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Exercise to Improve Pediatric Bone and Fat: A Systematic Review and Meta-analysis


Medicine & Science in Sports & Exercise: March 2014 - Volume 46 - Issue 3 - p 610–621
doi: 10.1249/MSS.0b013e3182a6ab0d
Applied Sciences

Purpose: This study aimed to determine the effects of school-based, bone-focused exercise interventions on bone, fat, and lean mass in children by systematically reviewing and meta-analyzing the literature.

Methods: Potentially relevant articles were identified by searching electronic databases. Abstracts were included if they described the effects of an in-school exercise intervention for children 5–17 yr old compared with controls and presented baseline and follow-up results for bone, fat, and lean measures. Identified studies were systematically reviewed for methodological quality. Meta-analyses were performed for whole body, lumbar spine, and femoral neck bone mineral content (BMC), fat, and lean mass.

Results: Sixteen eligible trials were identified including eight randomized controlled trials, three clinical controlled trials, and five nonrandomized, nonmatched studies. The quality analysis revealed two studies had low, nine had medium, and five had a high risk of bias. Meta-analyses revealed a small positive effect of bone-targeted exercise on whole body BMC (standardized mean difference [SMD] = 0.483, 95% CI = 0.132–0.833), femoral neck BMC (SMD = 0.292, 95% CI = −0.022 to 0.607), lumbar spine BMC (SMD = 0.384, 95% CI = 0.193–0.575), fat mass (SMD = −0.248, 95% CI = −0.406 to −0.089), and lean mass (SMD = 0.159, 95% CI = −0.076 to 0.394).

Conclusions: Beneficial effects of school-based, bone-targeted exercise were observed for bone and fat, but not for lean mass. Excluding trials with high risk of bias strengthened that effect. Considerable study heterogeneity may have obscured effects on lean mass. The effects observed for bone and fat support the pursuit of brief, jumping-focused interventions to reduce fat as well as enhance musculoskeletal tissue in school age children.

1Centre for Musculoskeletal Research, Griffith Health Institute, Gold Coast, Queensland, AUSTRALIA; 2School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, AUSTRALIA

Address for correspondence: Belinda Beck, Ph.D., F.A.C.S.M., School of Allied Health Sciences, Griffith University Gold Coast campus, QLD 4222, Australia; E-mail:

Submitted for publication April 2013.

Accepted for publication July 2014.

© 2014 American College of Sports Medicine