The effect of a high-impact jumping intervention on bone mass, bone stiffness and fitness parameters in adolescent athletes

Biomechanics of a Drop Landing: Osteogenic Stimulus Measures May Vary

OBJECTIVES

Impact exercises are known to increase bone mineral density (BMD) through the biological process of bone remodeling, increasing strength and resistance to fracture. The purpose of this study was to compare several measures that have been used as surrogates for bone impact as a magnitude of its potential to induce bone remodeling.

METHODS

Twenty healthy adults (10 male, 10 female) participated in a biomechanical investigation of how drop height and landing style (bilateral vs. unilateral) affect various estimates of bone remodeling stimuli. These stimuli surrogates include accelerations measured by Inertial Measurement Units (IMUs), ground reaction forces, joint contact forces estimated by musculoskeletal modeling, and tibia strains estimated by finite element modeling.

RESULTS

Drop height was directly related to stimulus magnitudes, but there was little benefit to drop heights greater than 0.4 m. In contrast, switching from a bilateral to a unilateral landing had a large positive effect. A post-hoc analysis revealed that a linear regression of kinematics and reaction force explained up to 79% of the variance in computationally expensive bone remodeling stimulus measures.

CONCLUSIONS

subject-specific bone strain analysis may not be necessary to understand the magnitude of a bone remodeling stimulus of an exercise.

Criteria and Guidelines for Returning to Running Following a Tibial Bone Stress Injury: A Scoping Review

Tibial bone stress injuries (BSIs) are common among long-distance runners. They have a high recurrence rate, and complexity emerges in the wider management and successful return to running. Following a tibial BSI, a critical component of complete rehabilitation is the successful return to running, and there is a lack of consistency or strong evidence to guide this process. The objectives of this review were to outline the criteria used in clinical decision-making prior to resuming running, and to establish evidence-based guidelines for the return to running process following a tibial BSI. Electronic databases including MEDLINE, CINAHL, Scopus, SPORTDiscus and AMED were searched for studies that stated criteria or provided guidelines on the objectives above. Fifty studies met the inclusion criteria and were included. Thirty-nine were reviews or clinical commentaries, three were retrospective cohort studies, two were randomised controlled trials, two were pilot studies, one was a prospective observational study, and three were case studies. Therefore, the recommendations that have been surmised are based on level IV evidence. Decisions on when an athlete should return to running should be shared between clinicians, coaches and the athlete. There are five important components to address prior to introducing running, which are: the resolution of bony tenderness, pain-free walking, evidence of radiological healing in high-risk BSIs, strength, functional and loading tests, and the identification of contributing factors. Effective return to running planning should address the athlete's risk profile and manage the risk by balancing the athlete's interests and reinjury prevention. An individualised graduated return to running programme should be initiated, often starting with walk-run intervals, progressing running distance ahead of speed and intensity, with symptom provocation a key consideration. Contributing factors to the initial injury should be addressed throughout the return to run process.

Resistance training presents beneficial effects on bone development of adolescents engaged in swimming but not in impact sports: ABCD Growth Study

BACKGROUND

Sports practice during adolescence is important to enhance bone development, although it may provide different effects depending on the mechanical impact present in the sport. Besides, resistance training (RT) may also induce bone changes directly (via muscle contractions) and indirectly (via myokines). However, there have been no studies analyzing the longitudinal influence of engaging in sport with and without added mechanical load. Thus, this study aims to analyze the combined effects of sports participation and resistance training on areal bone mineral density (aBMD) accrual in adolescent athletes participating in swimming and impact sports for 12-months.

METHODS

This was a 12-month longitudinal study. The sample comprised 91 adolescents (21 females) aged 10 to 18 years, engaged in impact sports (basketball, tennis, track & field, baseball and gymnastics, n = 66) and non-impact sport (swimming, n = 25). The sample was divided according to resistance training participation: impact sports only (n = 45), impact sports + resistance training (n = 21), swimming-only (n = 17) and swimming + resistance training (n = 8). aBMD and soft tissues were measured using dual-energy X-ray absorptiometry. Generalized linear models analysis was used for the resistance training (RT) x type of sport interaction in predicting aBMD changes overtime, adjusting for maturation, sex and baseline aBMD.

RESULTS

After 12-months, all groups showed a significant increase in aBMD, except for the swimming groups (regardless of resistant training), which showed a significant loss in spine aBMD (-0.045 [-0.085 to -0.004] g/cm2 in swimming-only and - 0.047 [-0.073 to -0.021] g/cm2 in swimming + RT). In comparisons between groups, only swimming + RT group, compared with swimming-only group presented higher upper limbs aBMD (0.096 g/cm2 [0.074 to 0.118] in swimming + RT vs. 0.046 [0.032 to 0.060] g/cm2 in swimming only; p < 0.05) and whole body less head (WBLH) aBMD (0.039 [0.024 to 0.054] g/cm2 in swimming + RT vs. 0.017 [0.007 to 0.027] g/cm2 swimming-only; p < 0.05).

CONCLUSION

Despite the significant gain in aBMD in all groups and body sites after 12-months, except for the spine site of swimmers, the results indicate that participation in RT seems to improve aBMD accrual in swimmers at the upper limbs and WBLH.

Relative Energy Deficiency in Sport (REDs) Indicators in Male Adolescent Endurance Athletes: A 3-Year Longitudinal Study

Longitudinal measurements of Relative Energy Deficiency in Sport (REDs) among adolescent male elite athletes are lacking. We aimed to monitor REDs indicators and their possible impact on performance in elite high-school cross-country skiing and biathlon athletes (n = 13) (16.3 ± 0.4 years, 179.4 ± 7.6 cm, 63.6 ± 8.2 kg body mass (BM), and peak oxygen uptake (VO2peak): 61.5 ± 5.3 mL/kg BM/min) every 6 months for 3 years. Protocols included assessments of energy availability (EA), body composition and bone mineral density (BMD), resting metabolic rate (RMR), disordered eating behavior, exercise addiction, VO2peak, and muscle strength. Data were analyzed using a linear mixed model. At baseline, 38% had low lumbar BMD (Z-score ≤ -1), and overall, bone health increased only slightly. VO2peak and muscle strength improved (p < 0.001), RMR decreased (p = 0.016), and no change was observed in EA or physiological or psychological REDs indicators. Conclusively, many of these young male athletes had poor bone health at baseline, and most either lost or did not achieve the expected pubertal bone mineral accrual, although no other indication of REDs was observed, while performance improved during the study period. Our findings highlight the importance of elite sports high schools focusing on screening for early detection of impaired bone health in male athletes.

