Tan Vina P S, Macdonald Heather M, Kim SoJung, Nettlefold Lindsay, Gabel Leigh, Ashe Maureen C, McKay Heather A
Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada; School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.
J Bone Miner Res. 2014 Oct;29(10):2161-81. doi: 10.1002/jbmr.2254.
A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic-database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight-bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross-sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies.
系统评价的大量证据支持负重运动对骨质积累的有效性，尤其是在生长阶段。然而，只有一项系统评价（限于随机对照试验）研究了体育活动（PA）对骨强度的作用。因此，我们的系统评价扩大了先前评价的范围，纳入了所有以儿童或青少年骨强度为主要结局的PA干预和观察性研究，包括有组织的体育参与研究。我们还试图识别伴随骨强度显著变化的骨骼要素（如骨量、结构、密度）。我们通过电子数据库、向前和参考文献检索，得到了14项干预性研究和23项观察性研究，这些研究符合我们的纳入标准。我们使用有效公共卫生实践项目（EPHPP）工具评估研究质量。由于研究之间存在异质性，我们采用叙述性综合分析，发现骨强度对PA的适应性与成熟度、性别和研究质量有关。五项负重PA干预研究中有三项评级为强，报告干预组的骨强度显著增加（3%至4%），而九项中等干预研究中只有三项有显著增加。最常伴随显著骨强度结果的是骨结构变化（如骨横截面积、皮质厚度，单独或联合）而非骨量。青春期前和青春期可能是男孩和女孩通过PA增强骨强度的最佳时机，尽管这一发现因更成熟组的现有研究较少而受到影响。尽管肌肉在骨骼对负荷的反应中起核心作用，但很少有研究识别出肌肉功能（或替代指标）对骨强度的具体贡献。尽管这不是当前评价的重点，但这似乎是未来研究的一个重要考虑因素。
