Skip to main content

Advertisement

SpringerLink
Log in

Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis

  • Review Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship are needed. This systematic review and meta-analysis investigated the effect of obesity on bone health and assessed the effect of structured intervention in children and adolescents with obesity. Medline complete, OVID, CINAHL, EMBASE and PubMed databases were searched for studies on obesity and bone health variables up to September 2016, then an update occurred in March 2016. Search items included obesity, childhood, dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Twenty-three studies (14 cross-sectional and nine longitudinal) matched the inclusion criteria. Results from the meta-analysis (cross-sectional studies) confirmed that children and adolescents with obesity have higher bone content and density than their normal weight peers. Results from longitudinal studies remain inconclusive as only 50% of the included studies reported a positive effect of a structured intervention program on bone health. As such, the meta-analysis reported that structured intervention did not influence bone markers despite having beneficial effects on general health in youth with obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bonnick SL (2010) Skeletal anatomy in densitometry. Bone densitometry in clinical practice. Springer, New York, 35–78

    Chapter  Google Scholar 

  2. Caffarelli C, Alessi C, Nuti R, Gonnelli S (2014) Divergent effects of obesity on fragility fractures. Clin Interv Aging 9:1629–1636

    PubMed  PubMed Central  Google Scholar 

  3. Campos R, de Mello MT, Tock L, da Silva PL, Corgosinho FC, Carnier J, de Piano A, Sanches PL, Masquio DC, Tuik S, Damaso AR (2013) Interaction of bone mineral density, adipokines and hormones in obese adolescents girls submitted in an interdisciplinary therapy. J Pediatr Endocrinol Metab 26:663–668

    Article  CAS  PubMed  Google Scholar 

  4. Campos RM, de Mello MT, Tock L, Silva PL, Masquio DC, de Piano A, Sanches PL, Carnier J, Corgosinho FC, Foschini D, Tufik S, Damaso AR (2014) Aerobic plus resistance training improves bone metabolism and inflammation in adolescents who are obese. J Strength Cond Res 28:758–766

    Article  PubMed  Google Scholar 

  5. Campos RM, de Piano A, da Silva PL, Carnier J, Sanches PL, Corgosinho FC, Masquio DC, Lazaretti-Castro M, Oyama LM, Nascimento CM (2012) The role of pro/anti-inflammatory adipokines on bone metabolism in NAFLD obese adolescents: effects of long-term interdisciplinary therapy. Endocrine 42:146–156

    Article  CAS  PubMed  Google Scholar 

  6. Chaplais E, Thivel D, Greene D, Dutheil F, Duche P, Naughton G, Courteix D (2015) Bone-adiposity cross-talk: implications for pediatric obesity: a narrative review of literature. J Bone Miner Metab 6:592–602

    Article  Google Scholar 

  7. Cohen J (1992) A power primer. Psychol Bull 112:155

    Article  CAS  PubMed  Google Scholar 

  8. Conger SA, Warren GL, Hardy MA, Millard-Stafford ML (2011) Does caffeine added to carbohydrate provide additional ergogenic benefit for endurance? Int J Sport Nutr Exerc Metab 21:71–84

    Article  CAS  PubMed  Google Scholar 

  9. Crabtree NJ, Arabi A, Bachrach LK, Fewtrell M, Fuleihan GE-H, Kecskemethy HH, Jaworski M, Gordon CM (2014) Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD pediatric official positions. J Clin Densitom 17:225–242

    Article  PubMed  Google Scholar 

  10. de Morton NA (2009) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother 55:129–133

    Article  PubMed  Google Scholar 

  11. Dimitri P, Bishop N, Walsh JS, Eastell R (2012) Obesity is a risk factor for fracture in children but is protective against fracture in adults: a paradox. Bone 50:457–466

    Article  CAS  PubMed  Google Scholar 

  12. Dimitri P, Jacques R, Paggiosi M, King D, Walsh J, Taylor Z, Frangi A, Bishop N, Eastell R (2015) Leptin may play a role in bone microstructural alterations in obese children. J Clin Endocrinol Metab 100:594–602

    Article  CAS  PubMed  Google Scholar 

  13. Dimitri P, Wales JK, Bishop N (2010) Fat and bone in children: differential effects of obesity on bone size and mass according to fracture history. J Bone Miner Res 25:527–536

    Article  PubMed  Google Scholar 

  14. Duval S, Tweedie R (2000) A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. J Am Stat Assoc 95:89–98

    Google Scholar 

  15. El-Hage R, Jacob C, Moussa E, Youssef H, Jaffré C (2009) Effects of 12 weeks of endurance training on bone mineral content and bone mineral density in obese, overweight and normal weight adolescent girls. Sci Sports 24:210–213

