Research articleLevels of Physical Activity That Predict Optimal Bone Mass in Adolescents: The HELENA Study
Introduction
Osteoporosis is a common health problem. In fact, about 2.7 million of European men and women suffer an osteoporotic fracture every year,1 which is associated with high morbidity and mortality rates.2 The economic burden of osteoporosis in Europe is higher than any kind of cancer (except lung cancer) or chronic cardiorespiratory diseases2, 3 and represents a direct annual cost of $48 billion.1 To improve the outcome for osteoporosis sufferers, prevention remains the most important action in public health.
Acquiring a high bone mass during childhood and adolescence is a key determinant of adult skeletal health4 and it may decrease the risk of osteoporotic fractures by 50%.5, 6 Exercise has been associated with bone accretion showing an important osteogenic effect, mainly when high-impact and weight-bearing physical activity occur.7 Muscle mass is also a determinant of bone development.8 Intensive physical activity, for example, participation in sport, is associated with increased development of muscle mass during growth.8, 9 Therefore, exercise may indirectly increase bone mass by increasing lean mass. In terms of bone health, it is not only the amount of physical activity that is important but also the type of physical activity.
Physical Activity Guidelines for children and adolescents recommend (1) that young people should accumulate at least 60 minutes (up to several hours) of moderate-to-vigorous physical activity (MVPA) per day; and (2) at least 3 days per week this should include activities to improve bone health and muscle strength.10 To date, most studies assessed physical activity subjectively (i.e., using questionnaires), even when it has been shown that participants could under- or over-report physical activity in this population group,11, 12 which is an important issue. However, few studies have evaluated the association of objectively assessed physical activity and bone mass in adolescents. One study13 showed a positive association between total hip BMC and the time spent (minutes/day) in vigorous and total physical activity in Swiss boys aged 6–13 years; although another study14 of boys and girls aged 11 years from the United Kingdom showed a positive association between lower limbs' BMD and the time spent (minutes/day) in MVPA.
It is relevant to know whether current physical activity recommendations for adolescents are sufficient for healthy bone mass development, and this has not been studied yet. Therefore, the aim of this report is to analyze the relationships between MVPA and vigorous physical activity (VPA) and bone mass in different regions (whole body, pelvis, lumbar spine, and total hip) and subregions (trochanter, intertrochanter, and femoral neck).
Section snippets
Subjects
The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) project is funded by the European Union and includes a cross-sectional multicenter study (HELENA–CSS) that was performed in adolescents aged 12.5–17.5 years from ten European cities15 in 2006–2007. The general characteristics of the HELENA–CSS have been described in detail elsewhere.16 In this report, the only sample included is from the only city (Zaragoza) where bone mineral content (BMC) and bone mineral density (BMD) were
Results
Table 1 shows descriptive characteristics (M±SD) of the study sample. For boys, active adolescents had a significantly higher calcium intake and calcium intake/lean mass ratio and they spent more minutes on MVPA and VPA than non-active ones (all p<0.05). For girls, active adolescents were significantly taller and spent more minutes on MVPA and VPA, and they had significantly lower body mass and BMI than non-active ones (all p<0.05). Except for lumbar spine BMD in girls (p<0.05; Table 2),
Discussion
The findings of the present study indicate that (1) there are no BMC and BMD differences in most body regions among adolescents regardless of whether they meet the current physical activity recommendations or not, and (2) specific thresholds of physical activity are associated with reduced or increased bone mass groups.
This is the first study analyzing, in adolescents, whether meeting the current physical activity recommendations (60 minutes/day of MVPA) or not has any effect on BMC and BMD at
Conclusion
The recommended levels of physical activity seem to be insufficient stimulus to guarantee increased bone mass. With some minutes/day of VPA, bone adaptations could be obtained at the hip. Specifically, BMD adaptations are obtained with just 32 minutes/day of VPA at the femoral neck, which is of great importance because of its clinical relevance to osteoporosis. It could be of interest if future studies aim to measure not only the amount of physical activity but also the type and, therefore, get
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2019, BoneCitation Excerpt :Regarding the ROC curves analyses, even though VPA reached statistical significance for the classification of bone mass status, the correspondent AUC were low and therefore the accuracy of VPA to stratify the sample according to bone mineral parameters was limited. It has been proposed that VPA and moderate-to-vigorous PA are best fit to identify those individuals with excellent bone health (>2 SD above the mean) rather than those with poor bone mineral status (>1 SD below the mean) [26]. Unfortunately, we were not able to test these results within our sample, since only 5 participants presented BMC values corresponding to the excellent category.
Bone health, activity and sedentariness at age 11–12 years: Cross-sectional Australian population-derived study
2018, BoneCitation Excerpt :Structured exercise programs demonstrate small improvements in bone measures (e.g. 5% greater bone mass) [6], but may not reflect effects of habitual activity. Studies investigating habitual activity consistently show small associations between larger durations (minutes/day) of moderate-vigorous (MVPA) or vigorous (VPA) physical activity and better bone health [7–11], while larger durations of sedentary behaviour show small associations with poorer bone health [12–15]. However, most studies have evaluated bone with dual x-ray absorptiometry (DXA) that measures areal bone density, which does not necessarily reflect true volumetric bone density due to variations in growth and bone size [16].
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2022, Frontiers in Physiology
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