Ci a ion: Rico-González, M.;
Ma ín-Moya, R.; Mo eno-Villanue a,
A. E ec s o Ea ly-Childhood-Based
In e en ions In luencing Bones: A
Sys ema ic Re iew. J. Func . Mo phol.
Kinesiol. 2024,9, 2. h ps://
doi.o g/10.3390/j mk9010002
Academic Edi o : Giuseppe
Musumeci
Recei ed: 22 No embe 2023
Re ised: 13 Decembe 2023
Accep ed: 15 Decembe 2023
Published: 20 Decembe 2023
Copy igh : © 2023 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
Jou nal o
Func ional Mo phology
and Kinesiology
Re iew
E ec s o Ea ly-Childhood-Based In e en ions In luencing
Bones: A Sys ema ic Re iew
Ma kel Rico-González 1,* , Rica do Ma ín-Moya 2and Ad ián Mo eno-Villanue a 3
1Depa men o Didac ics o Musical, Plas ic, and Co po al Exp ession, Uni e si y o he Basque Coun y,
UPV-EHU, 48940 Leioa, Spain
2Depa men o Physical Educa ion and Spo s, Facul y o Educa ion and Spo Sciences, Campus o Melilla,
Uni e si y o G anada, 52006 Melilla, Spain; ma inm@ug .es
3
Depa men o Heal h Sciences, Uni e si y Isabel I o Cas ille, 09003 Bu gos, Spain; mo [email p o ec ed]
*Co espondence: [email p o ec ed] o [email p o ec ed]
Abs ac : A heal hy li es yle om ea ly childhood is a c ucial ac o ha in luences bone- ela ed
ac o s in adul hood. In his con ex , physical educa ion o psychomo ici y om ea ly childhood is
an impo an oppo uni y o ace his p oblem. The p esen a icle aims o sys ema ically summa ize
school-based in e en ions, e alua ed h ough andomized con olled ial design, ha in luence
he bones o child en om ea ly childhood. A sys ema ic e iew o ele an a icles was ca ied ou
using ou main da abases (PubMed, P oQues Cen al (including 26 da abases), Scopus, and Web
o Sciences) un il 12 No embe 2023. F om a o al o 42 s udies ini ially ound, 12 we e included in
he quali a i e syn hesis. In b ie e ms, om ea ly childhood and du ing pube y, child en’s bones
a e pa icula ly esponsi e o exe cise, making his an ideal ime o in e en ions o maximize bone
heal h. The e o e, inco po a ing physical ac i i y in o school cu iculums is a s a egic app oach
o enhancing bone heal h in child en. Mainly, plyome ic exe cises can signi ican ly enhance bone
densi y and geome y. Ne e heless, collabo a ion among educa o s, heal hca e p o essionals, and
pa en s is key o designing and implemen ing hese e ec i e in e en ions.
Keywo ds: andomized con olled ials; heal h; eaching; educa ion; physiology; physical educa ion
1. In oduc ion
Physical exe cise is any bodily mo emen p oduced by skele al muscles ha expends
ene gy, al hough di e en ypes o exe cises may di e depending on he in ensi y, du a ion,
and equency o mo emen s [
1
]. Examples a e ae obic exe cise (i.e., any ac i i y ha uses
la ge muscle g oups, can be main ained con inuously, and is hy hmic in na u e) [
2
] o
o ce– eloci y-based exe cises (i.e., exe cises whe e he maximal o ce is in e sely ela ed
o he eloci y o sho ening) [
3
]. Fu he , he combina ion o di e en ypes o exe cises
may lead o di e en kinds o exe cise such as weigh -bea ing ae obic exe cises (i.e., impac
ac i i ies o any o he exe cise in which he a ms, ee , and legs a e bea ing he weigh ,
such as walking, s ai climbing, jogging, o dancing) o s eng h and/o esis ance exe cises
(i.e., he join s a e mo ed agains some kind o esis ance) [4].
Fo ins ance, he impo ance o physical exe cise add essed by he Uni ed Na ions
Educa ion, Scien i ic, and Cul u al O ganiza ion (UNESCO) suppo s he impo ance o
ueling an ac i e li es yle in all age anges [
5
]. Un o una ely, cu en da a highligh a
seden a y li es yle o 81% o child en, o ecas ing a 15% ela i e educ ion un il 2030 [
6
].
This ac may lead o nega i e consequences o child en’s heal h. An example o comba
his is educing he isk o su e ing om non-communicable diseases in adul hood, such
as high le els o obesi y- ela ed ch onic diseases including diabe es, me abolic synd ome,
o ca dio ascula disease (e.g., hype ension, ele a ed choles e ol) [
7
–
10
]. Hence, di e en
e ec s may be he eason o heal h isks and se ious long- e m consequences [11].