Skeletal site-specific effects of jump training on bone mineral density in adults: a systematic review and meta-analysis

Preserving or preventing declines in bone mineral density (BMD) is imperative. As jumping is a high-impact bone-loading action, this meta-analysis evaluated the efficacy of jump training to improve BMD and bone turnover relative to non-jumping controls in men and women > 18 years, following Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines. PubMed and COCHRANE Library databases were searched until February 2022. Fifteen articles (19 jumping-trials) met the predetermined search criteria. Eighteen trials were included for BMD data (n = 666 participants). There was a significant small-moderate effect of jumping on femoral neck BMD (%mean difference: 95%CI, +1.50%: 0.83%; 2.17%, p < 0.0001), that remained significant after sub-analysis by age for both younger (+1.81%: 0.98%; 2.65%) and older adults (+1.03%: 0.02%; 2.03%). BMD of total hip (+1.26%: 0.56%; 1.96% vs + 0.06%: -0.96%; 1.08%), and trochanter (+0.84%: 0.20%; 1.48% vs -0.16%: -1.08%; 0.76%) increased significantly with jump training only in younger adults and non-significantly at the lumbar spine (+0.84%: -0.02%; 1.7% vs -0.09%: -0.96%; 0.77%) only in younger but not older adults, respectively. The BMD response to jump training appears to be site-specific, with the highest sensitivity at the femoral neck. No dose-response effect suggests moderate certainty of a gain in femoral neck BMD when performing the median jump-load of 50 jumps four times weekly.

The Role of Oxidative Stress in Multiple Exercise-Regulated Bone Homeostasis

Bone is a tissue that is active throughout the lifespan, and its physiological activities, such as growth, development, absorption, and formation, are always ongoing. All types of stimulation that occur in sports play an important role in regulating the physiological activities of bone. Here, we track the latest research progress locally and abroad, summarize the recent, relevant research results, and systematically summarize the effects of different types of exercise on bone mass, bone strength and bone metabolism. We found that different types of exercise have different effects on bone health due to their unique technical characteristics. Oxidative stress is an important mechanism mediating the exercise regulation of bone homeostasis. Excessive high-intensity exercise does not benefit bone health but induces a high level of oxidative stress in the body, which has a negative impact on bone tissue. Regular moderate exercise can improve the body's antioxidant defense ability, inhibit an excessive oxidative stress response, promote the positive balance of bone metabolism, delay age-related bone loss and deterioration of bone microstructures and have a prevention and treatment effect on osteoporosis caused by many factors. Based on the above findings, we provide evidence for the role of exercise in the prevention and treatment of bone diseases. This study provides a systematic basis for clinicians and professionals to reasonably formulate exercise prescriptions and provides exercise guidance for patients and the general public. This study also provides a reference for follow-up research.

Effect of exercise on bone health in children and adolescents with cancer during and after oncological treatment: A systematic review and meta-analysis

Background: Although regular physical activity and exercise programs might improve bone health caused by oncological treatment and the disease itself, it remains unknown the pooled effect of exercise interventions following frequency, intensity, time and type prescriptions.

Objective: This systematic review and meta-analysis aimed to synthesise evidence regarding the effectiveness of exercise interventions on bone health in children and adolescents with cancer during and after oncological treatment.

Methods: A systematic search was conducted in the MEDLINE (via PubMed), Web of Science and Scopus databases from November 2021 to January 2022. Randomised controlled trials (RCTs) and non-RCTs reporting pre-post changes of the effectiveness of exercise interventions on DXA-measured bone parameters in young population (1–19 years) during or after oncological treatment were included. Pooled (ESs) and 95% confidence intervals (95%CIs) were calculated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.

Results: A total of eight trials with 341 participants were included. The meta-analyses did not reveal a statistically significant increase in whole body areal bone mineral density (ES = 0.10; 95%CI: −0.14, 0.34), lumbar spine (ES = 0.03; 95%CI: −0.21, 0.26) or femoral neck (ES = 0.10; 95%CI: −0.37, 0.56). Similarly, during the oncological treatment phase the ES was 0.04 (95%CI: −0.17, 0.25) and after the ES was 0.07 (95%CI: −0.20, 0.33).

Conclusion: To date, exercise interventions have been inappropriate and therefore, ineffective to illustrate any beneficial effect on bone health in children and adolescents with cancer during and after oncological treatment.

Systematic Review Registration: PROSPERO registration number: CRD42022310876

Correlation of Acceleration Curves in Gravitational Direction for Different Body Segments during High-Impact Jumping Exercises

Osteoporosis is a common disease of old age. However, in many cases, it can be very well prevented and counteracted with physical activity, especially high-impact exercises. Wearables have the potential to provide data that can help with continuous monitoring of patients during therapy phases or preventive exercise programs in everyday life. This study aimed to determine the accuracy and reliability of measured acceleration data at different body positions compared to accelerations at the pelvis during different jumping exercises. Accelerations at the hips have been investigated in previous studies with regard to osteoporosis prevention. Data were collected using an IMU-based motion capture system (Xsens) consisting of 17 sensors. Forty-nine subjects were included in this study. The analysis shows the correlation between impacts and the corresponding drop height, which are dependent on the respective exercise. Very high correlations (0.83-0.94) were found between accelerations at the pelvis and the other measured segments at the upper body. The foot sensors provided very weak correlations (0.20-0.27). Accelerations measured at the pelvis during jumping exercises can be tracked very well on the upper body and upper extremities, including locations where smart devices are typically worn, which gives possibilities for remote and continuous monitoring of programs.

A Systematic Review with Meta-Analysis on the Effects of Plyometric-Jump Training on the Physical Fitness of Combat Sport Athletes

We aimed to assess the athletic performance changes in combat sport athletes (CoSAs) after plyometric-jump training (PJT), compared to control conditions, through a systematic review with meta-analysis. Following PRISMA guidelines, three electronic databases were searched for includable articles, according to a PICOS approach. Using a random-effects model, Hedges' g effects sizes (ES) were calculated. Heterogeneity was assessed using the I2 statistic, with values of <25%, 25-75%, and >75% representing low, moderate, and high levels of heterogeneity, respectively. Statistical significance was set at p ≤ 0.05. The certainty of evidence was assessed using the GRADE approach. Twelve eligible articles were identified for systematic review, seven of high quality and five of moderate quality, according to the PEDro scale. The studies recruited taekwondo, silat, wrestling, judo, fencing, and karate athletes (292 total participants), including specific-active and active controls. Most participants had a mean age of <18 years and were males (n = 225). Compared to the control, PJT programmes, involving 4-12 weeks and 2-3 sessions per week, induced small to moderate improvements (ES = 0.47 to 1.04) in athletes' maximal strength (e.g., 1RM squat), vertical jump height, change-of-direction speed, and specific performance (e.g., fencing movement velocity), although without meaningful effects on body mass, fat mass, and muscle mass (ES = 0.02 to -0.06). Most (7 of 8) outcomes attained low heterogeneity. The outcome-level GRADE analysis indicated a certainty of evidence from low to moderate. In conclusion, PJT, when compared to control conditions, may improve CoSA athletic performance.

