Christine M. Snow

Jumping Improves Hip and Lumbar Spine Bone Mass in Prepubescent Children: A Randomized Controlled Trial

Physical activity during childhood is advocated as one strategy for enhancing peak bone mass (bone mineral content [BMC]) as a means to reduce osteoporosis‐related fractures. Thus, we investigated the effects of high‐intensity jumping on hip and lumbar spine bone mass in children. Eighty‐nine prepubescent children between the ages of 5.9 and 9.8 years were randomized into a jumping (n = 25 boys and n = 20 girls) or control group (n = 26 boys and n = 18 girls). Both groups participated in the 7‐month exercise intervention during the school day three times per week. The jumping group performed 100, two‐footed jumps off 61‐cm boxes each session, while the control group performed nonimpact stretching exercises. BMC (g), bone area (BA; cm2), and bone mineral density (BMD; g/cm2) of the left proximal femoral neck and lumbar spine (L1‐L4) were assessed by dual‐energy X‐ray absorptiometry (DXA; Hologic QDR/4500‐A). Peak ground reaction forces were calculated across 100, two‐footed jumps from a 61‐cm box. In addition, anthropometric characteristics (height, weight, and body fat), physical activity, and dietary calcium intake were assessed. At baseline there were no differences between groups for anthropometric characteristics, dietary calcium intake, or bone variables. After 7 months, jumpers and controls had similar increases in height, weight, and body fat. Using repeated measures analysis of covariance (ANCOVA; covariates, initial age and bone values, and changes in height and weight) for BMC, the primary outcome variable, jumpers had significantly greater 7‐month changes at the femoral neck and lumbar spine than controls (4.5% and 3.1%, respectively). In repeated measures ANCOVA of secondary outcomes (BMD and BA), BMD at the lumbar spine was significantly greater in jumpers than in controls (2.0%) and approached statistical significance at the femoral neck (1.4%; p = 0.085). For BA, jumpers had significantly greater increases at the femoral neck area than controls (2.9%) but were not different at the spine. Our data indicate that jumping at ground reaction forces of eight times body weight is a safe, effective, and simple method of improving bone mass at the hip and spine in children. This program could be easily incorporated into physical education classes.

High-impact exercise promotes bone gain in well-trained female athletes

Maximizing peak bone mass, as well as reducing its loss after menopause, is important for the prevention of osteoporosis. One mode of activity, gymnastics training, invokes high impact loading strains on the skeleton which may have powerful osteogenic effects. To examine the role of athletic activity, specifically gymnastics, on bone mineral density (BMD) accretion, we monitored longitudinal changes in regional and whole body BMD in collegiate women gymnasts and competitive athletes whose skeletons are exposed to differential loading patterns: runners and swimmers. Two cohorts were studied. Cohort I = 26 gymnasts (19.7 ± 1.2 years), 36 runners (21.1 ± 2.7 years) and 14 nonathletic women (19.3 ± 1.7 years) followed over an 8‐month period. Cohort II = 8 gymnasts (18.9 ± 1.1 years), 11 swimmers (20.0 ± 2.3 years) and 11 nonathletic women (19.0 ± 1.2 years) followed over a 12‐month period. Lumbar spine (L2–4), femoral neck, and whole body BMD (g/cm2) were assessed by dual‐energy X‐ray absorptiometry. For cohort I, the percent change in lumbar spine BMD after 8 months was significantly greater (p = 0.0001) in the gymnasts (2.8 ± 2.4%) than in the runners (−0.2 ± 2.0%) or controls (0.7 ± 1.3%). An increase in femoral neck BMD of 1.6 ± 3.6% in gymnasts was also greater (p < 0.05) than runners (−1.2 ± 3.0%) and approached significance compared with controls (−0.9 ± 2.2%, p = 0.06). For cohort II, gymnasts gained 2.3 ± 1.6% at the lumbar spine which differed significantly (p < 0.01) from changes in swimmers (−0.3 ± 1.5%) and controls (−0.4 ± 1.7%). Similarly, the change at the femoral neck was greater (p < 0.001) in gymnasts (5.0 ± 3.4%) than swimmers (−0.6 ± 2.8%) or controls (2.0 ± 2.3%). The percent change in BMD at any site did not differ between eumenorrheic and irregularly menstruating athletes. These results indicate that bone mineral at clinically relevant sites, the lumbar spine and femoral neck, can respond dramatically to mechanical loading characteristic of gymnastics training in college‐aged women. This occurred despite high initial BMD values and was independent of reproductive hormone status. The results provide evidence to support the view that high impact loading, rather than selection bias, underlies high BMD values characteristic of women gymnasts. Because all athletes underwent resistance training throughout the year of study, muscle strengthening activity did not appear to be a significant factor in the skeletal response observed in gymnasts. We conclude that activities resulting in high skeletal impacts may be particularly osteotropic for young women.