J. Func . Mo phol. Kinesiol. 2024,9, 2. h ps://doi.o g/10.3390/j mk9010002 h ps://www.mdpi.com/jou nal/j mk
J. Func . Mo phol. Kinesiol. 2024,9, 2 2 o 12
Among hese long- e m consequences a e bone- ela ed ac o s [
12
] such as bone mass,
p ope ies o cons i uen issue, and bone geome y [
13
]. One o he mos common diseases
is os eopo osis, which is a musculoskele al disease caused by a dec emen in bone mass and
des uc ion o he bone mic os uc u e [
14
]. Os eopo osis a ec s 200 million people wo ld-
wide, esul ing in 8.9 million ac u es e e y yea [
15
]. Acco ding o a ecen sys ema ic
e iew and me a-analysis, he p e alence o os eopo osis is 18.3% globally (
women = 23.1%
;
men = 11.7%) [
16
]. This disease is caused by changes in ho mone sec e ion ha lead o
he b eakdown o he o iginal balance in he body and cause dys unc ion in s uc u es
such as bones [
17
]. This diso de may be shown in he skele on by a educ ion in bone
mine al densi y caused by luc ua ions in os eoclas and os eoblas ac i i y [
14
]. Howe e ,
he p oblems ha may a ec bones may a ise om ea ly childhood. Fo example, some
o he diseases such as he me abolic bone disease o p ema u i y (cha ac e ized by skele al
demine aliza ion o , in some cases, agili y ac u es) a ise om p ena al and pos na al
ac o s, when an in an bo n p e e m may be dep i ed o e al mine al accumula ion [
18
].
Fo una ely, and conside ing he educ ion in he quali y o li e and mobili y ha bone-
ela ed diseases p o oke, many s udies ha e highligh ed non-pha macological app oaches
o he p e en ion o os eopo osis ega ding exe cise [
15
], an h opome y, sleep dis up ions
(e.g., abno mal sleep du a ion, nigh shi wo k) [
19
], o nu i ion (e.g., impo ance o cal-
cium and i amin D) [
15
], which may highligh he impo ance o ca ing o heal h- ela ed
habi s om he i s yea s o li e.
In a s udy pe o med wi h pa icipan s om ea ly childhood o 30 yea s o age [
20
],
he au ho s highligh ed ha he peak bone mass occu s be ween he end o he second
decade and ea ly in he hi d decade o li e, al hough i depends on he skele al si e. This
idea suppo s he impo ance o he ci cumpube al yea s o acc uing bone mine als [
20
].
Thus, due o he impo ance o li es yle in bone- ela ed ac o s, he impo ance o p ac ic-
ing egula exe cise om childhood o educing he isk o os eopo osis and associa ed
ac u es has been highligh ed. The con e gence o his c i ical pe iod o bone acc ual and
bone loading is conside ed a “window o oppo uni y” o he de elopmen o a heal hy
skele on. This impo an pe iod s a s om ea ly childhood, as a uni e sal consensus
highligh s he e ec s o an eceden s o educing adul bone heal h p oblems [
21
]. This ac
places educa ion, in gene al, and physical educa ion, in pa icula , as a c ucial oppo uni y
o ace his p oblem.
To da e, di e en sys ema ic e iews ha e ied o analyze he e ec s o exe cise on
bone- ela ed ac o s in child en and adolescen s. Examples a e analyzing he in luence
o physical ac i i y on bone s eng h in child en and adolescen s [
21
], he in luence o
seden a y beha io and bone heal h [
12
], and he compa ison o he associa ion be ween
bone heal h and di e en in ensi ies o accele ome e -de i ed habi ual physical ac i i y [
20
].
Howe e , o he bes o he au ho s’ knowledge, he e is no sys ema ic e iew ha ied o
analyze he e ec s o di e en school-based in e en ions, e alua ed h ough andomized
con olled ial design, on child en’s bone- ela ed ac o s om he ea ly childhood pe iod.
The p esen a icle aims o sys ema ically summa ize school-based in e en ions,
e alua ed h ough andomized con olled ial design, ha in luence he bones o child en
om ea ly childhood.
2. Ma e ials and Me hods
2.1. Expe imen al App oach o he P oblem
The p esen sys ema ic e iew was ca ied ou acco ding o wo guidelines: he
P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses (PRISMA) guide-
lines [22] and he guidelines o pe o ming sys ema ic e iews in spo sciences [23].
2.2. In o ma ion Sou ces
Fou main da abases we e selec ed o iden i y he a icles published be o e 12 No em-
be 2023: (1) PubMed, (2) P oQues Cen al (including 26 da abases), (3) Scopus, and
(4) Web o Sciences.
J. Func . Mo phol. Kinesiol. 2024,9, 2 3 o 12
2.3. Sea ch S a egy
Following he PICO design p o ided by PRISMA, he ollowing sea ch s a egy was
used o look o ele an a icles, whe e he au ho s we e no blinded o jou nal names o
manusc ip s’ au ho s:
(p eschool OR kinde ga en OR “p ima y educa ion” OR “elemen a y educa ion” OR
school) AND (“physical educa ion”) AND (bone*) AND (“ andomized con olled ial*”).