Effects of Plyometric Jump Training on Measures of Physical Fitness and Sport-Specific Performance of Water Sports Athletes: A Systematic Review with Meta-analysis

BACKGROUND

A growing body of literature is available regarding the effects of plyometric jump training (PJT) on measures of physical fitness (PF) and sport-specific performance (SSP) in-water sports athletes (WSA, i.e. those competing in sports that are practiced on [e.g. rowing] or in [e.g. swimming; water polo] water). Indeed, incoherent findings have been observed across individual studies making it difficult to provide the scientific community and coaches with consistent evidence. As such, a comprehensive systematic literature search should be conducted to clarify the existent evidence, identify the major gaps in the literature, and offer recommendations for future studies.

AIM

To examine the effects of PJT compared with active/specific-active controls on the PF (one-repetition maximum back squat strength, squat jump height, countermovement jump height, horizontal jump distance, body mass, fat mass, thigh girth) and SSP (in-water vertical jump, in-water agility, time trial) outcomes in WSA, through a systematic review with meta-analysis of randomized and non-randomized controlled studies.

METHODS

The electronic databases PubMed, Scopus, and Web of Science were searched up to January 2022. According to the PICOS approach, the eligibility criteria were: (population) healthy WSA; (intervention) PJT interventions involving unilateral and/or bilateral jumps, and a minimal duration of ≥ 3 weeks; (comparator) active (i.e. standard sports training) or specific-active (i.e. alternative training intervention) control group(s); (outcome) at least one measure of PF (e.g. jump height) and/or SSP (e.g. time trial) before and after training; and (study design) multi-groups randomized and non-randomized controlled trials. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. The DerSimonian and Laird random-effects model was used to compute the meta-analyses, reporting effect sizes (ES, i.e. Hedges' g) with 95% confidence intervals (95% CIs). Statistical significance was set at p ≤ 0.05. Certainty or confidence in the body of evidence for each outcome was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE), considering its five dimensions: risk of bias in studies, indirectness, inconsistency, imprecision, and risk of publication bias.

RESULTS

A total of 11,028 studies were identified with 26 considered eligible for inclusion. The median PEDro score across the included studies was 5.5 (moderate-to-high methodological quality). The included studies involved a total of 618 WSA of both sexes (330 participants in the intervention groups [31 groups] and 288 participants in the control groups [26 groups]), aged between 10 and 26 years, and from different sports disciplines such as swimming, triathlon, rowing, artistic swimming, and water polo. The duration of the training programmes in the intervention and control groups ranged from 4 to 36 weeks. The results of the meta-analysis indicated no effects of PJT compared to control conditions (including specific-active controls) for in-water vertical jump or agility (ES =  - 0.15 to 0.03; p = 0.477 to 0.899), or for body mass, fat mass, and thigh girth (ES = 0.06 to 0.15; p = 0.452 to 0.841). In terms of measures of PF, moderate-to-large effects were noted in favour of the PJT groups compared to the control groups (including specific-active control groups) for one-repetition maximum back squat strength, horizontal jump distance, squat jump height, and countermovement jump height (ES = 0.67 to 1.47; p = 0.041 to < 0.001), in addition to a small effect noted in favour of the PJT for SSP time-trial speed (ES = 0.42; p = 0.005). Certainty of evidence across the included studies varied from very low-to-moderate.

CONCLUSIONS

PJT is more effective to improve measures of PF and SSP in WSA compared to control conditions involving traditional sport-specific training as well as alternative training interventions (e.g. resistance training). It is worth noting that the present findings are derived from 26 studies of moderate-to-high methodological quality, low-to-moderate impact of heterogeneity, and very low-to-moderate certainty of evidence based on GRADE. Trial registration The protocol for this systematic review with meta-analysis was published in the Open Science platform (OSF) on January 23, 2022, under the registration doi https://doi.org/10.17605/OSF.IO/NWHS3 (internet archive link: https://archive.org/details/osf-registrations-nwhs3-v1 ).

Effect of Plyometric Jump Training on Skeletal Muscle Hypertrophy in Healthy Individuals: A Systematic Review With Multilevel Meta-Analysis

Objective: To examine the effect of plyometric jump training on skeletal muscle hypertrophy in healthy individuals. Methods: A systematic literature search was conducted in the databases PubMed, SPORTDiscus, Web of Science, and Cochrane Library up to September 2021. Results: Fifteen studies met the inclusion criteria. The main overall finding (44 effect sizes across 15 clusters median = 2, range = 1-15 effects per cluster) indicated that plyometric jump training had small to moderate effects [standardised mean difference (SMD) = 0.47 (95% CIs = 0.23-0.71); p < 0.001] on skeletal muscle hypertrophy. Subgroup analyses for training experience revealed trivial to large effects in non-athletes [SMD = 0.55 (95% CIs = 0.18-0.93); p = 0.007] and trivial to moderate effects in athletes [SMD = 0.33 (95% CIs = 0.16-0.51); p = 0.001]. Regarding muscle groups, results showed moderate effects for the knee extensors [SMD = 0.72 (95% CIs = 0.66-0.78), p < 0.001] and equivocal effects for the plantar flexors [SMD = 0.65 (95% CIs = -0.25-1.55); p = 0.143]. As to the assessment methods of skeletal muscle hypertrophy, findings indicated trivial to small effects for prediction equations [SMD = 0.29 (95% CIs = 0.16-0.42); p < 0.001] and moderate-to-large effects for ultrasound imaging [SMD = 0.74 (95% CIs = 0.59-0.89); p < 0.001]. Meta-regression analysis indicated that the weekly session frequency moderates the effect of plyometric jump training on skeletal muscle hypertrophy, with a higher weekly session frequency inducing larger hypertrophic gains [β = 0.3233 (95% CIs = 0.2041-0.4425); p < 0.001]. We found no clear evidence that age, sex, total training period, single session duration, or the number of jumps per week moderate the effect of plyometric jump training on skeletal muscle hypertrophy [β = -0.0133 to 0.0433 (95% CIs = -0.0387 to 0.1215); p = 0.101-0.751]. Conclusion: Plyometric jump training can induce skeletal muscle hypertrophy, regardless of age and sex. There is evidence for relatively larger effects in non-athletes compared with athletes. Further, the weekly session frequency seems to moderate the effect of plyometric jump training on skeletal muscle hypertrophy, whereby more frequent weekly plyometric jump training sessions elicit larger hypertrophic adaptations.

