Combined effects of interaction between physical activity and nutrition on bone health in children and adolescents: a systematic review

Abstract

Context: Osteoporosis is a major public health concern worldwide. Understanding the roles of diet and physical activity in ensuring adequate bone mass accrual during childhood and adolescence may help identify strategies to reduce the risk of osteoporotic fractures later in life.

Objective: The present systematic review was conducted to provide an overview of the current knowledge of the combined effects of physical activity and diet on bone mass accrual in children and adolescents.

Data sources: Data were obtained via searches of the PubMed, EMBASE, SPORTDiscus, and ISI Web of Science databases.

Study selection: Studies published in English and Spanish between 1887 and August 2013 were eligible for inclusion. Two investigators evaluated the studies against the inclusion and exclusion criteria. A total of 14 studies (7 cross-sectional and 7 experimental) were included in the review.

Data extraction: The Pedro score and the Black and Down's checklist were used to evaluate the methodological quality of the experimental and the cross-sectional studies, respectively. Study characteristics were summarized in accordance with the review's PICO criteria.

Data synthesis: Significant exercise-by-calcium interaction was detected at several different bone sites.

Conclusions: Although the results of cross-sectional studies were inconsistent, the results of randomized controlled trials showed that exercise has the potential to improve bone health under conditions of adequate calcium intake.

Keywords: adolescents; bone mass; calcium intake; children; diet; exercise; growth; weight-bearing exercise.