2.4. Inclusion/Exclusion C i e ia
Two au ho s independen ly comple ed he sea ch and compa ed esul s o ensu e
ha he same a icles we e iden i ied. Then, iden i ying in o ma ion om he pape s
( i le, au ho s, da e, and da abase) was downloaded and ans e ed in o an Excel sp ead-
shee (Mic oso Co po a ion, Redmond, WA, USA), and duplica es we e emo ed. The
emaining a icles we e independen ly sc eened o mee ing inclusion and exclusion c i-
e ia (Table 1). Mo eo e , ele an a icles no p e iously iden i ied we e also sc eened
iden ically, and u he s udies ha complied wi h he inclusion/exclusion c i e ia we e
included and labeled as “included om ex e nal sou ces”.
Table 1. Inclusion/exclusion c i e ia.
Topic Inclusion Exclusion Sea ch Cohe ence
Popula ion
Child en om p eschool,
kinde ga ens, o elemen a y
educa ion
Child en who do no a end p eschool,
kinde ga ens, o elemen a y educa ion
p eschool OR kinde ga en OR
“p ima y educa ion” OR
“elemen a y educa ion” OR school
In e en ion
o exhibi ion
Child en in ol ed in
school-aged in e en ion
Child en no in ol ed in p eschools o
elemen a y educa ion “physical educa ion”
Resul s Ou comes ela ed o bones
Resul s ex ac ed om eache ’s opinion,
in e iews, obse a ions, pe cep ions, o
expe iences du ing a ce ain p og am.
P og am p oposals wi hou conside ing
child en in hei s udies.
S udy p o ocols.
Bone
S udy design Randomized con olled ials
o pa allel ials
Non- andomized con olled ials o
pa allel ials “ andomized con olled ial*”
O he c i e ia Pee - e iewed, o iginal,
ull- ex s udies
A icles w i en wi hou pee s, e iewing
he comple e o iginal ex s udies. -
2.5. Da a Ex ac ion
Da a ex ac ion was p epa ed using an Excel sp eadshee in acco dance wi h he
Coch ane Consume s and Communica ion Re iew G oup’s da a ex ac ion empla e
(G oup, 2016). The sp eadshee was used o assess inclusion and exclusion equi emen s
o all selec ed s udies. The p ocess was independen ly conduc ed by he wo au ho s. Any
disag eemen ega ding s udy eligibili y was esol ed in a discussion. Full ex a icles
ha we e excluded om he analysis we e eco ded wi h easons o exclusion. All eco ds
we e s o ed in he sp eadshee .
2.6. Assessmen o S udy Me hodology
The Physio he apy E idence Da abase (PED o) scale was used o assess he me hod-
ological quali y o p e- es and pos - es s udies wi h expe imen al (EXP) and con ol (CON)
g oups andomly selec ed. The scale sco es he in e nal s udy alidi y in a ange o ze o
(low me hodological quali y) o 10 (high me hodological quali y). The sco e ha each
sec ion ecei es can be om ze o (“no”) o one (“yes”), depending on he quali y ob ained
by each poin . Ten i ems a e measu ed in he scale. S udies ha sco e om 9 o 10 on
he PED o scale a e conside ed o be o excellen me hodological quali y. S udies wi h a
J. Func . Mo phol. Kinesiol. 2024,9, 2 4 o 12
sco e be ween six and eigh ha e good me hodological quali y, be ween ou and i e, ai
quali y, and below ou poin s, poo me hodological quali y [24].
3. Resul s
3.1. Iden i ica ion and Selec ion o S udies
A o al o 42 o iginal a icles we e ound, o which 16 we e duplica es. Thus, a o al
o 26 unique a icles we e iden i ied. A e checking i les and abs ac s, se en a icles
we e excluded because hey did no mee inclusion c i e ion numbe i e. The ull ex o
he emaining 19 a icles was hen analyzed; one a icle was excluded because i did no
mee inclusion c i e ion numbe one, wo a icles we e excluded because hey did no mee
inclusion c i e ion numbe wo, and ou a icles we e excluded because hey did no mee
exclusion c i e ion numbe h ee. Thus, a o al o 12 a icles me all o he inclusion c i e ia
and we e included in he inal quali a i e syn hesis (Figu e 1).
J. Func . Mo phol. Kinesiol. 2024, 9, x FOR PEER REVIEW 4 o 13
2.6. Assessmen o S udy Me hodology
The Physio he apy E idence Da abase (PED o) scale was used o assess he me hod-
ological quali y o p e- es and pos - es s udies wi h expe imen al (EXP) and con ol
(CON) g oups andomly selec ed. The scale sco es he in e nal s udy alidi y in a ange
o ze o (low me hodological quali y) o 10 (high me hodological quali y). The sco e ha
each sec ion ecei es can be om ze o (“no”) o one (“yes”), depending on he quali y
ob ained by each poin . Ten i ems a e measu ed in he scale. S udies ha sco e om 9 o
10 on he PED o scale a e conside ed o be o excellen me hodological quali y. S udies
wi h a sco e be ween six and eigh ha e good me hodological quali y, be ween ou and
i e, ai quali y, and below ou poin s, poo me hodological quali y [24].