Programming Plyometric-Jump Training in Soccer: A Review

The aim of this review was to describe and summarize the scientific literature on programming parameters related to jump or plyometric training in male and female soccer players of different ages and fitness levels. A literature search was conducted in the electronic databases PubMed, Web of Science and Scopus using keywords related to the main topic of this study (e.g., “ballistic” and “plyometric”). According to the PICOS framework, the population for the review was restricted to soccer players, involved in jump or plyometric training. Among 7556 identified studies, 90 were eligible for inclusion. Only 12 studies were found for females. Most studies (n = 52) were conducted with youth male players. Moreover, only 35 studies determined the effectiveness of a given jump training programming factor. Based on the limited available research, it seems that a dose of 7 weeks (1−2 sessions per week), with ~80 jumps (specific of combined types) per session, using near-maximal or maximal intensity, with adequate recovery between repetitions (<15 s), sets (≥30 s) and sessions (≥24−48 h), using progressive overload and taper strategies, using appropriate surfaces (e.g., grass), and applied in a well-rested state, when combined with other training methods, would increase the outcome of effective and safe plyometric-jump training interventions aimed at improving soccer players physical fitness. In conclusion, jump training is an effective and easy-to-administer training approach for youth, adult, male and female soccer players. However, optimal programming for plyometric-jump training in soccer is yet to be determined in future research.

Body composition adaptations to lower-body plyometric training: a systematic review and meta-analysis

The aim of this meta-analysis was to explore the effects of plyometric jump training (PJT) on body composition parameters among males. Relevant articles were searched in the electronic databases PubMed, MEDLINE, WOS, and SCOPUS, using the key words "ballistic", "complex", "explosive", "force-velocity", "plyometric", "stretch-shortening cycle", "jump", "training", and "body composition". We included randomized controlled trials (RCTs) that investigating the effects of PJT in healthy male's body composition (e.g., muscle mass; body fat), irrespective of age. From database searching 21 RCTs were included (separate experimental groups = 28; pooled number of participants = 594). Compared to control, PJT produced significant increases in total leg muscle volume (small ES = 0.55, p = 0.009), thigh muscle volume (small ES = 0.38, p = 0.043), thigh girth (large ES = 1.78, p = 0.011), calf girth (large ES = 1.89, p = 0.022), and muscle pennation angle (small ES = 0.53, p = 0.040). However, we did not find significant difference between PJT and control for muscle cross-sectional area, body fat, and skinfold thickness. Heterogeneity remained low-to-moderate for most analyses, and using the Egger's test publication bias was not found in any of the analyses (p = 0.300-0.900). No injuries were reported among the included studies. PJT seems to be an effective and safe mode of exercise for increasing leg muscle volume, thigh muscle volume, thigh and calf girth, and muscle pennation angle. Therefore, PJT may be effective to improve muscle size and architecture, with potential implications in several clinical and sport-related contexts.

Effects of Plyometric Jump Training in Sand or Rigid Surface on Jump-Related Biomechanical Variables and Physical Fitness in Female Volleyball Players

Background: This study aims to assess the effects of 8 weeks of plyometric jump training (PJT) conducted on sand or a rigid court surface on jump-related biomechanical variables and physical fitness in female indoor volleyball players. Methods: Seventeen participants were randomly divided into a sand surface group (SsG, n = 8) and rigid surface group (RsG, n = 9). Both groups completed equal indoor volleyball training routines. Participants were assessed pre and post the 8-week PJT for jump-related biomechanical variables (countermovement jump (CMJ) RSI; drop jump (DJ) reactive strength index (RSI); spike jump (SJ) height; CMJ height; CMJ rate of force development (RFD); CMJ velocity at take-off; DJ height and CMJ peak force), 20 m linear sprint time, t test for change-of-direction sprint (CODs) time, Wingate test peak power (PP), cardiorespiratory endurance, and leg-press one-repetition maximum (1RM). Results: A two-way mixed analysis of variance (group × time) revealed that there was a significant group × time interaction between DJ height (p = 0.035) and CMJ peak force (p = 0.032) in favour of RsG and SsG, respectively. A significant interaction was also observed for cardiorespiratory endurance (p = 0.01) and 1RM (p = 0.002), both favouring the SsG. No other group × time interaction was observed. Conclusions: The type of surface used during PJT induced specific adaptations in terms of jump-related biomechanical variables and physical fitness in female indoor volleyball players. Based on the individual needs of the athletes, practitioners may prescribe one type of surface preferentially over another to maximize the benefits derived from PJT.

The Efficacy of Brief School-Based Exercise Programs in Improving Pubertal Bone Mass and Physical Fitness: A Randomized Controlled Trial

PURPOSE

To examine the effects of three types of school-based exercises on bone health and physical fitness function in Chinese boys and girls.

METHODS

One hundred and seventy-four Chinese boys and girls were randomly assigned into four groups: (1) sham exercise (ShEx); (2) high-impact exercise (HiEx); (3) high-impact exercise with various directions (HiExVi); and (4) high-intensity interval exercise (HiInEx). Speed of sound (SOS) and physical fitness parameters were determined before and after six-month intervention.