    Article  Google Scholar 

  16. El Hage Z, Theunynck D, Jacob C, Moussa E, Baddoura R, Zunquin G, El Hage R (2012) Bone mineral content and density in obese, overweight and normal weight adolescent boys. Leban Med J 61:148–154

    Article  Google Scholar 

  17. Ellis K, Shypailo R, Wong W, Abrams S (2003) Bone mineral mass in overweight and obese children: diminished or enhanced? Acta Diabetol 40:s274–s277

    Article  PubMed  Google Scholar 

  18. Fintini D, Brufani C, Grossi A, Ubertini G, Fiori R, Pecorelli L, Calzolari A, Cappa M (2011) Gender differences in bone mineral density in obese children during pubertal development. J Endocrinol Invest 34:e86–e91

    Article  CAS  PubMed  Google Scholar 

  19. Foley S, Quinn S, Jones G (2009) Tracking of bone mass from childhood to adolescence and factors that predict deviation from tracking. Bone 44:752–757

    Article  PubMed  Google Scholar 

  20. Gilsanz V, Chalfant J, Kalkwarf H, Zemel B, Lappe J, Oberfield S, Shepherd J, Wren T, Winer K (2011) Age at onset of puberty predicts bone mass in young adulthood. J Pediat 158:100–105

    Article  PubMed  Google Scholar 

  21. Goulding A, Grant AM, Williams SM (2005) Bone and body composition of children and adolescents with repeated forearm fractures. J Bone Miner Res 20:2090–2096

    Article  PubMed  Google Scholar 

  22. Goulding A, Taylor R, Jones I, Manning P, Williams S (2002) Spinal overload: a concern for obese children and adolescents? Osteoporos Int 13:835–840

    Article  CAS  PubMed  Google Scholar 

  23. Goulding A, Taylor R, Jones I, McAuley K, Manning P, Williams S (2000) Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord J Int Assoc Study Obes 24:627–632

    Article  CAS  Google Scholar 

  24. Goulding A, Taylor RW, Grant AM, Murdoch L, Williams SM, Taylor BJ (2008) Relationship of total body fat mass to bone area in New Zealand five-year-olds. Calcif Tissue Int 82:293–299

    Article  CAS  PubMed  Google Scholar 

  25. Haroun D, Wells J, Williams J, Fuller N, Fewtrell M, Lawson M (2005) Fat-free mass composition in obese and non-obese children: matched case-control analyses. Proceedings of Nutrition Society

  26. Hasanoǧlu A, Bideci A, Cinaz P, Tümer L, Ünal S (2000) Bone mineral density in childhood obesity. J Pediatr Endocrinol Metab 13:307–312

    PubMed  Google Scholar 

  27. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. Bmj. 327:557–560

    PubMed  Google Scholar 

  28. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I 2 index? Psychol Methods 11:193

    Article  PubMed  Google Scholar 

  29. Ivuskans A, Lätt E, Mäestu J, Saar M, Purge P, Maasalu K, Jürimäe T, Jürimäe J (2013) Bone mineral density in 11–13-year-old boys: relative importance of the weight status and body composition factors. Rheumatol Int 33:1681–1687

    Article  PubMed  Google Scholar 

  30. Ivuškāns A, Mäestu J, Jürimäe T, Lätt E, Purge P, Saar M, Maasalu K, Jürimäe J (2015) Sedentary time has a negative influence on bone mineral parameters in peripubertal boys: a 1-year prospective study. J Bone Miner Metab 33:85–92

    Article  PubMed  Google Scholar 

  31. Jeddi M, Dabbaghmanesh MH, Omrani GR, Ayatollahi SMT, Bagheri Z, Bakhshayeshkaram M (2015) Relative importance of lean and fat mass on bone mineral density in Iranian children and adolescents. Int J Endocrinol Metab 13:e25542

    Article  PubMed  PubMed Central  Google Scholar 

  32. Katzman DK, Bachrach LK, Carter DR, Marcus R (1991) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls*. J Clin Endocrinol Metab 73:1332–1339

    Article  CAS  PubMed  Google Scholar 

  33. Kröger H, Vainio P, Nieminen J, Kotaniemi A (1995) Comparison of different models for interpreting bone mineral density measurements using DXA and MRI technology. Bone 17:157–159

