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Impact Exercise for Optimal Bone Health in Growing Children: An Evidence-Based Approach to Exercise Prescription

  • Hawley C. Almstedt
  • Katherine B. Gunter
Chapter

Abstract

The nature of bone to adapt to mechanical loading is well accepted. Bone responds to increased mechanical strain by growing in size, gaining strength, increasing mineral content, and favorably altering bone structure. Physical activity imposes substantial mechanical strain through muscle and gravitational forces. Thus it follows that bone should grow favorably in its mass and structure to accommodate increased loads from physical activity. Data support that children who are physically active have enhanced bone mass and bone structure compared to less active peers. Physical activities shown to have the greatest osteogenic effects in the growing skeleton are those that have a significant “impact factor.” Impact activities are characterized by both the speed of loading and the magnitude of the load applied to bone. Greater forces, delivered quickly, through activities such as jumping appear to convey the greatest benefits to bone mass and size during growth, although resistance training may also elicit favorable development. Exercise interventions utilizing impact exercises report skeletal benefits when children achieve ground reaction forces three to eight times their body weight. Research thus far indicates that at least 7 months of impact exercise is essential to induce a measurable change in bone mass in children. For optimal bone growth, children should perform impact activities 3 days per week for 10–20 min; however, if they are to rely on typical playground activity it seems that 30–40 min of vigorous activities are necessary. Exercise performed during time of growth induces lifelong benefits suggesting there is a “window of opportunity” during pre- or early pubertal years to maximize skeletal growth and reap enduring benefits that will lower risk of fracture and osteoporosis during life as an adult. This chapter will explore the influence of impact exercise during growth on bone mass accrual and structure; present the available data regarding optimal exercise prescription, including timing and dose; and explore the potential for physical activity undertaken during childhood to mediate osteoporosis later in life.

Keywords

Physical Activity Bone Mass Resistance Training Bone Growth Ground Reaction Force 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