RESULTS

At the end of six-month intervention, participants in all groups show an increment of SOS compared with the baseline (p < 0.05), and the changes were higher in HiEx (mean: 38.878 m/s, 95% CI: 32.885~44.872, p = 0.001) and HiExVi groups (49.317 m/s, 42.737~55.897, p < 0.001) compared with ShEx group (20.049 m/s, 13.751~26.346). Six-month exercise training generated a reduction of percent of body fat (PBF) and waist-hip ratio (WHR) (p < 0.05). The decrease of PBF was greater in HiExVi (-1.222%, -1.820~-0.624, p = 0.012) and HiInEx groups (-1.395%, -1.809~-0.982, p = 0.003), whereas the reduction of WHR was larger in HiEx (-0.026, -0.039~-0.014, p = 0.009), HiExVi (-0.024, -0.036~-0.012, p = 0.021), and HiInEx groups (-0.035, -0.046~-0.024, p < 0.001) compared with ShEx group. Balance function (BLF), vital capacity (VC), standing long jump (SLJ), and sit up (SU) increased in all intervention groups (p < 0.05). The BLF increased in HiEx (6.332 s, 4.136~8.528, p = 0.001), HiExVi (10.489 s, 8.934~12.045, p < 0.001), and HiInEx groups (9.103 s, 7.430~10.776, p < 0.001) showed a greater change than that of ShEx group (1.727 s, 0.684~2.770). The increment of VC (273.049 mL, 199.510~346.587, p < 0.001) and SU (2.537 times/min, 0.639~4.435, p = 0.017) was higher in HiInEx group, whereas the accrual in SLJ was larger in HiExVi (7.488 cm, 4.936~10.040, p = 0.007) compared with ShEx group (58.902 mL, 7.990~109.814; -0.463 times/min, -2.003~1.077; 1.488 cm, -0.654~3.630).

CONCLUSION

The brief school-based exercises were effective in improving schoolchildren's health, but they showed different effects, with HiEx mostly improving bone health, HiInEx largely benefiting physical fitness function, and HiExVi enhancing both bone and physical fitness.

Jumping rope and whole-body vibration program effects on bone values in Olympic artistic swimmers

INTRODUCTION

Artistic swimming seems not to benefit bone development like other out-of-water physical activities. To increase bone acquisition, artistic swimming should combine water training with weight-bearing impact or strength activities. Artistic swimmers can be a population at risk of developing osteopenia and osteoporosis in later life. The aim of the present study was to evaluate the effects of a training program on bone mineral density (BMD), bone mineral content (BMC) and body composition in an Olympic artistic swimming team.

METHODS

Sixteen women aged 17-21 years, who train 30 h/week, at the Olympic Training Centre (Barcelona, Spain), were followed up over two seasons. The 1st season involved regular artistic swimming training without specific training to reduce the risk of osteopenia. The exercise intervention, jumping rope and whole-body vibration, was added in the 2nd season. The protocol included 20 min of training 2 days per week, over a 22-week period. Dual energy x-ray absorptiometry measured the bone variables and body composition. The daily diet, medical history and bone turnover markers were evaluated.

RESULTS

The intervention program increased BMD on lumbar spine (2.10%, p = 0.002), total hip (2.07%, p = 0.001), and femoral neck (2.39%, p = 0.02). Lower limb's fat mass decreased (10.17%, p = 0.038). No significant differences were found for any of the measured anthropometric characteristics between both time points in the 1st season. In conclusions, combined jump rope and vibration should be considered to reduce the risk of bone damage in artistic swimmers.

Effects of Low Energy Availability on Bone Health in Endurance Athletes and High-Impact Exercise as A Potential Countermeasure: A Narrative Review

Endurance athletes expend large amounts of energy in prolonged high-intensity exercise and, due to the weight-sensitive nature of most endurance sports, often practice periods of dietary restriction. The Female Athlete Triad and Relative Energy Deficiency in Sport models consider endurance athletes at high-risk for suffering from low energy availability and associated health complications, including an increased chance of bone stress injury. Several studies have examined the effects of low energy availability on various parameters of bone structure and markers of bone (re)modelling; however, there are differences in findings and research methods and critical summaries are lacking. It is difficult for athletes to reduce energy expenditure or increase energy intake (to restore energy availability) in an environment where performance is a priority. Development of an alternative tool to help protect bone health would be beneficial. High-impact exercise can be highly osteogenic and energy efficient; however, at present, it is rarely utilized to promote bone health in endurance athletes. Therefore, with a view to reducing the prevalence of bone stress injury, the objectives of this review are to evaluate the effects of low energy availability on bone health in endurance athletes and explore whether a high-impact exercise intervention may help to prevent those effects from occurring.

Categorizing 10 Sports According to Bone and Soft Tissue Profiles in Adolescents

PURPOSE

Considering the different loading and training characteristics of the sports practiced during growth, it is important to specify and categorize the bone and soft tissue adaptations in adolescent athletes. This study aimed to categorize 10 different loading sports and a nonsport group and identify the differences in bone density and soft tissues.

METHODS

The sample included 625 adolescents (10 to 17 yr of age) of 10 sports (soccer, basketball, volleyball, track and field, judo, karate, kung fu, gymnastics, baseball, and swimming) and a nonsport group. Dual-energy x-ray absorptiometry assessed areal bone mineral density (aBMD), bone mineral apparent density (BMAD), and soft tissues (lean soft tissue and fat mass). The results were adjusted for sex, peak height velocity status, lean soft tissue, fat mass, and weekly training volume.

RESULTS

The comparisons among groups showed that soccer had the highest whole-body aBMD (mean ± SEM: 1.082 ± 0.007 g·cm) and lower limb aBMD (1.302 ± 0.010 g·cm). Gymnastics presented the highest upper limb aBMD (0.868 ± 0.012 g·cm) and whole-body BMAD (0.094 ± 0.001 g·cm). Swimming presented the lowest aBMD values in all skeletal sites (except at the upper limbs) and whole-body BMAD. The soft tissue comparisons showed that soccer players had the highest lean soft tissue (43.8 ± 0.7 kg). The lowest fat mass was found in gymnasts (8.04 ± 1.0 kg).

CONCLUSION

The present study investigated and categorized for the first time 10 different sports according to bone density and soft tissue profiles. Soccer and gymnastics sport groups were found to have the highest bone density in most body segments, and both sports were among the groups with the lowest fat mass.

Effects of Plyometric Jump Training on Jump and Sprint Performance in Young Male Soccer Players: A Systematic Review and Meta-analysis

BACKGROUND

Even from a young age, modern soccer requires high levels of physical fitness development, particularly jumping and sprinting. Plyometric jump training (PJT), combined with young athletes' regular soccer sessions, has the potential to improve jumping and sprinting. However, studies exploring the effects of PJT are generally limited by small sample sizes. This problem of underpowered studies may, thus, be resolved by pooling study results in a meta-analysis.

OBJECTIVE

The objective of this systematic review with meta-analysis (SRMA) was to assess the effects of plyometric jump training (PJT) on jumping and sprinting among young male soccer players.