3. Resul s
3.1. Iden i ica ion and Selec ion o S udies
A o al o 42 o iginal a icles we e ound, o which 16 we e duplica es. Thus, a o al
o 26 unique a icles we e iden i ied. A e checking i les and abs ac s, se en a icles
we e excluded because hey did no mee inclusion c i e ion numbe i e. The ull ex o
he emaining 19 a icles was hen analyzed; one a icle was excluded because i did no
mee inclusion c i e ion numbe one, wo a icles we e excluded because hey did no
mee inclusion c i e ion numbe wo, and ou a icles we e excluded because hey did
no mee exclusion c i e ion numbe h ee. Thus, a o al o 12 a icles me all o he inclu-
sion c i e ia and we e included in he inal quali a i e syn hesis (Figu e 1).
Figu e 1. Flow diag am o he s udy.
3.2. Quali y Assessmen
The quali y assessmen o his sys ema ic e iew can be ound in Table 2:
Table 2. Me hodological assessmen o he included s udies.
Re e ence 1 2 3 4 5 6 7 8 9 10 Sco e
Anlike e al. [25] 1 1 1 1 1 1 0 1 1 1 9
Daly e al. [26] 1111111111 10
Fuchs e al. [27] 1111101110 8
Golds ein e al. [28]1111110111 9
J. Func . Mo phol. Kinesiol. 2024,9, 2 5 o 12
Table 2. Con .
Re e ence 1 2 3 4 5 6 7 8 9 10 Sco e
Gu in e al. [29] 1101110110 7
La sen e al. [30] 1111101111 9
Macdonald e al. [31]1111111111 10
MacKel ie e al. [32]1111110111 9
Meye e al. [33] 1111100101 7
Meye e al. [34] 1101110111 8
Weeks e al. [35] 1 1 1 1 1 1 1 1 1 0 9
Weeks and Beck [36]1111101111 9
No e: I em 1 = subjec s we e andomly alloca ed o g oups (in a c osso e s udy, subjec s we e andomly alloca ed
an o de in which ea men s we e ecei ed); I em 2 = alloca ion was concealed; I em 3 = he g oups we e
simila a baseline ega ding he mos impo an p ognos ic indica o s; I em 4 = he e was blinding o all subjec s;
I em 5 = he e
was blinding o all he apis s who adminis e ed he he apy; I em 6 = he e was blinding o all
assesso s who measu ed a leas one key ou come; I em 7 = measu es o a leas one key ou come we e ob ained
om mo e han 85% o he subjec s ini ially alloca ed o g oups; I em 8 = all subjec s o whom ou come measu es
we e a ailable ecei ed he ea men o con ol condi ion as alloca ed o , whe e his was no he case, da a o
a leas one key ou come was analyzed by “in en ion o ea ”; I em 9 = he esul s o be ween-g oup s a is ical
compa isons a e epo ed o a leas one key ou come; I em 10 = he s udy p o ides bo h poin measu es and
measu es o a iabili y o a leas one key ou come.
F om he 12 included a icles, eigh ob ained an excellen me hodological quali y
sco e [
25
,
26
,
28
,
30
,
32
,
35
,
36
], while he emaining ou s udies ob ained a good me hodologi-
cal quali y sco e [27,29,33,34]. None o he included s udies had ai o poo me hodologi-
cal quali y.
3.3. S udy Cha ac e is ics
A o al o 12 a icles we e inally selec ed. F om hem, only wo deal wi h subjec s
abou pube al age (13–17 yea s) [
35
,
36
], while he emaining 10 a icles analyzed subjec s
in bo h p epube al and ea ly pube al s ages (6–12 yea s) [
25
,
30
–
34
]. In addi ion, i is
wo h no ing he wide a ie y o coun ies ha in eg a ed his ype o s udy, such as
he USA [
27
,
29
], Swi ze land [
25
,
33
,
34
], Is ael [
28
], Canada [
31
,
32
], Denma k [
30
], and
Aus alia [35,36].
Assessmen ools: Dual-ene gy X- ay abso p iome y (DXA) was
used [25–27,29,30,32–36]
,
ollowed by ul asound densi ome e [
28
,
35
,
36
] and pe iphe al quan i a i e compu ed
omog aphy (pQCT) [26,31].
In e en ion p o ocols: Six a icles ca ied ou in e en ion p og ams based on plyo-
me ic exe cises (mainly high-in ensi y aining ha in ol es explosi e mo emen s based
on he S e ch-Sho ening Cycle (SSC)). This cycle enhances he powe o he subsequen
mo emen [
25
,
27
,
30
,
32
,
35
,
36
], while he es o he s udies pu posed o he me hodologies:
he implemen a ion o a ied high-in ensi y ac i i ies in 10-min ime pe iods [
28
,
31
,
33
,
34
]
and spo s p ac ices [26,29,30].
Du a ion o he in e en ions: The du a ion o he di e en in e en ion p o ocols was
cha ac e ized by he e ogenei y, wi h pe iods anging om 7 mon hs [
27
,
32
] o 4 yea s [
26
].