BMC

Bone mineral content

BMD

Bone mineral density

cm

Centimeters

CSA

Cross-sectional area

DXA

Dual-energy x-ray absorptiometry

GRF

Ground reaction force

HJRF

Hip joint reaction force

MVPA

Moderate to vigorous physical activity

NIH

National Institutes of Health

PHV

Peak height velocity

1 RM

One-repetition maximum

References

  1. Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA. A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan bone mineral accrual study. J Bone Miner Res. 1999;14:1672–9.PubMedCrossRefGoogle Scholar
  2. Bauer JJ, Fuchs RK, Smith GA, Snow CM. Quantifying force magnitude and loading rate from drop landings that induce osteogenesis. J Appl Biomech. 2001;17:142–52.Google Scholar
  3. Baxter-Jones AD, Mirwald RL, McKay HA, Bailey DA. A longitudinal analysis of sex differences in bone mineral accrual in healthy 8-19-year-old boys and girls. Ann Hum Biol. 2003;30:160–75.PubMedCrossRefGoogle Scholar
  4. Blimkie CJ, Rice S, Webber CE, Martin J, Levy D, Gordon CL. Effects of resistance training on bone mineral content and density in adolescent females. Can J Physiol Pharmacol. 1996;74:1025–33.PubMedCrossRefGoogle Scholar
  5. Courteix D, Lespessailles E, Peres SL, Obert P, Germain P, Benhamou CL. Effect of physical training on bone mineral density in prepubertal girls: a comparative study between impact-loading and non-impact-loading sports. Osteoporos Int. 1998;8:152–8.PubMedCrossRefGoogle Scholar
  6. Engsberg JR, Lee AG, Tedford KG, Harder JA. Normative ground reaction force data for able-bodied and below-knee-amputee children during walking. J Pediatr Orthop. 1993a;13:169–73.PubMedGoogle Scholar
  7. Engsberg JR, Lee AG, Tedford KG, Harder JA. Normative ground reaction force data for able-bodied and trans-tibial amputee children during running. Prosthet Orthot Int. 1993b;17:83–9.PubMedGoogle Scholar
  8. Eser P, Hill B, Ducher G, Bass S. Skeletal benefits after long-term retirement in former elite female gymnasts. J Bone Miner Res. 2009;24:1981–8.PubMedCrossRefGoogle Scholar
  9. Fuchs RK, Bauer JJ, Snow CM. Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res. 2001;16:148–56.PubMedCrossRefGoogle Scholar
  10. Fuchs RK, Cusimano B, Snow CM. Box jumping: a bone-building exercise for elementary school children. J Phys Educ Recreation Dance 2002;73:22–5;36.Google Scholar
  11. Greene DA, Wiebe PN, Naughton GA. Influence of drop-landing exercises on bone geometry and biomechanical properties in prepubertal girls: a randomized controlled study. Calcif Tissue Int. 2009;85:94–103.PubMedCrossRefGoogle Scholar
  12. Gunter K, Baxter-Jones AD, Mirwald RL, Almstedt H, Fuchs RK, Durski S, Snow C. Impact exercise increases BMC during growth: an 8-year longitudinal study. J Bone Miner Res. 2008a;23:986–93.PubMedCrossRefGoogle Scholar
  13. Gunter K, Baxter-Jones AD, Mirwald RL, Almstedt H, Fuller A, Durski S, Snow C. Jump starting skeletal health: a 4-year longitudinal study assessing the effects of jumping on skeletal development in pre and circum pubertal children. Bone. 2008b;42:710–8.PubMedCrossRefGoogle Scholar
  14. Heinonen A, Sievanen H, Kannus P, Oja P, Pasanen M, Vuori I. High-impact exercise and bones of growing girls: a 9-month controlled trial. Osteoporos Int. 2000;11:1010–7.PubMedCrossRefGoogle Scholar
  15. Hind K, Burrows M. Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone. 2007;40:14–27.PubMedCrossRefGoogle Scholar
  16. Janz KF, Burns TL, Levy SM, Torner JC, Willing MC, Beck TJ, Gilmore JM, Marshall TA. Everyday activity predicts bone geometry in children: the iowa bone development study. Med Sci Sports Exerc. 2004;36:1124–31.PubMedCrossRefGoogle Scholar
  17. Janz KF, Gilmore JME, Levy SM, Letuchy EM, Burns TL, Beck TJ. Physical activity and femoral neck bone strength during childhood: the Iowa Bone Development Study. Bone. 2007;41:216–22.PubMedCrossRefGoogle Scholar
  18. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR. American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc. 2004;36:1985–96.PubMedCrossRefGoogle Scholar
  19. MacKelvie KJ, McKay HA, Khan KM, Crocker PR. A school-based exercise intervention augments bone mineral accrual in early pubertal girls. J Pediatr. 2001;139:501–8.PubMedCrossRefGoogle Scholar
  20. MacKelvie KJ, Khan KM, Petit MA, Janssen PA, McKay HA. A school-based exercise intervention elicits substantial bone health benefits: a 2-year randomized controlled trial in girls. Pediatrics. 2003;112:e447.PubMedCrossRefGoogle Scholar
  21. MacKelvie KJ, Petit MA, Khan KM, Beck TJ, McKay HA. Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys. Bone. 2004;34:755–64.PubMedCrossRefGoogle Scholar
  22. McKay HA, MacLean L, Petit M, MacKelvie-O’Brien K, Janssen P, Beck T, Khan KM. “Bounce at the Bell”: a novel program of short bouts of exercise improves proximal femur bone mass in early pubertal children. Br J Sports Med. 2005;39:521–6.PubMedCrossRefGoogle Scholar
  23. McNitt-Gray JL. Kinetics of the lower extremities during drop landings from three heights. J Biomech. 1993;26:1037–46.PubMedCrossRefGoogle Scholar
  24. Morris FL, Naughton GA, Gibbs JL, Carlson JS, Wark JD. Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res. 1997;12:1453–62.PubMedCrossRefGoogle Scholar
  25. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39:1867–82.PubMedCrossRefGoogle Scholar
  26. Nordstrom A, Karlsson C, Nyquist F, Olsson T, Nordstrom P, Karlsson M. Bone loss and fracture risk after reduced physical activity. J Bone Miner Res. 2005;20:202–7.PubMedCrossRefGoogle Scholar
  27. Petit MA, McKay HA, MacKelvie KJ, Heinonen A, Khan KM, Beck TJ. A randomized school-based jumping intervention confers site and maturity-specific benefits on bone structural properties in girls: a hip structural analysis study. J Bone Miner Res. 2002;17:363–72.PubMedCrossRefGoogle Scholar
  28. Pittenger VM, McCaw ST, Thomas DQ. Vertical ground reaction forces of children during one- and two-leg rope jumping. Res Q Exerc Sport. 2002;73:445–9.PubMedGoogle Scholar
  29. Valdimarsson O, Alborg HG, Duppe H, Nyquist F, Karlsson M. Reduced training is associated with increased loss of BMD. J Bone Miner Res. 2005;20:906–12.PubMedCrossRefGoogle Scholar
  30. Warden SJ, Fuchs RK, Castillo AB, Nelson IR, Turner CH. Exercise when young provides lifelong benefits to bone structure and strength. J Bone Miner Res. 2007;22:251–9.PubMedCrossRefGoogle Scholar
  31. Welch JM, Turner CH, Devareddy L, Arjmandi BH, Weaver CM. High impact exercise is more beneficial than dietary calcium for building bone strength in the growing rat skeleton. Bone. 2008;42:660–8.PubMedCrossRefGoogle Scholar
  32. Wiebe PN, Blimkie CJ, Farpour-Lambert N, Briody J, Marsh D, Kemp A, Cowell C, Howman-Giles R. Effects of single-leg drop-landing exercise from different heights on skeletal adaptations in prepubertal girls: a randomized controlled study. Pediatr Exerc Sci. 2008;20:211–28.PubMedGoogle Scholar
  33. Witzke KA, Snow CM. Effects of plyometric jump training on bone mass in adolescent girls. Med Sci Sports Exerc. 2000;32:1051–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Natural ScienceLoyola Marymount UniversityLos AngelesUSA
  2. 2.Department of Nutrition and Exercise Sciences, Extension Family & Community Health ProgramOregon State UniversityCorvallisUSA

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