METHODS

The SRMA included peer-reviewed articles that incorporated PJT in healthy players (i.e., < 23 years of age), a control group, and a measure of jumping or sprinting. Means and standard deviations of outcomes were converted to Hedges' g effect sizes (ES), using the inverse variance random-effects model. Moderator analyses were conducted for PJT duration, frequency, total number of sessions, participants' chronological age, and FIFA age categories (i.e., U-17 vs. U-20 vs. U-23). A multivariate random-effects meta-regression was also conducted.

RESULTS

Thirty-three studies were included, comprising 1499 participants. PJT improved vertical jump tests (ES = 0.60-0.98; all p < 0.01) and linear sprint performance (ES = 0.60-0.98; p < 0.03). Interventions of > 7 weeks and > 14 PJT sessions induced greater effects compared to PJT with ≤ 7 weeks and ≤ 14 total sessions on 10-m sprint performance (between group p = 0.038).

CONCLUSION

PJT is effective in improving jumping and sprinting performance among young male soccer players. Greater 10-m linear sprinting improvements were noted after interventions > 7-week duration and > 14 sessions, suggesting a greater return from exposure to longer PJT interventions, partially in support for the adoption of a long-term approach to athletic development in young athletes. However, with reference to the findings of the meta-regression, and those from the remaining subgroup and single factors analysis, a robust confirmation regarding the moderator role of participant's age or PJT configuration effects on young soccer player's fitness qualities needed.

Effect of Various Types of Muscle Contraction with Different Running Conditions on Mouse Humerus Morphology

How various types of muscle contraction during exercises affect bone formation remains unclear. This study aimed to determine how exercises with different muscle contraction types affect bone morphology. In total, 20 mice were used and divided into four groups: Control, Level, Down Slow, and Down. Different types of muscle contraction were induced by changing the running angle of the treadmill. After the intervention, micro-computed tomography (Micro-CT), tartrate-resistant acid phosphatase/alkaline phosphatase (ALP) staining, and immunohistochemical staining were used to analyze the humerus head, tendon-to-bone attachment, and humerus diaphyseal region. Micro-CT found that the volume ratio of the humeral head, the volume of the tendon-to-bone attachment region, and the area of the humeral diaphyseal region increased in the Down group. However, no difference was detected in bone morphology between the Level and Down Slow groups. In addition, histology showed activation of ALP in the subarticular subchondral region in the Down Slow and Down groups and the fibrocartilage region in the tendon-to-bone attachment. Moreover, Osterix increased predominantly in the Down Slow and Down groups.Overall bone morphological changes in the humerus occur only when overuse is added to EC-dominant activity. Furthermore, different type of muscle contractile activities might promote bone formation in a site-specific manner.

Testing the Functional Model of Bone Development: Direct and Mediating Role of Muscle Strength on Bone Properties in Growing Youth

This study examines the functional model of bone development in peri-pubertal boys and girls. Specifically, we implemented a mixed-longitudinal design and hierarchical structural models to provide experimental evidence in support of the conceptual functional model of bone development, postulating that the primary mechanical stimulus of bone strength development is muscle force. To this end, we measured radial and tibial bone properties (speed of sound, SOS), isometric grip and knee extensors strength, bone resorption (urinary NTX concentration), body mass index (BMI), somatic maturity (years from peak height velocity) and skeletal maturity (bone age) in 180 children aged 8–16 years. Measurements were repeated 2–4 times over a period of 3 years. The multilevel structural equation modeling of 406 participant-session observations revealed similar results for radial and tibial SOS. Muscle strength (i.e., grip strength for the radial and knee extension for tibial model) and NTX have a significant direct effect on bone SOS (β = 0.29 and −0.18, respectively). Somatic maturity had a direct impact on muscle strength (β = 0.24) and both a direct and indirect effect on bone SOS (total effect, β = 0.30). Physical activity and BMI also had a significant direct impact on bone properties, (β = 0.06 and −0.18, respectively), and an additional significant indirect effect through muscle strength (β = 0.01 and 0.05, respectively) with small differences per bone site and sex. Muscle strength fully mediated the impact of bone age (β = 0.14) while there was no significant effect of energy intake on either muscle strength or bone SOS. In conclusion, our results support the functional model of bone development in that muscle strength and bone metabolism directly affect bone development while the contribution of maturity, physical activity, and other modulators such as BMI, on bone development is additionally modulated through their effect on muscle strength.

The Mediating Role of Lean Soft Tissue in the Relationship between Somatic Maturation and Bone Density in Adolescent Practitioners and Non-Practitioners of Sports

This study aimed to identify the mediating effect of lean soft tissue (LST) in the association between somatic maturation and areal bone mineral density (aBMD) in adolescents by sex and sport participation. The sample included 558 adolescents (401 males, mean age of 14.0 years) that were practitioners of sports (11 sport modalities, n = 402) and a non-sport group (n = 157). Somatic maturation was assessed by using a validated peak height velocity prediction equation. Dual-energy X-ray absorptiometry (DXA) was used to assess aBMD (upper and lower limbs, spine and total body less head—TBLH) and LST. For both sexes, LST mediated the association between somatic maturation and aBMD at all skeletal sites (mediation percentage ranging from 36.3% to 75.4%). For sport and non-sport groups, the LST also mediated the association between somatic maturation and aBMD at all skeletal sites (mediation percentage ranging from 51.6% to 85.6%). The direct effect was observed in all groups, except for lower limbs and TBLH in the non-sport group. The association between somatic maturation and aBMD was mediated by LST in adolescents of both sexes and regardless of involvement in organized sports. Our findings highlighted the role of improving LST to mitigate the association of somatic maturation with aBMD.

Plyometric jump training effects on the physical fitness of individual-sport athletes: a systematic review with meta-analysis

Background

The aim of this study is to conduct a systematic review with meta-analysis to explore the effects of plyometric jump training (PJT) on the physical fitness of individual sport athletes (ISA).

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched through PubMed, Web of Science, and SCOPUS electronic databases. We included controlled studies that incorporated a PJT intervention among ISA (with no restriction for age or sex), that included a pre-to-post intervention assessment of physical fitness (e.g., sprint; jump). From the included studies, relevant data (e.g., PJT and participants characteristics) was extracted. We assessed the methodological quality of the included studies using the PEDro scale. Using a random-effects model, meta-analyses for a given outcome was conducted. Means and standard deviations for a measure of pre-post-intervention physical fitness from the PJT and control groups were converted to Hedges' g effect size (ES). Heterogeneity was assessed using the I ² statistic. The risk of bias was explored using the extended Egger's test. The statistical significance threshold was set at p < 0.05. Moderator analyses were conducted according to the sex, age and sport background of the athletes.

