Combined effects of physical activity and calcium on bone health in children and adolescents: a systematic review of randomized controlled trials

Yang, Xi; Zhai, Yali; Zhang, Jian; Chen, Jingyi; Liú, Dan; Wang, Zhao

doi:10.1007/s12519-019-00330-7

Cited by 24 publications

(19 citation statements)

References 31 publications

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“…A recent systematic review has shown an additive effect of calcium intake and PA on bone health in children with low dietary calcium intake. The effect was more evident when the supplementation was done in early puberty and in weight-bearing bones (96). Nevertheless, the available data are still inconclusive as based on small sample sizes, no randomized controlled trials and no longitudinal studies.…”

Section: Exercise and Mechanical Signals Are Anabolic To Skeletal Tissuementioning

confidence: 99%

The Bones of Children With Obesity

et al. 2020

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Excess adiposity in childhood may affect bone development, ultimately leading to bone frailty. Previous reports showing an increased rate of extremity fractures in children with obesity support this fear. On the other hand, there is also evidence suggesting that bone mineral content is higher in obese children than in normal weight peers. Both adipocytes and osteoblasts derive from multipotent mesenchymal stem cells (MSCs) and obesity drives the differentiation of MSCs toward adipocytes at the expense of osteoblast differentiation. Furthermore, adipocytes in bone marrow microenvironment release a number of pro-inflammatory and immunomodulatory molecules that up-regulate formation and activation of osteoclasts, thus favoring bone frailty. On the other hand, body adiposity represents a mechanical load, which is beneficial for bone accrual. In this frame, bone quality, and structure result from the balance of inflammatory and mechanical stimuli. Diet, physical activity and the hormonal milieu at puberty play a pivotal role on this balance. In this review, we will address the question whether the bone of obese children and adolescents is unhealthy in comparison with normal-weight peers and discuss mechanisms underlying the differences in bone quality and structure. We anticipate that many biases and confounders affect the clinical studies conducted so far and preclude us from achieving robust conclusions. Sample-size, lack of adequate controls, heterogeneity of study designs are the major drawbacks of the existing reports. Due to the increased body size of children with obesity, dual energy absorptiometry might overestimate bone mineral density in these individuals. Magnetic resonance imaging, peripheral quantitative CT (pQCT) scanning and high-resolution pQCT are promising techniques for the accurate estimate of bone mineral content in obese children. Moreover, no longitudinal study on the risk of incident osteoporosis in early adulthood of children and adolescents with obesity is available. Finally, we will address emerging dietary issues (i.e., the likely benefits for the bone health of polyunsaturated fatty acids and polyphenols) since an healthy diet (i.e., the Mediterranean diet) with balanced intake of certain nutrients associated with physical activity remain the cornerstones for achieving an adequate bone accrual in young individuals regardless of their adiposity degree.

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Section: Exercise and Mechanical Signals Are Anabolic To Skeletal Tissuementioning

confidence: 99%

The Bones of Children With Obesity

et al. 2020

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“…In addition, we have considered the fact that bone remodelling process requires approximately 5 months [49]. Dietary counselling on calcium and vitamin D will be provided to the participants in both control and intervention groups due to having an adequate calcium and vitamin D levels is important as both interact with physical activity to enhance bone mass (Item 9) [28,50].…”

Section: Exercise Programme Rationalementioning

confidence: 99%

“…Highintensity, weight bearing physical activity that elicit a variety of strains and include multiple rest periods is known to improve bone mass [22][23][24][25], accrual [26] and maintenance [27] as the skeleton adapts to the loads under which it is placed. Likewise, an adequate calcium and vitamin D intake in combination with physical activity is necessary to obtain beneficial gains in bone health in children and adolescents [28,29]. In this sense, calcium and vitamin D supplementation did not add benefit to nutritional counselling for improving bone outcomes among adolescents and young adults survivors of acute lymphoblastic leukaemia [30].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…According to World Health Organization adolescents should be physically active daily as part of play, games, sports, transportation, recreation, physical education, or planned exercise, in the context of family, school, and community activities. Therefore, it is recommended that adolescents practice 60 minutes of moderate to vigorous PA every day to optimize health benefits [21,22,23].…”

Section: Physical Activitymentioning

confidence: 99%

Physical Activity and Adolescent Health: What Should We Know?

Ciampo

2020

ACRI

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Adolescence is characterized by a period of physical, emotional, social and cultural transformations, significant increase in size and changes in physical appearance. At this stage of life the individual is very susceptible to influences of the environment, nutrition, climate, interpersonal relationships and physical activity, among others. This article presents some of the main physical and emotional characteristics of adolescence and the importance of physical activity, highlighting the benefits for physical and mental health, and proposing actions to increase this practice among adolescents.

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Combined effects of physical activity and calcium on bone health in children and adolescents: a systematic review of randomized controlled trials

Cited by 24 publications

References 31 publications

The Bones of Children With Obesity

The Bones of Children With Obesity

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

Physical Activity and Adolescent Health: What Should We Know?

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