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

Abstract

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

The inverse relationship between fatness and bone mineral content is mediated by the adolescent appendicular skeletal muscle mass index: The Cogni-Action Project

“…Thereby, increasing ASMI through physical activity (i.e., resistance training) would help to increase bone quality through fat reduction ( 62 , 68 , 69 ). This suggestion has practical applicability, as a meta-analysis ( 70 ) that evaluated the effect of interventions with high-intensity physical exercise and sports mini-games at school showed that girls are more responsive to increasing bone mineral density than boys.…”

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

“…The associations between bone mass and physical fitness variables can be based on evidence on the osteogenic effect in childhood of some types of physical exercise ( Rutherford, 1999 ; Vicente-Rodríguez, 2006 ). Different controlled trials in school and non-school settings demonstrate that although the intensity is important, the type of activity also has an important influence on the osteogenic effect ( Tan et al, 2014 ; Larsen et al, 2018 ; García-Hermoso et al, 2021 ; Mello et al, 2021 ). This influence takes place through the actions of the reaction force of the different activities.…”

“…The calculation was performed for tests of the F family, considering that the research project foresees association analyses, carried out in another study ( Mello, 2020 ). The alpha used was 0.05, the effect size used was f 2 = 0.15 (moderate) ( Mello et al, 2021 ), and eight variables as predictors. From this protocol, considering the sample size of the present study, the power of the test (1-β) identified was 0.95.…”

“…Because its development is related to low bone mass and marked deterioration of bone tissue, it is a consensus that optimizing the accumulation of bone mass during childhood and adolescence, through physical exercise, is an effective way to prevent osteoporosis and maintain adequate bone health in adulthood (Rutherford, 1999). In this way, three recent systematic reviews (Torres-Costoso et al, 2020;García-Hermoso et al, 2021;Mello et al, 2021) indicated the muscular strength, global physical fitness and vigorous physical activities practice as useful skeletal health markers during development and maturation.…”

Speed, agility, and musculoskeletal fitness are independently associated with areal bone mineral density in children

“…In this sense, the systematic reviews by Mello et al (2021) and García-Hermoso et al (2021) demonstrate that interventions with physical exercise and physical activity with vigorous intensity (both with a positive effect on physical fitness) promote gains in bone mass in children and adolescents [e.g., bone mineral content (BMC) and bone mineral density (BMD)]. As Gómez-Bruton et al (2017) have shown that increase in lower limb power through plyometric exercises (effects on muscle power) in children and adolescents causes positive effects on general BMC.…”