Results

Twenty-six studies of moderate-high methodological quality were included (total participants, n = 667). Compared to controls, PJT improved vertical jump (ES = 0.49; p < 0.001; I = 0.0%), linear sprint (ES = 0.23; p = 0.032; I ² = 10.9%), maximal strength (ES = 0.50; p < 0.001; I² = 0.0%) and endurance performance (ES = 0.30; p = 0.028; I² = 11.1%). No significant effect was noted for sprint with change of direction (ES = 0.34; p = 0.205; I² = 70.9%). Athlete's sex, age and sport background had no modulator role on the effect of PJT on vertical jump, linear sprint, maximal strength and endurance performance. Among the included studies, none reported adverse effects related to the PJT intervention.

Conclusions

PJT induces small improvements on ISA physical fitness, including jumping, sprinting speed, strength and endurance.

Effects of Plyometric Jump Training on Physical Fitness in Amateur and Professional Volleyball: A Meta-Analysis

We aimed to examine the effects of plyometric jump training (PJT) on measures of physical fitness in amateur and professional volleyball players. A systematic electronic literature search was carried out in the databases PubMed, MEDLINE, Web of Science, and SCOPUS. Controlled studies including pre-to-post intervention tests of physical fitness and involving healthy volleyball players regardless of age and sex were considered. A random-effects model was used to calculate effect sizes (ES) between intervention and control groups. Moderator analyses considered programme duration, training frequency, total number of training sessions and jumps, participants' sex, age, and expertise level. The Physiotherapy Evidence Database scale was used to assess the methodological quality of the included studies. Eighteen moderate-to-high quality (median of 5 PEDro points) studies were eligible, comprising a total of 746 athletes. None of the included studies reported injuries related to the PJT intervention. The main findings showed small-to-moderate effects (p < 0.05) of PJT on linear sprint speed (ES = 0.70), squat jump (ES = 0.56), countermovement jump (CMJ) (ES = 0.80), CMJ with arm swing (ES = 0.63), drop jump (ES = 0.81), and spike jump height (ES = 0.84). Sub-analyses of moderator factors included 48 data sets. Only age had a significant effect on CMJ performance. Participants aged ≥16 years achieved greater improvements in CMJ performance compared to <16 years old (ES = 1.28 and 0.38, respectively; p = 0.022). No significant differences (p = 0.422) were identified between amateur (ES = 0.62) and professional volleyball players (ES = 1.01). In conclusion, PJT seems safe and is effective in improving measures of physical fitness in amateur and professional volleyball players, considering studies performed in both male and female.

Effects of Complex Training on Sprint, Jump, and Change of Direction Ability of Soccer Players: A Systematic Review and Meta-Analysis

The aim of this meta-analysis was to evaluate the effects of complex training (CT) on sprint, jump, and change of direction (COD) ability among soccer players. After an electronic search, 10 peer-reviewed articles were considered in the meta-analysis. The athletes included in this meta-analysis were amateur to professional level male soccer players (age range, 14–23 years). These studies incorporated CT in soccer players who were compared to a control group. Significant moderate to large improvements were observed in the CT group [sprint: standard mean difference (SMD) = 0.92–1.91; jump: SMD = 0.96–1.58; COD: SMD = 0.97–1.49] when compared to control groups. Subgroup analysis were also conducted based on age, duration, and competitive level. The beneficial effects of CT were greater in players <18 vs. ≥18 years (linear sprinting; SMD = 2.01 vs. −0.13), after ≥8 vs. <8 weeks (jumping and COD; SMD = 1.55–2.01 vs. 0.31–0.64, respectively) and among professional vs. amateur players (linear sprinting and with COD; SMD = 1.53–1.58 vs. 0.08–0.63, respectively). In conclusion, regular soccer training programs may be supplemented with CT to improve sprint, jump, and COD performance. A longer duration of CT (≥8 weeks) seems to be optimal in improving the physical abilities of soccer players. Professional players and <18 years players may benefit more from CT program.

The effect of an online exercise programme on bone health in paediatric cancer survivors (iBoneFIT): study protocol of a multi-centre randomized controlled trial

BACKGROUND

New approaches on paediatric cancer treatment aim to maintain long-term health. As a result of radiotherapy, chemotherapy or surgery, paediatric cancer survivors tend to suffer from any chronic health condition. Endocrine dysfunction represents one of the most common issues and affects bone health. Exercise is key for bone mass accrual during growth, specifically plyometric jump training. The iBoneFIT study will investigate the effect of a 9-month online exercise programme on bone health in paediatric cancer survivors. This study will also examine the effect of the intervention on body composition, physical fitness, physical activity, calcium intake, vitamin D, blood samples quality of life and mental health.

METHODS

A minimum of 116 participants aged 6 to 18 years will be randomized into an intervention (n = 58) or control group (n = 58). The intervention group will receive an online exercise programme and diet counselling on calcium and vitamin D. In addition, five behaviour change techniques and a gamification design will be implemented in order to increase the interest of this non-game programme. The control group will only receive diet counselling. Participants will be assessed on 3 occasions: 1) at baseline; 2) after the 9 months of the intervention; 3) 4 months following the intervention. The primary outcome will be determined by dual energy X-ray absorptiometry (DXA) and the hip structural analysis, trabecular bone score and 3D-DXA softwares. Secondary outcomes will include anthropometry, body composition, physical fitness, physical activity, calcium and vitamin D intake, blood samples, quality of life and mental health.

DISCUSSION

Whether a simple, feasible and short in duration exercise programme can improve bone health has not been examined in paediatric cancer survivors. This article describes the design, rationale and methods of a study intended to test the effect of a rigorous online exercise programme on bone health in paediatric cancer survivors. If successful, the iBoneFIT study will contribute to decrease chronic health conditions in this population and will have a positive impact in the society.

TRIAL REGISTRATION

Prospectively registered in isrctn.com: isrctn61195625 . Registered 2 April 2020.

Tapering strategies applied to plyometric jump training: a systematic review with meta-analysis of randomized-controlled trials

INTRODUCTION

The purpose of this systematic review was to analyze the effect of plyometric jump training (PJT) applied in conjunction with tapering strategies on the jump performance of team-sport athletes.

