The effect of exercise on bone mass and structural geometry during growth.
The effect of exercise on bone mass and structural geometry during growth.
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DOI：
10.1159/000103003
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发表时间：
2007-01-01
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影响因子：
--
通讯作者：
Daly, Robin M
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作者：
Daly, Robin M
据广泛报道，定期负重锻炼对生长期间的骨矿物质含量和面积骨矿物质密度有有益的影响，但这些变化背后的结构基础仍然不确定。在年轻的运动型儿童中，参与高冲击性运动已被证明可以增强骨骼负荷部位长骨骨膜和/或骨内膜表面的骨形成。参与适度的体力活动，娱乐游戏或以学校为基础的运动干预措施，旨在专门负荷骨也被证明可以提高骨矿物质的积累。然而，关于运动训练或一般体力活动对骨的表面特异性影响的数据很少。基于有限的数据，它似乎是骨骼的结构反应，运动在生长过程中是成熟依赖性和性别特异性;青春期前的运动似乎增加骨膜附着在两种性别，而在青春期期间或后期的运动似乎导致骨膜扩张男孩，但皮质内收缩女孩。在大多数情况下，这些几何变化导致骨弯曲强度增加。然而，关于青春期前或青春期周围是否是干预最大成骨反应的最佳时间，存在对比结果;这两个时期可能都是结合体力活动以优化骨骼健康的重要时间。关于增强儿童和青少年骨骼强度所需的最佳运动剂量（强度，频率，持续时间和进展速度）也有许多未解决的问题。我们知道负重锻炼很重要，而且活动应该是动态的，本质上是可变的，应用迅速和间歇性的，并且需要相对较少的负荷循环。虽然已经设计了几种有效的干预措施来改善骨量，但还需要进一步的研究来确定特定的运动计划或活动，以优化生长过程中的骨结构和强度。也许最重要的是，还需要进一步的工作来确定在生长过程中任何运动引起的骨量和结构的变化是否会在骨折发生时保持到老年。
Regular weight-bearing exercise is widely reported to have beneficial effects on bone mineral content and areal bone mineral density during growth, but the structural basis underlying these changes remains uncertain. In young athletic children, participation in high-impact sports has been shown to enhance bone formation on the periosteal and/or endosteal surfaces of long bones at loaded skeletal sites. Participation in moderate physical activity, recreational play or school-based exercise interventions designed to specifically load bone have also been shown to enhance bone mineral accrual. However, few data are available on the surface-specific effects of exercise training or general physical activity on bone. Based on the limited data available, it would appear that the structural response of bone to exercise during growth is maturity dependent and sex specific; prior to puberty exercise appears to increase periosteal apposition in both sexes, whereas during or late in puberty exercise appears to result in periosteal expansion in boys but endocortical contraction in girls. In most cases, these geometric changes lead to an increase in bone bending strength. However, there are contrasting results as to whether the pre- or peripubertal years are an optimal time to intervene for the greatest osteogenic response; it is likely that both periods represent an important time for incorporating physical activity to optimize bone health. There are also many unresolved questions as to the optimal dose of exercise (intensity, frequency, duration and rate of progression) needed to enhance bone strength in children and adolescents. We know that weight-bearing exercise is important, and that activities should be dynamic, variable in nature, applied rapidly and intermittently, and that relatively few loading cycles are required. Although several effective interventions have been designed for improving bone mass, further research is needed to define the specific exercise programs or activities that will optimize bone structure and strength during growth. Perhaps most importantly, further work is also needed to determine whether any exercise-induced alterations in bone mass and structure during growth are maintained into old age when fractures occur.