Hind K, Burrows M
University of Leeds, Centre for Bone and Body Composition Research, Ground Floor, Wellcome Wing, The General Infirmary, Leeds, LS1 3EX, UK.
Bone. 2007 Jan;40(1):14-27. doi: 10.1016/j.bone.2006.07.006. Epub 2006 Sep 7.
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.
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.
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).
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.
骨质疏松症是一种严重的骨骼疾病，由于目前尚无治愈方法，因此非常强调对其进行预防，包括优化峰值骨量。越来越多的证据表明，定期进行负重运动是在生长过程中增强骨骼状态的有效策略。本系统评价评估了迄今为止关于运动对儿童和青少年骨矿物质积累影响的随机和非随机对照试验。
通过在线检索Medline和Cochrane数据库来识别研究。符合纳入标准的研究被纳入评价，并根据偏倚风险进行分级。
共审查了22项试验。9项在青春期前儿童（坦纳I期）中进行，8项在青春期早期（坦纳II - III期）中进行，5项在青春期（坦纳IV - V期）中进行。每组样本量从n = 10到65不等。运动干预包括游戏、舞蹈、阻力训练和跳跃运动，持续时间从3个月到48个月不等。大约一半的试验（n = 10）包括地面反作用力（GRF）数据（体重的2至9倍）。所有青春期早期儿童试验、6项青春期前儿童试验和2项青春期儿童试验均报告运动对骨骼有积极影响（P < 0.05）。与对照组相比，青春期前运动者6个月内骨参数的平均增加幅度为0.9 - 4.9%，青春期早期为1.1 - 5.5%，青春期为0.