Ou comes: Rega ding he esul s o bone pa ame e s, 10 ou o 12 s udies de ec ed
signi ican imp o emen s in he in e en ion g oups compa ed o hei espec i e con ol
g oups [26–35].
Sex and age: Signi ican imp o emen s in bo h sexes we e ound, al hough bo h agen s
achie ed di e en magni udes in he a iables analyzed [26,28,31,32,35].
Finally, only wo a icles examined he adhe ence and con inui y o he imp o e-
men s acqui ed om he in e en ion p og ams a e a ew yea s [
33
,
36
], while only one
highligh ed he impo ance o physical ac i i y habi s du ing he h ee yea s wi hou
in e en ion [33].
The cha ac e is ics o he s udies we e ex ac ed and a e clus e ed in Table 3:
J. Func . Mo phol. Kinesiol. 2024,9, 2 6 o 12
Table 3. In e en ions o imp o ing bone- ela ed ac o s.
In e en ion Resul s
Re e ence
Aim Sample Name/G oups In e en ion Main Ideas
Du a ion
E alua ion
Tool Va iables Resul s Conclusions
Anlike
e al. [25]
Assess adap a ions o
he lowe leg
muscle-bone uni
Nº child en: 45
Schools: 3
Coun y: Swi ze land
Mean age:
10.6 ±1.1 yea s
Range: 8–12 yea s
EXP (n= 22)
45’ sessions (×1/week) and
90’ sessions (×1/week)
EXP: Jumping p o ocol
(10 min) wi hin physical
educa ion classes.
CON: Educa ion classes in
acco dance wi h he o icial
cu iculum by playing ag
and/o ela ed ac i i ies.
9 mon hs
DXA
XCT 3000
Scanne
FmILH
Tibial bone
s eng h/geome y
No signi ican changes in bone
s eng h/geome y in EXP and
CON (+3% o +1% poin s,
espec i ely)
Rela ionship be ween Fm1LH and
BMC a he 14% si e e y s ong in
bo h g oups (0.51 ≤R2 ≤0.88)
In he child en, g ow h and
exe cise did no inc ease
bone s eng h
p opo ionally, meaning ha
he adap i e p ocesses we e
no igh ly coupled and did
no ollow di e en
ime cou ses.
CON (n= 23)
Daly
e al. [26]
E alua e e ec s o a
specialis - augh PE
p og am on bone
s eng h and body
composi ion
Nº child en: 727
Schools: 29
Coun y: 30
Mean age: 8.1 ±0.3 yea s
EXP (n= 398)
Li es yle o
Ou Kids
(LOOK) s udy 50’ sessions (×2/week)
INT: Bluea h
Founda ion p og am
CON: Cu en p ac ice
4 yea s DXA
pQCT
BMC
Radius and ibia
(4% and 66%
si es) bone
s uc u e
Volume ic
densi y
BMC simila in bo h g oups.
EXP gi ls had g ea e gains in
co ical a ea (CoA) and co ical
hickness (CoTh) a he mid- ibia
(CoA = +7.5%; CoTh = +5.0%) and
adius (CoA = +9.3%;
CoTh = +14.4%)
EXP boys had gains in mid- ibia
CoTh (+5.2%)
Specialis -led school-based
PE p og am imp o es
co ical bone s uc u e, due
o educed endoco ical
expansion.
CON (n= 329)
Fuchs
e al. [27]
In es iga e he e ec s
o high-in ensi y
jumping on hip and
lumba spine bone
mass in child en
Nº child en: 89
Schools: 1
Coun y: USA
Mean age: 7.5 ±0.16
EXP (n= 45) 20’ sessions (×3/week)
EXP: Jump o he 61-cm-high
boxes, using he 20-cm-high
boxes as a s ep
CON: Non-impac /jumping
exe cises.
7 mon hs DXA BMC
Bone a ea
BMD
G ea changes in emo al neck
(+4.5%) and lumba spine (+3.1%)
in EXP compa ed o CON.
BMD a he lumba
spine signi ican ly g ea e in EXP
han in CON (+2.0%).
Bone a ea had signi ican ly g ea e
inc eases in EXP a he emo al
neck han con ols (+2.9%)
Jumping a g ound eac ion
o ces o eigh imes body
weigh is a sa e, e ec i e,
and simple me hod o
imp o ing bone mass a he
hip and spine in child en.
CON (n= 44)
Golds ein
e al. [28]
In es iga e he e ec on
young child en who
pa icipa ed in a
school-based
in e en ion p og am
on bone p ope ies
Nº child en: 295
Schools: 5
Coun y: Is ael
Range age: 6–8 yea s
EXP EXP: 10’ weekly medium- o
high-in ensi y ac i i ies
CON: Cu en p ac ice 1 yea Ul asound
Densi ome e
Dis al adius
Tibia sha
Dis al adius p ope ies imp o ed
signi ican ly o bo h boys and gi ls
in EXP (boys: +2.80%; gi ls: +3.30%)
Tibia sha p ope ies only
signi ican ly imp o ed o boys
(+1.90%)
Dis al adius p ope ies o
child en can be posi i ely
a ec ed by a sho , easy o
implemen in e en ion
p og am ha does no
equi e special esou ces.
