Effects of Exercise and Sports Intervention and the Involvement Level on the Mineral Health of Different Bone Sites in the Leg, Hip, and Spine: A Systematic Review and Meta-Analysis

Thiago P Oliveira; Mário C Espada; Danilo A Massini; Ricardo A M Robalo; Tiago A F Almeida; Víctor Hernández-Beltrán; José M Gamonales; Eliane A Castro; Dalton M Pessôa Filho

doi:10.3390/ijerph20156537

Effects of Exercise and Sports Intervention and the Involvement Level on the Mineral Health of Different Bone Sites in the Leg, Hip, and Spine: A Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2023 Aug 7;20(15):6537. doi: 10.3390/ijerph20156537.

Authors

Thiago P Oliveira¹, Mário C Espada^{2

3

4}, Danilo A Massini^{1

5}, Ricardo A M Robalo^{2

6}, Tiago A F Almeida^{1

5}, Víctor Hernández-Beltrán⁷, José M Gamonales^{7

8}, Eliane A Castro^{1

9}, Dalton M Pessôa Filho^{1

5}

Affiliations

¹ Graduate Programme in Human Development and Technology, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil.
² Instituto Politécnico de Setúbal, Escola Superior de Educação, 2914-504 Setúbal, Portugal.
³ Life Quality Research Centre (LQRC-CIEQV, Leiria), Complexo Andaluz, Apartado, 2040-413 Rio Maior, Portugal.
⁴ CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisboa, Portugal.
⁵ Department of Physical Education, School of Sciences (FC), São Paulo State University (UNESP), Bauru 17033-360, Brazil.
⁶ Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002 Lisboa, Portugal.
⁷ Research Group in Optimization of Training and Performance Sports, Faculty of Sport Science, University of Extremadura, 10005 Cáceres, Spain.
⁸ Faculty of Health Sciences, University of Francisco de Vitoria, 28223 Madrid, Spain.
⁹ LFE Research Group, Universidad Politécnica de Madrid (UPM), 28040 Madrid, Spain.

Abstract

The current study analysed whether the osteogenic stimuli of exercises and sports have an independent effect on bone mineral density (BMD). Studies with a design having two different cohorts were searched and selected to distinguish the effect due to long-term involvement (i.e., athletes vs. non-active young with good bone health) and due to the planning of intervention (i.e., pre- vs. post-training) with exercises and sports. Moreover, only studies investigating the bone sites with a body-weight support function (i.e., lower limb, hip, and spine regions) were reviewed, since the osteogenic effects have incongruous results. A meta-analysis was performed following the recommendations of PRISMA. Heterogeneity (I²) was determined by combining Cochran's Q test with the Higgins test, with a significance level of α = 0.05. The studies reporting the effect of involvement in exercise and sports showed high heterogeneity for the lower limb, total hip, and spine (I² = 90.200%, 93.334%, and 95.168%, respectively, with p < 0.01) and the effect size on sports modalities (Hedge's g = 1.529, 1.652, and 0.417, respectively, with p < 0.05) ranging from moderate to high. In turn, the studies reporting the effect of the intervention planning showed that there was no heterogeneity for the lower limb (I² = 0.000%, p = 0.999) and spine (I² = 77.863%, p = 0.000); however, for the hip, it was moderate (I² = 49.432%, p = 0.054), with a low effect between the pre- and post-training moments presented only for the hip and spine (Hedge's g = 0.313 and 0.353, respectively, with p < 0.05). The current analysis supported the effect of involvement in exercise and sports by evidencing the effect of either weight-bearing or non-weight-bearing movements on BMD at the femoral, pelvic, and lumbar bones sites of the athletes when comparing to non-athletes or non-active peers with healthy bones. Moreover, the effect of different exercise and sports interventions highlighted the alterations in the BMD in the spine bone sites, mainly with long-term protocols (~12 months) planned with a stimulus with high muscle tension. Therefore, exercise and sport (mainly systematic long-term practice) have the potential to increase the BMD of bones with body-weight support beyond the healthy values reached during life phases of youth and adulthood.

Keywords: bone; health; physical activity; sports.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Bone Density / physiology
Bone and Bones
Exercise / physiology
Humans
Leg*
Lower Extremity
Sports*

Grants and funding

The authors would like to thank São Paulo Research Foundation-FAPESP (PROCESS 2018/16706-3) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES–Finance Code 001) for the partial financial support. The collaboration of T.A.F.A. and E.A.C was possible thanks to the scholarships granted by the CAPES, in the scope of the Program CAPES-PrInt, process number 88887.310463/2018-00, Mobility Number 88887.580265/2020-00 and International Cooperation Project Number 88887.572557/2020-00. This research was also funded by the Foundation for Science and Technology, I.P., Grant/Award Number UIDB/04748/2020 and Instituto Politécnico de Setúbal. Also, the research was partially funded by the Group for the Optimisation of Training and Sports Performance (GOERD) of the Faculty of Sports Sciences of the University of Extremadura and partially supported by the funding for research groups (GR21149) granted by the Government of Extremadura (Employment and infrastructure office—Consejería de Empleo e Infraestructuras), with the contribution of the European Union through the European Regional Development Fund (ERDF). Also, the author José M. Gamonales was supported by a grant from the Requalification Program of the Spanish University System, Field of Knowledge: Biomedical (MS-18).