Academic journal article Iranian Journal of Public Health

Influence of Adolescents' Physical Activity on Bone Mineral Acquisition: A Systematic Review Article

Academic journal article Iranian Journal of Public Health

Influence of Adolescents' Physical Activity on Bone Mineral Acquisition: A Systematic Review Article

Article excerpt


Osteoporosis is a progressive systemic skeletal disease marked by low bone mass and microarchitectural deterioration of bone tissue resulting in bone fragility with increased susceptibility to fracture (1, 2). Osteoporosis incidence increases significantly with advancing age (3) and is usually silent without any signs and symptoms of decreasing bone density. Bone fracture often occurs as the first presentation of osteoporosis (4). Significant morbidity, cost and reduced quality of life have been attributed to osteoporosis (5). Preventive strategies are a crucial first step to overcoming this global problem. Prevention of osteoporosis undertake by maximizing bone tissue accretion during growing yr, maintaining bone tissue acquisition during adulthood and reducing bone loss in elderly (6, 7).

During adolescence, peak bone mineral accrual occurs and continues to accumulate until PBM is achieved. PBM is the maximum accretion of bone mass and strength deposited in one's life at the end of the growth period (8). The time frame differs, either during the first two decades (9), early third decade (10), or late third decade (7) of life or even as early as 16 yr old (11). After PBM was achieved, bone is lost at a rate of about 0.5%-1.0% per yr at most skeletal site (12). PBM together with subsequent bone loss are important determinants associated with risks of osteoporosis (13, 7).

Interestingly, adolescence offers a window of opportunity within the critical two-yr surrounding the age of peak bone mineral accrual (7). About 26% of adult peak total body bones mineral were accrued during this key time (14-16). Thus, adolescent years could be the final opportunity to maximize PBM. High PBM is an important determinant in preventing osteoporosis and risk of osteoporotic fracture (7, 17- 20).

Early detection and prevention to improve bone health will only be possible by identification of modifiable lifestyle factors that may augment bone mineral accrual. During this critical window, early detection could identify adolescents 'at-risk of low bone mass' followed by modifying lifestyle factors through lifestyle modification such as exercise.

Several modifiable lifestyle factors may contribute to adolescent bone health. These include Physical activity (PA), medications, body weight, healthy nutrition and other lifestyle factors such as smoking that can deteriorate bone health (10, 21). Exercise during the early stage of life plays an important role for the prevention of osteoporosis (22).

Exercise is often used interchangeably with PA because both share some common elements. Exercise is a sub-category of PA planned, structured, repetitive and purposive with an intention to improve or maintain physical fitness (23). On the other hand, PA is a parental term that covers all activities. By definition, PA is described as any bodily movement produced by skeletal muscles that require energy expenditure beyond resting expenditure. (23). There are four area of PA includes frequency, intensity (dose), time (duration), and type (load) or also known as (FITT). PA may involve some form of loading (weightbearing) or free of loading (non-weight-bearing). Weight-bearing (WB) is defined as movement or type of exercise forces the body (muscle and bones) to work against the force of gravity while carrying body weight such as walking, jogging or dancing (24).

Results from the high-quality reviews of controlled trials during the growing years had provided us with a better understanding on bone adaptation to weight bearing. However, interventional studies do not represent general population activities. Observational studies allow for comparison between different kinds of the same exposure to evaluate in the same population. Therefore, the purpose of this review was to examine relevant observational studies and to provide a systematic literature review over the influence of adolescents' PA in optimizing's bone health. …

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