CON
Gu in
e al. [29]
E alua e he e ec o a
3-yea a e -school PA
in e en ion on ae obic
i ness and pe cen
body a
Nº child en: 206
Schools: 18
Coun y: USA
Mean age: 8.5 ±0.6 yea s
EXP (n= 42)
(Fi Kid
p og am.)
80’ sessions (×5/week)
EXP: Spo skills, ae obic
i ness,
s eng h, and lexibili y + 40
min o igo ous PA
CON: Cu en PA p ac ice
3 yea s DXA BMD EXP inc eased mo e han CON in
BMD (+14.2%; p≤0.01)
An a e -school p og am
ocusing on MVPA had a
bene icial e ec on i ness
and body composi ion, bu
his bene icial e ec was los
du ing he summe .
CON (n= 164)
J. Func . Mo phol. Kinesiol. 2024,9, 2 7 o 12
Table 3. Con .
In e en ion Resul s
Re e ence
Aim Sample Name/G oups In e en ion Main Ideas
Du a ion
E alua ion
Tool Va iables Resul s Conclusions
La sen
e al. [30]
In es iga e whe he
musculoskele al
i ness o school
child en aged
8–10 yea s was a ec ed
by equen in ense PE
sessions
Nº child en: 295
Schools: 6
Coun y: Denma k
Mean age: 9.3 ±0.3 yea s
Range age: 8–10 yea s
CST (n= 83)
SSG (n= 96)
40’/session
CST: ×4 sessions/week;
6–10 s a ions wi h plyome ic
and s eng h exe cises
SSG: ×5 sessions/week; 3 s.
3 oo ball o baske ball games
CON: ×5 sessions/week o
cu en p ac ice
10
mon hs DXA aBMD
BMC
SSG had highe change sco es in
leg aBMD compa ed wi h CON
and CST (SSG s. CON:
19 mg/cm2, 95% CI 11 o 39,
p< 0.05; SSG s. CST: 12 mg/cm2,
95% CI 3 o 21, p< 0.05).
CST had highe change sco es in
whole-body BMC compa ed wi h
CON (CST s. CON: 25 g, 95% CI
10 o 39, p< 0.05)
Well-o ganized in ense
physical educa ion classes
can con ibu e posi i ely o
de elop musculoskele al
heal h in young child en.
CON (n= 116)
Macdonald
e al. [31]
De e mine whe he
“AS! BC” p og am
would imp o e ibial
bone s eng h in boys
and gi ls
Nº child en: 410
Schools: 10
Coun y: Canada
(Mean age:
10.3 ±0.6 yea s)
EXP (n= 281)
(Ac ion Schools!
BC p og am) 40’ sessions (×2/week)
EXP: 1º componen : +15’ PA
(×5 days/week)
2º componen : ×3 pe iods o
3’ PA (×4 days/week)
CON: Cu en p ac ice
(40’ sessions; ×2/week)
16
mon hs pQCT BSI
SSIp
EXP boys had a g ea e inc ease
in BSI (+774.6 mg2/mm4; 95% CI:
672.7, 876.4) han CON boys
(+650.9 mg2/mm4; 95% CI:
496.4, 805.4)
EXP boys had a g ea e inc ease in
SSIp (+198.6 mm3; 95% CI: 182.9,
214.3) han CON boys (+177.1
mm3; 95% CI: 153.5, 200.7)
Change in BSI and SSIp was simila
be ween CON and EXP gi ls
A simple, p agma ic
p og am o daily ac i i y
enhances bone s eng h
a he dis al ibia in
p epube al boys.
CON (n= 129)
MacKel ie
e al. [32]
E alua e he e ec s o
PE in e en ion
p og am on bone
mine al acc ual in
p epube al
and ea ly pube al gi ls
Nº child en: 87
Schools: 14
Coun y: Canada
Mean age: 10 ±0.7 yea s
Range age: 8.7–11.7 yea s
EXP (n= 45)
EXP: 10’ sessions (×3/week)
ci cui o a ied
jumping ac i i ies
CON: 10’ sessions o
s e ching wa m-up a he
beginning o
hei PE classes
7 mon hs DXA
BMC and BMD
o : Lumba spine
P oximal emu
Femo al neck
No di e ence in change in bone
pa ame e s be ween
p epube al EXP and CON
EXP ea ly pube al gi ls gained
mo e bone a he emo al neck and
lumba spine (1.5% o 3.1%) han
CON ea ly pube al gi ls (p< 0.05)
In gi ls, ea ly pube y may
be a pa icula ly oppo une
ime du ing g ow h o
simple exe cise
in e en ions o ha e a
posi i e e ec on bone
heal h.