EVIDENCE ACQUISITION

The meta-analysis included: 1) randomized-controlled studies that incorporated a PJT program; 2) cohorts of team-sport athletes; 3) jump performance assessments; and 4) studies that incorporated a programmed taper. A systematic search was conducted in distinct electronic databases for relevant studies. Aside from jump performance, the extracted data included characteristics of the participants, PJT, and tapering. Means and standard deviations were used to calculate the effect sizes (ES). To assess the effects of moderator variables, subgroup analyses were performed. The statistical significance level was set as P<0.05.

EVIDENCE SYNTHESIS

From 7020 records initially identified, 14 studies were eligible for meta-analysis. Across all included studies, there was a moderate, significant improvement in jump performance (ES=0.73; P<0.001). Additionally, the subgroup analysis demonstrated that the duration and intensity of the taper and the volume of the PJT induced similar improvements in jump performance (P<0.01).

CONCLUSIONS

In summary, PJT interventions that included a programmed taper induced significant improvements in jump performance in team-sport athletes. These effects were observed after different tapering strategies in terms of volume, taper duration, and the type of PJT prescribed.

Physical Fitness and Bone Health in Young Athletes and Nonathletes

BACKGROUND

Physical activity (PA) and physical fitness (PF) are crucial for bone health. However, children participating in competitive sports with high PA are at a greater risk of fracture from trauma or overuse. Given the importance of bone development during adolescence, associations between commonly used physical fitness tests with distal third radius (R-SoS) and midshaft tibia (T-SoS) speed of sound by quantitative ultrasound were assessed in adolescent athletes and nonathletes.

HYPOTHESIS

The relationship between physical fitness tests and R-SoS and T-SoS will differ depending on sex and athletic status.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Physical fitness of 285 boys (156 athletes) and 311 girls (74 athletes) aged 10 to 18 years was assessed through strength, speed, agility, and cardiorespiratory tests. Linear regression was used to assess the associations of physical fitness tests with R-SoS and T-SoS.

RESULTS

For boys, favorable associations were observed between physical fitness tests with R-SoS in athletes and T-SoS in both athletes and nonathletes (P < 0.05). For nonathlete girls, favorable associations were found for handgrip (R-SoS and T-SoS, both P < 0.05), whereas the progressive aerobic cardiovascular endurance run, vertical jump, speed at 20 m and 40 m were only favorably associated with T-SoS. For athlete girls, the association between handgrip (P = 0.03), vertical jump, and 4 × 10 m shuttle run (P < 0.05) with T-SoS was significantly related to a bone outcome.

CONCLUSION

The handgrip test and vertical jump were associated with T-SoS in boys and girls independent of sport status. These results suggest that physical fitness is associated with bone health in adolescents, particularly boys, and that the relationship between physical fitness and bone may differ depending on sex and athletic status.

CLINICAL RELEVANCE

Physical fitness tests are simple, easy-to-use tools for monitoring bone health and should be used by sport and health professsionals to promote healthy sport participation and prevent bone injuries.

Methodological characteristics and future directions for plyometric jump training research: A scoping review update

The aim of this scoping review was a) to update a previous review on the main methodological characteristics and shortcomings in the plyometric jump training (PJT) literature, and b) to recommend, in light of the identified methodological gaps, future research perspectives. We searched four electronic databases. From 6128 potentially relevant articles, 420 were considered eligible for inclusion. As an update of a previous review, this represents an increase of ~200 articles, illustrating that this field of research is growing fast. However, the relative "quality" or shortcomings were similar when compared to the preceding scoping review. In the current article, the main identified shortcomings were an insufficient number of studies conducted with females, individual sports, and high-level athletes (~22%, ~7%, and ~14% of overall studies, respectively); insufficient description of training prescription (~54% of studies); and studies missing an active/passive control group and a randomized group allocation process (~37% and ~24% of overall studies, respectively). Furthermore, PJT was often combined with other training methods and added to the participants' regular training routines (~50% and ~35% of overall studies, respectively). The main outcomes of this scoping review urge researchers to conduct PJT studies of high methodological quality (eg, randomized controlled trials) to get trustworthy evidence-based knowledge. In addition, owing to the limited research conducted with females, individual sports, and high-level athletes, more studies are needed to substantiate the available findings. Finally, the identification of cohort-specific PJT dose-response relations which elicit optimal training effects still needs to be identified, particularly in the long term.

Position Statement: Exercise Guidelines to Increase Peak Bone Mass in Adolescents

Background

An increase in bone mineral density during adolescence increases resistance to fractures in older age. The Korean Society for Bone and Mineral Research and the Korean Society of Exercise Physiology developed exercise guidelines to increase the peak bone mass (PBM) in adolescents based on evidence through a systematic review of previous research.

Methods

Articles were selected using the systematic method, and the exercise guidelines were established by selecting key questions (KQs) and defining the effects of exercises based on evidence through a literature review for selecting the final exercise method. There were 9 KQs. An online search was conducted on articles published since 2000, and 93 articles were identified.

Results

An increase in PBM in adolescence was effective for preventing osteoporosis and fractures in older age. Exercise programs as part of vigorous physical activity (VPA) including resistance and impact exercise at least 5 to 6 months were effective for improving PBM in adolescents. It is recommended that resistance exercise is performed 10 to 12 rep·set⁻¹ 1-2 set·region⁻¹ and 3 days·week⁻¹ using the large muscles. For impact exercises such as jumping, it is recommended that the exercise is performed at least 50 jumps·min⁻¹, 10 min·day⁻¹ and 2 days·week⁻¹.

Conclusions

Exercise guidelines were successfully developed, and they recommend at least 5 to 6 months of VPA, which includes both resistance and impact exercises. With the development of exercise guidelines, the incidence of osteoporosis and fractures in the aging society can be reduced in the future, thus contributing to improved public health.

Stimulation of Piezo1 by mechanical signals promotes bone anabolism

Mechanical loading, such as caused by exercise, stimulates bone formation by osteoblasts and increases bone strength, but the mechanisms are poorly understood. Osteocytes reside in bone matrix, sense changes in mechanical load, and produce signals that alter bone formation by osteoblasts. We report that the ion channel Piezo1 is required for changes in gene expression induced by fluid shear stress in cultured osteocytes and stimulation of Piezo1 by a small molecule agonist is sufficient to replicate the effects of fluid flow on osteocytes. Conditional deletion of Piezo1 in osteoblasts and osteocytes notably reduced bone mass and strength in mice. Conversely, administration of a Piezo1 agonist to adult mice increased bone mass, mimicking the effects of mechanical loading. These results demonstrate that Piezo1 is a mechanosensitive ion channel by which osteoblast lineage cells sense and respond to changes in mechanical load and identify a novel target for anabolic bone therapy.