NEUROMUSCULAR FITNESS IN EARLY LIFE AND ITS IMPACT ON BONE HEALTH IN ADULTHOOD: A SYSTEMATIC REVIEW

Barbosa, Cynthia Correa Lopes; Romanzini, Catiana Leila Possamai; Batista, Mariana Biagi; Fernandes, Rômulo Araújo; Romanzini, Marcelo; Kemper, Han; Coelho-e-Silva, Manuel João; Ronque, Enio Ricardo Vaz

doi:10.1590/1984-0462/2020/38/2019119

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Revista Paulista de Pediatria

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REVIEW ARTICLE • Rev. paul. pediatr. 38 • 2020 • https://doi.org/10.1590/1984-0462/2020/38/2019119 copy

NEUROMUSCULAR FITNESS IN EARLY LIFE AND ITS IMPACT ON BONE HEALTH IN ADULTHOOD: A SYSTEMATIC REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To systematically review the literature to verify the relationship between neuromuscular fitness indicators in childhood/adolescence and bone strength variables in adulthood.

Data sources:

A systematic review was conducted in PUBMED, SCOPUS, SPORTDiscus, Web of Science, PsycINFO, LILACS, and SciELO, covering the entire period until March 2019.

Data synthesis:

The search identified 1149 studies. After duplicity analysis and eligibility criteria, four studies were reported. In one study, baseline was childhood and, in the others, adolescence. In childhood, when adjusting the model for age and body mass index, a statistically significant relation was found for girls: standing long jump with quantitative ultrasound index (β=0.11; p<0.05) and with speed of sound (β=0.14; p<0.01). However, when controlling muscular performance in adulthood, the relationship was no longer significant. In adolescence, coefficients ranged from 0.16 for neuromotor battery and bone mineral density (BMD) in the lumbar region to 0.38 for hanging leg lift test and BMD of arms. The explained variance varied between 2% (bent arm hang for BMD total) and 12% (hanging leg-lift for BMD arms), therefore, a higher performance in neuromuscular fitness in adolescence was associated with better bone strength in adulthood.

Conclusions:

In adults, bone strength variables showed significant correlation from low to moderate magnitude with neuromuscular fitness indicators in adolescence, but not in childhood, after controlling for adult performance in neuromuscular fitness. However, there is limited evidence to support the neuromuscular fitness in early life as a determinant of bone strength in adulthood.

Keywords:
Muscle strength; Bone mineral density; Childhood; Adolescence

Item	Topic and recommendation
1	Title and Abstract: a) Included in the title and/or abstract at least one of the keywords used in the search; b) Abstract provides a synopsis of what was performed and found.
2	Introduction: Explained the reasons and scientific basis for conducting the research.
3	Introduction: Includes general and specific objectives clearly considering any pre-established hypotheses.
4	Methods: Presented at the beginning of the document the key elements of the study design.
5	Methods: Described the relevant context, places, and dates, including recruitment, exposure, monitoring, and data collection periods.
6	Methods: Presented the eligibility criteria, as well as the sources and methods of selecting the participants. Specify follow-up methods when applicable (cohort studies).
7	Methods: Clearly defined all variables: response, exposure, predictive, confounding, and effect modifiers. If applicable, provided diagnostic criteria.
8	Methods: Specified and detailed the methods and instruments of measurement.
9	Methods: Sample size was rationally determined.
10	Methods: a) Explained how the quantitative variables were treated in the analysis; b) At least one statistical test was performed to verify the relationship in question.
11	Results: a) Presented at least one numerical information related to the analysis of the relationship in question; b) If variables categorized, described the cut-off points.
12	Results: Provided unadjusted estimates and, if applicable, adjusted for confounding factors (specify), as well as their accuracy (e.g., 95% confidence intervals).
13	Discussion: Summarized the main results of the study.
14	Discussion: Discuss the limitations, consider possible sources of bias or inaccuracy.
15	Discussion: a) Presented a prudent overall interpretation of the results considering the objectives, limitations, multiplicity of analyzes, and results of similar studies; b) Discussed the possibility of generalizing the results (external validity).