CON (n= 42)
Meye
e al. [33]
Measu ed BMC and
aBMD 3 yea s a e
cessa ion o he KISS
in e en ion
o in es iga e whe he
he bene icial
sho - e m e ec s
pe sis ed
Nº child en: 502
Schools: 15
Coun y: Swi ze land
Mean age: 9.2 ±2.2 yea s
Range age: 6–12 yea s
EXP (n= 297)
(KISS p og am) 45’ sessions (×3/week)
EXP: Addi ional 10’ Impac
loading ac i i ies (×2/week)
CON: Cu en PA p ac ice.
9 mon hs DXA
BMC and aBMD
o : To al body
Femo al neck
To al hip Lumba
spine
EXP showed signi ican ly highe
Z-sco es o BMC a o al body
(0.157 uni s (0.031–0.283); p= 0.015),
emo al neck (0.205 uni s
(0.007–0.402); p= 0.042) and a o al
hip (0.195 uni s (0.036 o 0.353);
p= 0.016) compa ed o CON.
EXP had highe Z-sco es o aBMD
o o al body (0.167 uni s (0.016 o
0.317); p= 0.030) compa ed o CON.
Bene icial e ec s on BMC o
a nine mon h KISS p og am
appea ed o pe sis o e
h ee yea s. Pa o he
main ained e ec s may be
explained by cu en
physical ac i i y habi s.
CON (n= 205)
J. Func . Mo phol. Kinesiol. 2024,9, 2 8 o 12
Table 3. Con .
In e en ion Resul s
Re e ence
Aim Sample Name/G oups In e en ion Main Ideas
Du a ion
E alua ion
Tool Va iables Resul s Conclusions
Meye
e al. [34]
De e mine whe he a
school-based PA
p og am du ing one
school-yea in luences
BMC and BMD
Nº child en: 502
Schools: 15
Coun y: Swi ze land
Mean age: 9.2 ±2.2 yea s
Range age: 6–12 yea s
EXP (n= 297)
(KISS p og am)
45’ sessions (×3/week)
EXP: Addi ional 10’ Impac
loading ac i i ies (×2/week)
CON: Cu en PA p ac ice
9 mon hs DXA
BMC and aBMD
o : To al body
Femo al neck
To al hip Lumba
spine
Compa ed o CON, EXP child en
showed s a is ically signi ican
inc eases in BMC o o al body,
emo al neck, and lumba spine by
5.5%, 5.4% and 4.7% (all p< 0.05),
espec i ely.
EXP child en had g ea e inc eases
in BMD o o al
body and lumba spine by 8.4%
and 7.3% (bo h p< 0.01),
espec i ely, compa ed o CON.
A gene al school-based PA
in e en ion can inc ease
bone heal h in elemen a y
school child en o bo h
gende s, pa icula ly be o e
pube y.
CON (n= 205)
Weeks
e al. [35]
De e mine he e ec o
POWER PE p og am
on pa ame e s o bone
and muscle s eng h in
heal hy adolescen boys
and gi ls
Nº child en: 81
Schools: 1
Coun y: Aus alia
Mean age:
13.8 ±0.4 yea s
Range age: 12–14 yea s
EXP (n= 43)
(POWER PE
p og am) (×2/week)
EXP: 10’ Jumping exe cises a
he beginning o each PE class.
CON: Usual PE wa m-up
ac i i ies
8 mon hs
DXA
Ul asound
Densi ome e
BMC
Bone geome ic
EXP boys expe ienced mo e
imp o emen s in calcaneal
b oadband ul asound a enua ion
(+5.0%) compa ed o CON (+1.4%)
EXP gi ls had mo e imp o ed
emo al neck BMC (+13.9%) and
lumba spine BMAD (+5.2%) han
CON (+4.9% and +1.5%,
espec i ely)
The POWER PE p og am
imp o ed indices o bone in
heal hy adolescen boys and
gi ls in he high school PE
se ing wi hou he need o
addi ional s a ing o
equipmen .
CON (n= 38)
Weeks &
Beck [36]
De e mine i he
musculoskele al
bene i s o a POWER
PE p og am in heal hy
adolescen boys and
gi ls we e main ained
3 yea s la e
Nº child en: 29
Schools: 1
Coun y: Aus alia
Mean age:
17.3 ±0.4 yea s
Range age: 16–18 yea s
EXP (n= 11)
(POWER PE
p og am)
(×2/week)
EXP: 10’ Jumping exe cises a
he beginning o each PE class.
CON: Usual PE wa m-up
ac i i ies
3 yea s
la e
DXA
Ul asound
Densi ome e
BMC
Bone geome ic
No signi ican g oup di e ences in
h ee-yea change in b oadband
ul asound a enua ion o
BMC a any si e (p> 0.05)
Os eogenic bene i s o an
8-mon h in-school jumping
in e en ion o adolescen s
can be sus ained o a leas
h ee yea s (in o young
adul hood).
CON (n= 18)
No e: BMC = Bone mine al con en ; BMD = Bone mine al densi y; BSI = Bone s eng h index; CI = Con idence in e al; CON = Con ol g oup; CST = Ci cui s eng h aining;
DXA = Dual-ene gy X- ay abso p iome y; EXP = Expe imen al g oup; FmILH = Mul iple one-legged hopping; PA = Physical ac i i y; PE = Physical exe cise; pQCT = Pe iphe al
quan i a i e compu ed omog aphy; SSG = Small sided game; SSIp = Pola s eng h s ain index.