Effects of plyometric jump training on bone mass in adolescent girls.

PURPOSE The purpose of this study was to investigate the effects of 9 months of plyometric jump training on bone mineral content (BMC), lower extremity performance, and static balance in adolescent girls (aged 14.6 +/- 0.5 yr; 22.7 +/- 14.0 months past menarche). METHODS Exercisers (N = 25) trained 30-45 min, three times per week, performing various exercises using weighted vests (squats, lunges, calf raises) and plyometrics (hopping, jumping, bounding, and box depth jumps). The program was designed to load the lower extremities. Controls (N = 28), matched to exercisers for age and months past menarche, maintained their usual activities. The following were assessed at baseline and 9 months: BMC, strength by isokinetic dynamometry, power (Wingate), and static balance. RESULTS Repeated measures ANOVA revealed no significant differences between groups for BMC, nor were the changes in anthropometric or performance variables, analyzed by MANOVA, significant. In follow-up analyses, t-tests for independent samples revealed that both groups experienced a significant (P < 0.01) increase in percent change in bone mass compared to zero, for the whole body (mean: 3.7% exercisers, 3.6% controls), femoral neck (4.5% vs 2.4%), lumbar spine (L2-4) (6.6% vs 5.3%), and femoral shaft (3.4% vs 2.3%), but only the exercisers improved BMC of the greater trochanter (3.1% vs 1.9%). Furthermore, the exercise group significantly improved knee extensor strength (14.7% vs 7.3%) and medial/lateral balance (38.1% vs 9.5%), whereas the control group demonstrated no changes. The variety of lateral movement activities performed by the exercise group may have contributed to the differences observed between groups for greater trochanter bone mineral density (BMD), leg strength, and medial/lateral balance. CONCLUSION The trends observed in bone mass between groups suggest that plyometric jump training continued over a longer period of time during adolescent growth may increase peak bone mass.

Impact Exercise Increases BMC During Growth: An 8‐Year Longitudinal Study

Our aim was to assess BMC of the hip over 8 yr in prepubertal children who participated in a 7‐mo jumping intervention compared with controls who participated in a stretching program of equal duration. We hypothesized that jumpers would gain more BMC than control subjects. The data reported come from two cohorts of children who participated in separate, but identical, randomized, controlled, school‐based impact exercise interventions and reflect those subjects who agreed to long‐term follow‐up (N = 57; jumpers = 33, controls = 24; 47% of the original participants). BMC was assessed by DXA at baseline, 7 and 19 mo after intervention, and annually thereafter for 5 yr (eight visits over 8 yr). Multilevel random effects models were constructed and used to predict change in BMC from baseline at each measurement occasion. After 7 mo, those children that completed high‐impact jumping exercises had 3.6% more BMC at the hip than control subjects whom completed nonimpact stretching activities (p < 0.05) and 1.4% more BMC at the hip after nearly 8 yr (BMC adjusted for change in age, height, weight, and physical activity; p < 0.05). This provides the first evidence of a sustained effect on total hip BMC from short‐term high‐impact exercise undertaken in early childhood. If the benefits are sustained into young adulthood, effectively increasing peak bone mass, fracture risk in the later years could be reduced.

Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women

We studied the effects of a 6‐month withdrawal of exercise after 12 months of progressive impact (jump) plus lower body resistance training on risk factors for hip fracture in premenopausal women (age, 30‐45 years). Twenty‐nine women completed the 12‐month training and detraining programs and were compared with 22 matched controls. Bone mineral density (BMD) at the greater trochanter, femoral neck, lumbar spine, and whole body and body composition (% body fat) were measured by dual energy X‐ray absorptiometry (DXA; Hologic QDR‐1000/W). Knee extensor and hip abductor strength were assessed via isokinetic dynamometry (Kin‐Com 500H); maximum leg power was tested using a Wingate Anaerobic Power test; and dynamic postural stability was measured on a stabilimeter (Biodex). All measurements were conducted at baseline, 12 months and 18 months with an additional midtraining measurement of BMD. Exercisers trained three times per week in a program of 100 jumps and 100 repetitions of resistance exercises at each session. Intensity was increased using weighted vests to final values of 10% and 13% of body weight (BW) for jump and resistance exercises, respectively. Differences between groups from training were analyzed by repeated measures analysis of covariance (ANCOVA), adjusted for baseline values. Detraining effects were analyzed by comparing the changes from training with the changes from detraining using repeated measures analysis of variance (ANOVA). Baseline values were not significantly different between exercisers and controls. Percent change over the training period was significantly greater in the exercise group than in the control group at the greater trochanter (2.7 ± 2.5% vs. 0.8 ± 0.8%, respectively; p < 0.01) and approached significance at the femoral neck (1.2 ± 3.2% vs. −0.3 ± 1.9%, respectively; p = 0.06). Significant improvements also were observed in exercisers versus controls for strength and power with exercisers increasing 13‐15% above controls, whereas stability was not different between groups. After 6 months of detraining, BMD and muscle strength and power decreased significantly toward baseline values, whereas control values did not change. We conclude that the positive benefits of impact plus resistance training on the musculoskeletal system in premenopausal women reverse when training is withdrawn. Therefore, continued training, perhaps at a reduced frequency and intensity, is required to maintain the musculoskeletal benefit from exercise that may lower fracture risk in later life.

Jump starting skeletal health: A 4-year longitudinal study assessing the effects of jumping on skeletal development in pre and circum pubertal children ☆

INTRODUCTION Evidence suggests bone mineral increases attributable to exercise training prior to puberty may confer a significant advantage into adulthood. However, there is a dearth of supportive prospective longitudinal data. The purpose of this study was to assess bone mineral content (BMC) of the whole body (WB), total hip (TH), femoral neck (FN) and lumbar spine (LS) over four years in pre-pubertal boys and girls following a 7-month jumping intervention. METHODS The study population included 107 girls and 98 boys aged 8.6+/-0.88 years at baseline. Participating schools were randomly assigned as either intervention or control school. Children at the intervention school (n=101) participated in a jumping intervention embedded within the standard PE curriculum. The control school children (n=104) had similar exposure to PE without the jumping intervention. BMC was assessed by DXA at baseline, at 7-month post intervention, and annually thereafter for three years totaling 5 measurement opportunities. Multi-level random effects models were constructed and used to predict change from study entry in BMC parameters at each measurement occasion. RESULTS A significant intervention effect was found at all bone sites. The effect was greatest immediately following the intervention (at 7 months) but still significant three years after the intervention. At 7 months, intervention participants had BMC values that were 7.9%, 8.4%, 7.7% and 7.3% greater than the controls at the LS, TH, FN and WB, respectively (p<0.05), when the confounders of age, maturity and tissue mass were controlled. Three years after the intervention had concluded the intervention group had 2.3%, 3.2%, 4.4% and 2.9% greater BMC than controls at the LS, TH, FN and WB respectively (p<0.05), when the confounders of age, maturity and tissue mass were controlled. CONCLUSIONS This provides evidence that short-term high impact exercise in pre-puberty has a persistent effect over and above the effects of normal growth and development. If the benefits are sustained until BMC plateaus in early adulthood, this could have substantial effects on fracture risk.

Bone Health Across the Lifespan—Exercising Our Options

BECK, B. R., and C. M. Snow. Bone health across the lifespan—exercising our options. Exerc. Sport Sci. Rev., Vol. 31, No. 3, pp. 117–122, 2003. Exercise is frequently extolled as an osteoporosis treatment. In reality, the use of exercise as an osteoporosis intervention lies more in its ability to: 1) maximize peak bone mass attained in youth; 2) maintain bone mass or reduce age-related bone loss; and 3) preserve muscle strength and postural stability to reduce the risk of falling and fracturing in the later years.

