research investigating the longitudinal effects of the most popular sports on bone development in adolescent males is scarce. The aim is to investigate the effect of 12-month participation in osteogenic and non-osteogenic sports on bone development.

DESIGN

A 12-month study was conducted in adolescent males involved in football, swimming and cycling and compared with an active control group.

METHODS

116 adolescent males (13.1±0.1years at baseline): 37 footballers, 37 swimmers, 28 cyclists and 14 active controls were followed for 12 months. Bone mineral content (BMC) was measured by dual-energy X-ray absorptiometry, and bone stiffness was measured by quantitative ultrasound. Bone outcomes at 12 months were adjusted for baseline bone status, age, height, lean mass and moderate to vigorous physical activity.

RESULTS

Footballers had higher improvement in adjusted BMC at the total body, total hip, shaft, Ward's triangle, legs and bone stiffness compared to cyclists (6.3-8.0%). Footballers had significantly higher adjusted BMC at total body, shaft and legs compared to swimmers (5.4-5.6%). There was no significant difference between swimmers and cyclists for any bone outcomes. Swimming and cycling participation resulted in non-significant lower bone development at most sites of the skeleton compared to controls (-4.3 to -0.6%).

CONCLUSIONS

Football participation induces significantly greater improvements in BMC and bone stiffness over 12 months compared to cycling and swimming.

CLINICAL TRIAL REGISTRATION

ISRCTN17982776.

Influence of different sports on fat mass and lean mass in growing girls

PURPOSE

The aim of this study was to analyze and compare the effects of different sports (swimming, football, basketball, and handball) on fat mass and lean mass in prepubertal and pubertal girls.

METHODS

Two hundred girls (10.6 ± 1.5 years old, Tanner stages I-III) participated in the study and were divided into 5 groups: 40 swimmers, 40 football players, 40 basketball players, 40 handball players, and 40 controls. Fat and lean masses at whole body, arms, trunk, and legs were measured using dual-energy X-ray absorptiometry (DXA). Pubertal status was determined using Tanner test. Effects of different sports on fat and lean masses were assessed through analysis of covariance with height as covariates. Analyses were performed separately in 2 groups depending on the Tanner stage (prepubertal and pubertal).

RESULTS

The girls of the control group had less lean mass and more fat mass compared to the girls who play sports (p < 0.05). There were differences in body fat between sports. The swimmers and football players had less body fat (p < 0.05). On the other hand, handball players showed the highest values in lean mass (p < 0.05).

CONCLUSION

Impact sports (football, basketball, and handball) and low-impact sports (swimming) provide an appropriate development of lean mass in growing girls. We can conclude that people practicing sports at early ages ensure a lower fat mass and higher lean mass compared to those who do not practice. These results may be useful as a preventive method of adult obesity.