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Kathleen F. Janz and Shelby L. Francis

Although there is strong and consistent evidence that childhood and adolescent physical activity is osteogenic, the evidence concerning its sustained effects to adult bone health is not conclusive. Therefore the value of interventions, in addition to beneficial bone adaptation, could be exposure to activities children enjoy and therefore continue. As such, interventions should provide skills, pleasure, and supportive environments to ensure continued bone-strengthening physical activity with age. Until the dose-response as well as timing of physical activity to bone health is more fully understood, it is sensible to assume that physical activity is needed throughout the lifespan to improve and maintain skeletal health. Current federal guidelines for health-related physical activity, which explicitly recommend bone-strengthening physical activities for youth, should also apply to adults.

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Donald A. Bailey and Alan D. Martin

A considerable amount of research into osteoporosis has focused on the management and treatment of bone loss in later life. More recently, a limited amount of research has been directed toward the development of an optimal level of peak bone mass during the adolescent and early adult years. While genetics is a major determinant of bone status, there is considerable evidence that physical activity is an important nonhereditary factor. Studies on adults suggest that the positive effect of physical activity on bone is modest in the short term but may be quite powerful with more intense activity that overloads the muscular system for a longer time period. In children, however, our knowledge about the long-term effects of physical activity on bone accretion is incomplete. This paper presents a review of the pediatric literature dealing with the relationship of physical activity to bone mineral density status in the adolescent population.

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Lauren A. Burt, David A. Greene, and Geraldine A. Naughton

skeletal health of young male gymnasts. Methods Search Strategy and Selection Criteria In December 2016, the search strategy was run using 6 online databases: CINAHL, Embase, MEDLINE, Scopus, SPORTDiscus, and Web of Science. Table  1 provides an example of the terms used in the search strategy. Table 1

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Joshua N. Farr, Deepika R. Laddu, and Scott B. Going

Although primarily considered a disorder of the elderly, emerging evidence suggests the antecedents of osteoporosis are established during childhood and adolescence. A complex interplay of genetic, environmental, hormonal and behavioral factors determines skeletal development, and a greater effort is needed to identify the most critical factors that establish peak bone strength. Indeed, knowledge of modifiable factors that determine skeletal development may permit optimization of skeletal health during growth and could potentially offset reductions in bone strength with aging. The peripubertal years represent a unique period when the skeleton is particularly responsive to loading exercises, and there is now overwhelming evidence that exercise can optimize skeletal development. While this is not controversial, the most effective exercise prescription and how much investment in this prescription is needed to significantly impact bone health continues to be debated. Despite considerable progress, these issues are not easy to address, and important questions remain unresolved. This review focuses on the key determinants of skeletal development, whether exercise during childhood and adolescence should be advocated as a safe and effective strategy for optimizing peak bone strength, and whether investment in exercise early in life protects against the development of osteoporosis and fractures later in life.

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Marta C. Erlandson, Shonah B. Runalls, Stefan A. Jackowski, Robert A. Faulkner, and Adam D.G. Baxter-Jones

peak bone mass during growth could reduce the risk of fracture later in life by 50% ( 9 ). Of the modifiable factors that influence bone development, physical activity may have the greatest potential to impact lifetime skeletal health. It is well documented that habitual physical activity during

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Zach Fassett, Adam E. Jagodinsky, David Q. Thomas, and Skip M. Williams

little effect on increasing bone strength and BMD and no longer aid in preventing attenuating effects on bone loss into late adulthood ( 17 ). However, prepubertal or early pubertal bone growth contributes to a greater peak bone mass, which can improve skeletal health into adulthood ( 9 ). Activities

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Erreka Gil-Rey, Kevin C. Deere, Sara Maldonado-Martín, Natalia Palacios-Samper, Agueda Azpeitia, Esteban M. Gorostiaga, and Jon H. Tobias

metabolic and cardiovascular benefits of PA, this approach may be less tractable when examining skeletal health. The musculoskeletal system adapts to the mechanical stimuli like walking or running. The higher the level of impact, the greater the bone deformation and the formation of new and stronger bone

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Harshvardhan Singh, Bethany A. Moore, Roshita Rathore, Michael G. Bemben, and Debra A. Bemben

women, but not in men. This is clinically important for older women as aging is associated with an increase in fat mass and lower skeletal health. Specifically, fatness is considered a barrier to physical activity in women ( Ball, Crawford, & Owen, 2000 ). Although evidence of a direct relationship

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Janelle Prince, Eric Schussler, and Ryan McCann

benefits for body composition, skeletal health, cardiorespiratory fitness, depression, anxiety, and academic achievement, 13 and it also improves cognition through increased cerebral blood flow, oxygen extraction, brain metabolism, and neuroplasticity. 14 – 16 Aerobic exercise conducted at subsymptom and

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Sami Yli-Piipari, Arto Gråsten, Mikko Huhtiniemi, Kasper Salin, Sanni Seppälä, Harto Hakonen, and Timo Jaakkola

). Cardiorespiratory fitness has, furthermore, been found to have a long-term effect predicting 31 and 24% of MVPA in males and females, respectively ( Glenmark, Hedberg, & Jansson, 1994 ). Other research has also revealed muscular strength/endurance and flexibility to have a more positive effect on skeletal health