    Article  PubMed  Google Scholar 

  34. Lau PW, Kong Z, Choi C-R, Clare C, Chan DF, Sung RY, Leung BW (2010) Effects of short-term resistance training on serum leptin levels in obese adolescents. J Exerc Sci Fit 8:54–60

    Article  Google Scholar 

  35. Lee NK, Sowa H, Hinoi E, Ferron M, Ahn JD, Confavreux C, Dacquin R, Mee PJ, McKee MD, Jung DY (2007) Endocrine regulation of energy metabolism by the skeleton. Cell 130:456–469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Leonard MB, Zemel BS, Wrotniak BH, Klieger SB, Shults J, Stallings VA, Stettler N (2015) Tibia and radius bone geometry and volumetric density in obese compared to non-obese adolescents. Bone 73:69–76

    Article  PubMed  Google Scholar 

  37. Maggio ABR, Aggoun Y, Martin XE, Marchand LM, Beghetti M, Farpour-Lambert NJ (2011) Long-term follow-up of cardiovascular risk factors after exercise training in obese children. Int J Pediat Obes IJPO 6:e603–e610

    Article  Google Scholar 

  38. Martin A, Saunders H, David D, Susan S, Sproule J (2014) Lifestyle intervention for improving school achievement in overweight or obese children and adolescents. Cochrane Database Syst Rev. doi:10.1002/14651858.CD009728.pub2

    PubMed Central  Google Scholar 

  39. McGuigan MR, Tatasciore M, Newton RU, Pettigrew S (2009) Eight weeks of resistance training can significantly alter body composition in children who are overweight or obese. J Strength Cond Res 23:80–85

    Article  PubMed  Google Scholar 

  40. Mead E, Atkinson G, Richter B, Metzendorf MI, Baur L, Finer N, Corpeleijn E, O’Malley C, Ells LJ (2016) Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 11:CD012436

  41. Nagasaki K, Kikuchi T, Hiura M, Uchiyama M (2004) Obese Japanese children have low bone mineral density after puberty. J Bone Miner Metab 22:376–381

    Article  PubMed  Google Scholar 

  42. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, et al. (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781

    Article  PubMed  PubMed Central  Google Scholar 

  43. Nishiyama KK, Macdonald HM, Moore SA, Fung T, Boyd SK, McKay HA (2012) Cortical porosity is higher in boys compared with girls at the distal radius and distal tibia during pubertal growth: an HR-pQCT study. J Bone Miner Res 27:273–282

    Article  PubMed  Google Scholar 

  44. Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, Summerbell CD (2009) Interventions for treating obesity in children. Cochrane Database Syst Rev. doi:10.1002/14651858.CD001872.pub2

    PubMed  Google Scholar 

  45. Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E (2003) Interventions for treating obesity in children. Cochrane Database Syst Rev 3(3):CD001872

    Google Scholar 

  46. Rauch F (2012) The dynamics of bone structure development during pubertal growth. J Musculoskelet Neuronal Interact 12:1–6

    CAS  PubMed  Google Scholar 

  47. Reinehr T (2011) Effectiveness of lifestyle intervention in overweight children. Proc Nutr Soc 70:494–505

    Article  PubMed  Google Scholar 

  48. Ripka WL, Modesto JD, Ulbricht L, Gewehr PM (2016) Obesity impact evaluated from fat percentage in bone mineral density of male adolescents. PLoS One 11:e0163470

    Article  PubMed  PubMed Central  Google Scholar 

  49. Rochefort GY, Rocher E, Aveline PC, Garnero P, Bab I, Chappard C, Jaffré C, Benhamou CL (2011) Osteocalcin–insulin relationship in obese children: a role for the skeleton in energy metabolism. Clin Endocrinol 75:265–270

    Article  CAS  Google Scholar 

  50. Rocher E, Chappard C, Jaffre C, Benhamou C-L, Courteix D (2008) Bone mineral density in prepubertal obese and control children: relation to body weight, lean mass, and fat mass. J Bone Miner Metab 26:73–78

    Article  PubMed  Google Scholar 

  51. Rocher E, El Hage R, Chappard C, Portier H, Rochefort GY, Benhamou C-L (2013) Bone mineral density, hip bone geometry, and calcaneus trabecular bone texture in obese and normal-weight children. J Clin Densitom 16:244–249

    Article  PubMed  Google Scholar 

  52. Russell M, Mendes N, Miller KK, Rosen CJ, Lee H, Klibanski A, Misra M (2010) Visceral fat is a negative predictor of bone density measures in obese adolescent girls. J Clin Endocrinol Metab 95:1247–1255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Shapses SA, Sukumar D (2012) Bone metabolism in obesity and weight loss. Annu Rev Nutr 32:287–309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Sioen I, Lust E, De Henauw S, Moreno L, Jiménez-Pavón D (2016) Associations between body composition and bone health in children and adolescents: a systematic review. Calcif Tissue Int 99:557–577