J. Func . Mo phol. Kinesiol. 2024,9, 2 9 o 12
4. Discussion
The p esen a icle aimed o sys ema ically summa ize school-based in e en ions,
e alua ed h ough andomized con olled ial design, ha in luence he bones o child en
om ea ly childhood.
In his e iew, he e we e only h ee p og ams de eloped du ing physical educa ion
classes. The e o e, since i is a s a egic app oach o enhancing bone heal h in child en,
aking ad an age o he po en ial o his cu icula subjec and inco po a ing physical
exe cise p og ams in school cu icula is necessa y [
37
]. By a ge ing his in e en ion
a an age whe e bones a e mos esponsi e o exe cise, and ensu ing ha i is inclusi e
and adap able o bo h gende s, educa ion om ea ly childhood can play a pi o al ole
in es ablishing he ounda ion o li elong bone heal h and o e all well-being. Following
MacKel ie e al. [
32
], ea ly pube y may be a pa icula ly sui able ime o gi ls du ing
g ow h o pe o ming physical exe cise in e en ions in o de o ha e a posi i e e ec on
bone heal h. In his con ex , he onse o pube y b ings an inc emen in gi ls’ es ogen
le els, which signi ican ly in luence bone densi y. In ac , es ogen is i al o closing he
g ow h pla es and inc easing he bone mine al densi y [
38
]. While he pa e ns o bone
g ow h may a y be ween boys and gi ls, he bene i s o physical ac i i y o bone heal h
a e signi ican in bo h gende s [39].
The egula plyome ic exe cises may also lead o an inc emen in bone mine al densi y
in he lowe ex emi ies, which is a key ac o in o e all bone
heal h [25,27,30,32,35,36]
.
Beyond densi y, he plyome ic exe cises can also imp o e bone geome y, making bones
no jus dense bu also s uc u ally sound [
40
]. O he ypes o exe cise ha can in lu-
ence bones a e weigh -bea ing physical ac i i ies such as unning, jumping, and spo s,
which can s imula e bone g ow h h ough mechano-s imula ion [
41
]. The s ess placed
on bones du ing hese ac i i ies p omp s bone- o ming cells o inc ease bone mass and
s eng h [
42
]. Following La sen e al. [
30
], since peak bone mass is no ye achie ed in
his popula ion g oup, his pe iod is op imal o in e en ions like plyome ic aining o
enhance bone p ope ies. In addi ion, he plyome ic exe cises also con ibu e o imp o ed
muscula s eng h, coo dina ion, and balance, which a e impo an o o e all physical
de elopmen [43].
In his e iew, o al body, emo al neck, and lumba spine showed imp o emen s in
BMC and BMD du ing physical exe cise p og ams in bo h sexes [
27
,
32
–
35
]. Acco ding o
Lu e al. [
44
], he emo al neck, a c i ical egion o he hip, bene i s g ea ly om physical
exe cise. Gi en he emo al neck’s impo ance in weigh -bea ing and i s ulne abili y
in la e li e (e.g., hip ac u es), s eng hening his a ea du ing childhood is pa icula ly
bene icial [
37
]. The lumba spine is ano he key a ea ha bene i s om egula physical
exe cise. Exe cises ha in ol e bending, wis ing, and li ing can inc ease he BMC and
BMD in he e eb ae, which a e i al o spinal heal h and pos u e [
45
]. Building s ong
bones du ing childhood can educe he isk o os eopo osis and ac u es la e in li e,
especially in ulne able a eas like he hip and spine [46].
The impac o physical exe cise p og ams on he dis al adius and ibia p ope ies in
bo h boys and gi ls, wi h gi ls expe iencing g ea e gains in he co ical a ea (CoA) and
co ical hickness (CoTh) a he mid- ibia and adius [
47
], is an in iguing aspec o pedia ic
bone de elopmen and adap a ion o exe cise. These ou comes a e highligh ed in his
sys ema ic e iew in a ious s udies [
26
,
28
]. The obse a ion ha gi ls show inc emen s
in CoA and CoTh in he mid- ibia and adius may be linked o ho monal di e ences
and hei esponse o mechanical loading du ing ce ain de elopmen al s ages [
48
]. Boys
also bene i om exe cise p og ams in e ms o bone p ope ies and he pa e n o hei
bone de elopmen . Mo eo e , boys may espond di e en ly o exe cise due o ac o s like
ho monal changes, g ow h a es, and he iming o g ow h spu s [
49
]. The co ical a ea
and co ical hickness a e key indica o s o bone s eng h [
50
]. The co ical bone is he
dense ou e su ace o bone ha con ibu es signi ican ly o bone s eng h and s abili y.
This e iew highligh s he need o inco po a e physical exe cise p og ams in o school
cu icula om ea ly childhood o enhancing bone heal h in child en, emphasizing ha