Concurrent Validity of the BOD POD and Dual Energy X-Ray Absorptiometry Techniques for Assessing Body Composition in Young Women

The purpose of this study was to determine the concurrent validity of the BOD POD (BP) (Life Measurement Instruments) and Dual Energy X-Ray Absorptiometry (DXA) Elite 4500A (Hologic, Inc.) techniques for assessing the body fat percentage of young women. The participants were forty-three white college-aged women (19.4 +/- 1.4 years) with a BMI of 23.4 +/- 2.3. Both body composition analyses were completed on the same day and were taken within 10 minutes of each other. Body fat percentage was estimated to be 24.3 (SE = 1.1) and 23.8 (SE = 0.8) using the BP and DXA techniques, respectively. Exact matches, in terms of body fat percentage, were obtained for 10 of the 43 participants (23.3%). In conclusion, our data supports the concurrent validity of the BP and DXA techniques for assessing body fat in young women.

Lean body mass and leg power best predict bone mineral density in adolescent girls.

PURPOSE We evaluated anthropometric and performance measures that best predict bone mineral density (BMD) and bone mineral content (BMC) in 54 adolescent girls (14.6 +/- 0.5 yr; 22.7 +/- 14.0 months past menarche). METHODS Whole body, femoral neck, greater trochanter, lumbar spine (L2-L4), and mid-femoral shaft BMD and BMC, and whole body bone-free lean mass and fat mass were assessed using DXA (Hologic QDR 1000/W). Knee extensor strength and leg power were assessed by isokinetic dynamometry and the Wingate Anaerobic Power Test, respectively. RESULTS Whole body lean mass was correlated with BMD at all bone sites (r = 0.45-0.77; P < 0.001) and was more highly correlated with bone at all sites than was body weight. Leg power was also associated with BMD at all sites (r = 0.41-0.67; P < 0.001), whereas leg strength correlated significantly with all sites (r = 0.41-0.53; P < 0.001) except the lumbar spine. Stepwise regression analyses revealed that 59% of the variance in whole body BMD was predicted by lean mass alone. No other variables, including fat mass, height, months past menarche, leg power, or leg strength, contributed additionally to the regression model. Similarly, lean mass was the only predictor of lumbar spine and femoral shaft BMD (R2 = 0.25, R2 = 0.37, respectively), while femoral neck and trochanteric BMD were best predicted by leg power (R2 = 0.38, R2 = 0.36, respectively). Similar but stronger models emerged using BMC as the outcome, with lean mass and leg power explaining the most variance in BMC values. CONCLUSION In this group of adolescent girls, lean body mass and leg power best predicted BMC and BMD of the whole body, lumbar spine, femoral shaft, and hip, which may suggest an important role for muscle mass development during growth to maximize peak bone density.

Bone gains and losses follow seasonal training and detraining in gymnasts.

The response of the human skeleton to high magnitude loading and unloading is poorly understood. Our aim was to evaluate changes in bone mineral density (BMD) in a group of intercollegiate gymnasts (n = 8, age = 18.6+/-0.8 years) over 24 months that included two 8-month competitive seasons and two 4-month offseasons. BMD of the hip, spine, and whole body was evaluated by DXA (Hologic QDR-1000/W) at baseline, 8, 12, 20, and 24 months. Results indicated significant seasonal trends in BMD of the femoral neck, trochanter, total hip, lumbar spine, and whole body. Specifically, there was a strikingly consistent pattern of bone density increases over the training seasons followed by clear declines in the offseasons. Increases at the spine were 3.5% and 3.7% followed by declines of 1.5% and 1.3% in the offseasons. Total hip BMD increased 2.3% and 1.9% during the competitive seasons followed by decreases of 1.5% and 1.2% in the offseasons. We observed a significant 24-month increase of 4.3% in spine BMD but no significant overall change at the hip. In conclusion, the human skeleton demonstrated a measurable response to high magnitude loading and unloading that was consistent across bone sites over 24 months of observation.