References - online databases	Item															Total
References - online databases	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	Total
1. Kemper et al., (2000)¹⁸18. Kemper HC, Twisk JW, van Mechelen W, Post GB, Roos JC, Lips P. A fifteen-year longitudinal study in young adults on the relation of physical activity and fitness with the development of the bone mass: the Amsterdam Growth and Health Longitudinal Study. Bone. 2000;27:847-53. https://doi.org/10.1016/s8756-3282(00)00397-5 https://doi.org/https://doi.org/10.1016/...	1	1	1	1	1	1	1	1	0.5	1	1	1	1	0	0.5	13
2. Delvaux et al., (2001)²³23. Delvaux K, Lefevre J, Philippaerts R, Dequeker J, Thomis M, Vanreusel B, et al. Bone mass and lifetime physical activity in Flemish males: a 27-year follow-up study. Med Sci Sport Exerc. 2001;33:1868-75. https://doi.org/10.1097/00005768-200111000-00011 https://doi.org/https://doi.org/10.1097/...	1	1	0.5	1	1	1	1	1	0.5	1	1	1	1	1	0.5	13.5
3. Barnekow-Bergkvist et al., (2006)²⁴24. Barnekow-Bergkvist M, Hedberg G, Pettersson U, Lorentzon R. Relationships between physical activity and physical capacity in adolescent females and bone mass in adulthood. Scand J Med Sci Sports. 2006;16:447-55. https://doi.org/10.1111/j.1600-0838.2005.00500.x https://doi.org/https://doi.org/10.1111/...	1	1	1	0.5	1	1	1	1	0.5	1	1	1	1	1	1	14
4. Foley et al., (2008)¹⁷17. Foley S, Quinn S, Dwyer T, Venn A, Jones G. Measures of childhood fitness and body mass index are associated with bone mass in adulthood: a 20-year prospective study. J Bone Miner Res. 2008;23:994-1001. https://doi.org/10.1359/jbmr.080223 https://doi.org/https://doi.org/10.1359/...	1	1	1	0.5	1	1	1	1	1	1	1	1	1	1	0.5	14

Author/ages	Sample	Neuromuscular fitness	Bone strength	Results
Kemper et al.¹⁸18. Kemper HC, Twisk JW, van Mechelen W, Post GB, Roos JC, Lips P. A fifteen-year longitudinal study in young adults on the relation of physical activity and fitness with the development of the bone mass: the Amsterdam Growth and Health Longitudinal Study. Bone. 2000;27:847-53. https://doi.org/10.1016/s8756-3282(00)00397-5 https://doi.org/https://doi.org/10.1016/... BS: 13-16 years FUp: 21-27 years	83 Boys 98 Girls	Battery with 7 tests: ArmP, BAH, 10 LL, 10x5 m SR, S-R, plate tapping, SLJ; single score	BMD lumbar (L1-L4), femoral neck, distal radius; DXA	Regression coefficient revealed that neuromuscular fitness in adolescence was correlated with lumbar (0.16; p=0.05) and femoral neck BMD (0.18; p=0.05)
Delvaux et al.²³23. Delvaux K, Lefevre J, Philippaerts R, Dequeker J, Thomis M, Vanreusel B, et al. Bone mass and lifetime physical activity in Flemish males: a 27-year follow-up study. Med Sci Sport Exerc. 2001;33:1868-75. https://doi.org/10.1097/00005768-200111000-00011 https://doi.org/https://doi.org/10.1097/... BS: 13 years FUp1: 18 years FUp2: 40 years	126 Boys	LL, BAH, vertical jump, ArmP; Absolute score of change in performance was calculated between 18 and 13 years	BMD and BMC TB and lumbar region; DXA	Correlated in ArmP and the TB (r=0.19) and lumbar BMC (r=0.21), and in LL and the BMC of the TB (r=0.19). At 18 years, BAH with total BMC (r=0.21), ArmP total BMC (r=0.28) and lumbar BMC (r=0.27)
Barnekow-Bergkvist et al.²⁴24. Barnekow-Bergkvist M, Hedberg G, Pettersson U, Lorentzon R. Relationships between physical activity and physical capacity in adolescent females and bone mass in adulthood. Scand J Med Sci Sports. 2006;16:447-55. https://doi.org/10.1111/j.1600-0838.2005.00500.x https://doi.org/https://doi.org/10.1111/... BS: 15-17 years FUp: 35-37 years	36 Girls	Hanging LL, handgrip, two HL	TB, arms, legs, lumbar, trochanter, femoral neck BMD; DXA	Two HL was predictor for TB BMD (R²adj=0.10); the hanging LL (R²adj=0.12) and handgrip (R²adj=0.08) for BMD arms; and the two HL for BMD legs (R²adj=0.11) and BMD trochanter (R²adj=0.08*)
Foley et al.¹⁷17. Foley S, Quinn S, Dwyer T, Venn A, Jones G. Measures of childhood fitness and body mass index are associated with bone mass in adulthood: a 20-year prospective study. J Bone Miner Res. 2008;23:994-1001. https://doi.org/10.1359/jbmr.080223 https://doi.org/https://doi.org/10.1359/... BS: 7-15 years FUp: 26-36 years	691 Boys 743 Girls	Leg strength test with dynamometer, SLJ	Ultrasound of calcaneal	In boys, no measure was predictive of quantitative ultrasound parameters. In girls too, after adjusted for performance adult, SLJ with QUI (β=0.07) and with speed of sound (β=0.08)

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[1] *Corresponding author. E-mail: cynthiac@utfpr.edu.br (C.C.L. Barbosa).