A comparison of the associations between bone health and three different intensities of accelerometer-derived habitual physical activity in children and adolescents: a systematic review

Abstract

Purpose Positive associations have been identified between bone outcomes and accelerometer-derived moderate (MPA) and vigorous (VPA) physical activity (PA) in youth, however, it remains unclear which intensity is most beneficial. This systematic review aimed to summarise accelerometer-derived methods used to estimate habitual PA in children and adolescents and determine whether the magnitude of association was consistently stronger for a particular intensity (MPA/MVPA/VPA). Methods Observational studies assessing associations between accelerometer-derived MPA and/or MVPA and VPA with bone outcomes in children and adolescents (≤ 18 years) were identified in MEDLINE, EMBASE, Web of Science, SPORTDiscus and the Cochrane Central Register of Controlled Trials. Thirty articles were included (total n=20,613 (10,077 males), 4- 18 years). Chi-square tests determined whether the proportion of significant associations and strongest within-study associations, differed significantly between intensities. Results Accelerometer methods were highly variable between studies. Of the 570 associations analysed, 186 were significant (p<0.05). The proportion of within-study strongest associations differed by PA intensity (3x2 χ 2=86.6, p<0.001) and was significantly higher for VPA (39%) compared to MVPA (5%; 2x2 χ 2=55.3, p<0.001) and MPA (9%, 2x2 χ 2=49.1, p<0.001). Conclusion Results indicated a greater benefit of VPA over MPA/MVPA, however, variability in accelerometer-derived methods used prevents the precise bone-benefitting amount of VPA from being identified. Long epochs and numerous intensity cut-point definitions mean that bone-relevant PA has likely been missed or misclassified in this population. Future research should explore the use of shorter epochs (1s) and identify bone-specific activity intensities, rather than using pre-defined activity classifications more relevant to cardiovascular health.