Exercise in school Physical Education increase bone mineral content and density: Systematic review and meta-analysis

ABSTRACT

This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions through Physical Education (PE) exercises on bone mineral content (BMC) and density (BMD) of children and adolescents. The research was conducted using the online electronic databases PubMed, Science Direct, Web of Science and Scopus (March 2021). The analysis was restricted to school-based studies that examined the effect of PE interventions on BMC and BMD in schoolchildren (<18 years old). Standardised mean differences (SMD) with 95% confidence interval (CI) and random-effects models were calculated. The heterogeneity and inconsistency of the studies were estimated using Cochran’s Q-statistic and I², respectively. Twenty-two studies with 2,556 participants were selected. PE interventions were associated with a significant increase in BMC (SMD = 1.348; 95% CI, 1.053–1.643) and BMD (SMD = 0.640; 95% CI, 0.417–0.862). Femoral neck subgroup analysis indicate an increase in BMC for boys (SMD = 1.527; 95% CI, 0.990–2.065) and girls (SMD = 1.27; 95% CI, 0.782–1.767), and in BMD for boys (SMD = 0.518; 95% CI, 0.064–0.972) and girls (SMD = 0.817; 95% CI, 0.349–1.284). Finally, increases are reported in the lumbar spine BMC for boys (SMD = 1.860; 95% CI, 1.018–2.700) and girls (SMD = 1.275; 95% CI, 0.782–1.767). This meta-analysis provides insights into the effectiveness of interventions aimed at including physical exercise in PE on bone mass, suggesting that increasing the proportion of curriculum time allocated to PE may improve students’ BMD and BMC, especially in the femoral neck and lumbar spine.

KEYWORDS:

• School-based programme
• sports
• functional exercise
• bone health
• children

Acknowledgements

The authors would like to acknowledge Coordenadoria de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Brazil) for the Ph.D. scholarships of the authors Júlio Mello and Augusto Pedretti. The authors would like to acknowledge Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil) for de researcher scholarship level 1-D of the Adroaldo Gaya. The authors would like to acknowledge Dr. Will Stahl-Timmins for the use of the Graphical Overview for Evidence Reviews (GOfER) software. Dr. García-Hermoso is a Miguel Servet Fellow (Instituto de Salud Carlos III – CP18/0150). Dr. Júlio Mello worked in the development of the research question, contributed to the development of inclusion and exclusion criteria, performed the literature search (first coder), screened articles for eligibility, performed data analysis, drafted and critically revised the manuscript. Dr. Augusto Pedretti was the second coder for all reviewed abstracts and full texts, screened articles for eligibility and reviewed the manuscript critically for important intellectual content. Dr. Antonio García-Hermoso was responsible for data checking, data analysis supervisor, drafted and critically revised the manuscript. Drs. Clarice Martins and Anelise Gaya contributed to drafting the manuscript, results’ discussion and reviewed it critically for important intellectual content. Dr. Michael Duncan contributed to the development of inclusion and exclusion criteria, drafted and reviewed the manuscript critically for important intellectual content. Dr. Adroaldo Gaya had guided the development of the research question and the inclusion and exclusion criteria, screened articles for eligibility and approved the version to be published. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).