    Article  CAS  PubMed  Google Scholar 

  55. Specker BL, Schoenau E (2005) Quantitative bone analysis in children: current methods and recommendations. J Pediatr 146:726–731

    Article  PubMed  Google Scholar 

  56. Stettler N, Berkowtiz RI, Cronquist JL, Shults J, Wadden TA, Zemel BS, Leonard MB (2008) Observational study of bone accretion during successful weight loss in obese adolescents. Obesity (Silver Spring) 16:96–101

    Article  Google Scholar 

  57. Tan VP, Macdonald HM, Kim S, Nettlefold L, Gabel L, Ashe MC, McKay HA (2014) Influence of physical activity on bone strength in children and adolescents: a systematic review and narrative synthesis. J Bone Miner Res 29:2161–2181

    Article  PubMed  Google Scholar 

  58. Tsang TW, Kohn M, Chow CM, Singh MF (2009) A randomised placebo-exercise controlled trial of Kung Fu training for improvements in body composition in overweight/obese adolescents: the “Martial Fitness” study. J Sports Sci Med 8:97–106

    PubMed  PubMed Central  Google Scholar 

  59. Van Leeuwen J, Koes B, Paulis W, Van Middelkoop M (2017) Diferences in bone mineral density between normal-weight children and children with overweight and obesity: a systematic review and meta-analysis. Obes Rev 18:526–546

    Article  PubMed  Google Scholar 

  60. Verheggen RJ, Maessen MF, Green DJ, Hermus AR, Hopman MT, Thijssen DH (2016) A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev 17:664–690

    Article  CAS  PubMed  Google Scholar 

  61. Wang Q, Wang XF, Iuliano-Burns S, Ghasem-Zadeh A, Zebaze R, Seeman E (2010) Rapid growth produces transient cortical weakness: a risk factor for metaphyseal fractures during puberty. J Bone Miner Res 25:1521–1526

    Article  PubMed  Google Scholar 

  62. Wang Y (2002) Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics 110:903–910

    Article  PubMed  Google Scholar 

  63. Ward KA, Mughal Z, Adams JE (2007) Tools for measuring bone in children and adolescents. Bone densitometry in growing patients. Springer, New York, 15–40

    Chapter  Google Scholar 

  64. Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL (2003) Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial. JAMA 289:1805–1812

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Authors would like to acknowledge Kathryn Duncan from the Australian Catholic University for her expert guidance with the literature search strategy.

Author information

Authors and Affiliations

  1. Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), EA 3533, Blaise Pascal University, 5 Impasse Amelie Murat, TS60026 cs 60026, Aubière Cedex, 63178, Clermont-Ferrand, France

    Elodie Chaplais, Frederic Dutheil, David Thivel & Daniel Courteix

  2. School of Exercise Science, Australian Catholic University, Strathfield Campus, Locked Bag 2002, Strathfield, NSW, 2135, Australia

    Elodie Chaplais, Geraldine Naughton, David Greene, Frederic Dutheil & Daniel Courteix

  3. CRNH-Auvergne, Clermont-Ferrand, France

    Frederic Dutheil, David Thivel & Daniel Courteix

  4. Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France

    Frederic Dutheil

  5. Biostatistics Unit (DRCI), University Hospital CHU G. Montpied, 63000, Clermont-Ferrand, France

    Bruno Pereira

  6. School of Exercise Science, Australian Catholic University, Melbourne Campus, Locked Bag 4115, Fitzroy MDC, Fitzroy, VIC, 3065, Australia

    Elodie Chaplais, Geraldine Naughton, David Greene, Frederic Dutheil & Daniel Courteix

  7. Clermont University, Clermont-Ferrand, France

    Elodie Chaplais, Frederic Dutheil, David Thivel & Daniel Courteix

Authors
  1. Elodie Chaplais
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geraldine Naughton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Greene
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frederic Dutheil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bruno Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David Thivel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Courteix
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elodie Chaplais.

Ethics declarations

Conflict of interest

None of the authors has any conflicts of interest to declare.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaplais, E., Naughton, G., Greene, D. et al. Effects of interventions with a physical activity component on bone health in obese children and adolescents: a systematic review and meta-analysis. J Bone Miner Metab 36, 12–30 (2018). https://doi.org/10.1007/s00774-017-0858-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-017-0858-z

Keywords

Search

Navigation