Effects of Physical Exercise on Whole-Body Bone Mineral Density in Adolescents: A Systematic Review and Meta-analysis

Abstract

Context:

Adolescence is a critical period for bone development, and physical exercise has been recognized as a key factor in promoting bone health. Whole-body bone mineral density (BMD) serves as a vital indicator of bone strength and future fracture risk.

Objective:

To systematically review and perform a meta-analysis of the effects of physical exercise on whole-body BMD in adolescents, identifying types of exercise beneficial for bone health.

Data Sources:

A comprehensive search was conducted across databases including Web of Science, PubMed, Embase, EBSCOhost, Cochrane, and Scopus to identify relevant studies published between 1991 and 2025.

Study Selection:

Studies were selected based on predefined inclusion criteria that focused on adolescents, physical exercise, and whole-body BMD outcomes. A total of 12 studies involving 1845 participants met the criteria for inclusion.

Study Design:

Systematic review and meta-analysis.

Level of Evidence:

Level 1.

Data Extraction:

Data were extracted using the Cochrane Handbook guidelines, and meta-analysis was conducted using Review Manager software. Publication bias was assessed using a funnel plot.

Results:

Physical exercise increased whole-body BMD significantly in adolescents (pooled effect size of mean difference, 0.06; 95% CI, 0.04, 0.09; P < 0.001). Physical exercise significantly improved whole-body BMD in both male and female adolescents, but the effect was more pronounced in boys (P < 0.001) compared with girls (P = 0.002). High-impact and weightbearing exercises, such as basketball, soccer, ice hockey, and boxing, significantly enhanced whole-body BMD in adolescents, whereas nonweightbearing exercises, such as swimming, had a weaker effect on BMD improvement. Judo showed no significant effect.

Conclusion:

Physical exercise, particularly high-impact sports, significantly enhances whole-body BMD in adolescents, especially in boys. These findings highlight the importance of incorporating effective physical activities into adolescent physical education to promote optimal bone health.