Increasing weight-bearing physical activity and calcium intake for bone mass growth in children and adolescents: a review of intervention trials

OBJECTIVE: The purpose of this review is to evaluate the current state-of-the-science for interventions to increase bone mass gains in children and adolescents using weight-bearing physical activity or calcium supplementation. METHODS: Studies were located using computerized and manual searches of the empirical literature. Inclusion criteria were: (a) intervention study targeting weight-bearing physical activity or calcium intake; (b) inclusion of a control group; (c) subject age range under 18 years; and (d) outcome measured bone mineral density or bone mineral content. RESULTS: Weight-bearing physical activity and calcium supplement intervention studies both consistently show positive effects on bone mass gains in children and adolescents. The most consistent findings for both weight-bearing physical activity and calcium were for lumbar spine and total body bone sites. Only weight-bearing physical activity interventions had significant effects on the femoral neck sites. Low power may have contributed to the lack of statistically significant findings in several studies and also prevented proper evaluation of potential interactions between pubertal status and interventions on bone mass gains. CONCLUSIONS: Increases in weight-bearing physical activity or calcium intake have positive effects on bone mass gains in children and adolescents. Further research is needed to evaluate: (a) the long-term durability of these effects; (b) specific dose-response associations; (c) interactions between weight-bearing physical activity and calcium intake; and (d) interactions between pubertal development and weight-bearing physical activity or calcium intake on bone mass outcomes.