Is Bone Tissue Really Affected by Swimming? A Systematic Review

PLoS ONE

Volumn 8, Issue 8, 2013, Pages

  Gómez Bruton, Alejandro ^a   Gónzalez Agüero, Alejandro ^a,b   Gómez Cabello, Alba ^a   Casajús, José A ^a   Vicente Rodríguez, Germán ^a  

^a UNIVERSITY OF ZARAGOZA   (Spain)

^b ABERYSTWYTH UNIVERSITY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ALKALINE PHOSPHATASE; AMINO TERMINAL TELOPEPTIDE; ESTRADIOL; GHRELIN; LEPTIN; LUTEINIZING HORMONE; OSTEOCLAST DIFFERENTIATION FACTOR; SOMATOMEDIN C; TESTOSTERONE;

AGE DISTRIBUTION; BONE DENSITY; BONE GROWTH; BONE MASS; BONE METABOLISM; BONE MINERAL; BONE STRENGTH; BONE STRUCTURE; BONE TISSUE; BONE TURNOVER; CALCIUM INTAKE; DISEASE RESISTANCE; FRACTURE; HORMONE BLOOD LEVEL; HUMAN; OSSIFICATION; OSTEOLYSIS; REVIEW; SEX DIFFERENCE; SWIMMING; SYSTEMATIC REVIEW; TRAINING;

ABSORPTIOMETRY, PHOTON; ATHLETES; BODY COMPOSITION; BONE AND BONES; BONE DENSITY; EXERCISE; HUMANS; SPORTS; SWIMMING;

EID: 84881347621     PISSN: None     EISSN: 19326203     Source Type: Journal    
DOI: 10.1371/journal.pone.0070119     Document Type: Review

References (114)

1. Vasikaran S, Cooper C, Eastell R, Griesmacher A, Morris HA, et al. (2011) International Osteoporosis Foundation and International Federation of Clinical Chemistry and Laboratory Medicine position on bone marker standards in osteoporosis. Clin Chem Lab Med 49: 1271-1274.
2. Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ, 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137: 1001-1005.
3. Consensus development conference: diagnosis prophylaxis and treatment of osteoporosis (1993) Am J Med. 94: 646-650.
4. Bailey DA, Faulkner RA, McKay HA, (1996) Growth, physical activity, and bone mineral acquisition. Exerc Sport Sci Rev 24: 233-266.
5. Nordstrom A, Karlsson C, Nyquist F, Olsson T, Nordstrom P, et al. (2005) Bone loss and fracture risk after reduced physical activity. J Bone Miner Res 20: 202-207.
6. Young N, Formica C, Szmukler G, Seeman E, (1994) Bone density at weight-bearing and nonweight-bearing sites in ballet dancers: the effects of exercise, hypogonadism, and body weight. J Clin Endocrinol Metab 78: 449-454.
7. Vicente-Rodriguez G, (2006) How does exercise affect bone development during growth? Sports Med 36: 561-569.
8. Bergmann P, Body JJ, Boonen S, Boutsen Y, Devogelaer JP, et al. (2010) Loading and skeletal development and maintenance. J Osteoporos 2011: 786752.
9. Wolff I, van Croonenborg JJ, Kemper HC, Kostense PJ, Twisk JW, (1999) The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos Int 9: 1-12.
10. Duncan CS, Blimkie CJ, Cowell CT, Burke ST, Briody JN, et al. (2002) Bone mineral density in adolescent female athletes: relationship to exercise type and muscle strength. Med Sci Sports Exerc 34: 286-294.
11. Delecluse C, Roelants M, Verschueren S, (2003) Strength increase after whole-body vibration compared with resistance training. Med Sci Sports Exerc 35: 1033-1041.
12. Karlsson MK, Nordqvist A, Karlsson C (2008) Physical activity increases bone mass during growth. Food Nutr Res 52.
13. Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JAL, (2009) Exercise and bone mass in adults. Sports Medicine 39: 439-468.
14. Ferry B, Duclos M, Burt L, Therre P, Le Gall F, et al. (2011) Bone geometry and strength adaptations to physical constraints inherent in different sports: comparison between elite female soccer players and swimmers. J Bone Miner Metab 29: 342-351.
15. Ferry B, Lespessailles E, Rochcongar P, Duclos M, Courteix D (2012) Bone health during late adolescence: Effects of an 8-month training program on bone geometry in female athletes. Joint Bone Spine In press.
16. Maimoun L, Coste O, Philibert P, Briot K, Mura T, et al. (2013) Testosterone secretion in elite adolescent swimmers does not modify bone mass acquisition: a 1-year follow-up study. Fertil Steril 99: 270-278.
17. Maimoun L, Coste O, Philibert P, Briot K, Mura T, et al. (2013) Peripubertal female athletes in high-impact sports show improved bone mass acquisition and bone geometry. Metabolism.
18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62: e1-34.
19. Olmedillas H, Gonzalez-Aguero A, Moreno LA, Casajus JA, Vicente-Rodriguez G, (2012) Cycling and bone health: a systematic review. BMC Med 10: 168.
20. Tooth L, Ware R, Bain C, Purdie DM, Dobson A, (2005) Quality of reporting of observational longitudinal research. Am J Epidemiol 161: 280-288.
21. Schott AM, Weill-Engerer S, Hans D, Duboeuf F, Delmas PD, et al. (1995) Ultrasound discriminates patients with hip fracture equally well as dual energy X-ray absorptiometry and independently of bone mineral density. J Bone Miner Res 10: 243-249.
22. Nilsson BE, Westlin NE, (1971) Bone density in athletes. Clin Orthop Relat Res 77: 179-182.
23. Cassell C, Benedict M, Specker B, (1996) Bone mineral density in elite 7- to 9-yr-old female gymnasts and swimmers. Med Sci Sports Exerc 28: 1243-1246.
24. Courteix D, Lespessailles E, Obert P, Benhamou CL, (1999) Skull bone mass deficit in prepubertal highly-trained gymnast girls. Int J Sports Med 20: 328-333.
25. Courteix D, Lespessailles E, Peres SL, Obert P, Germain P, et al. (1998) Effect of physical training on bone mineral density in prepubertal girls: a comparative study between impact-loading and non-impact loading sports. Osteoporos Int 8: 152-158.
26. Courteixi D, Lespessailles E, Loiseau-Peres S, Obert P, Ferry B, et al. (1998) Lean tissue mass is a better predictor of bone mineral content and density than body weight in prepubertal girls. Revue du Rhumatisme (English Edition) 65: 328-336.
27. Jurimae J, Cicchella A, Tillmann V, Latt E, Haljaste K, et al. (2009) Effect of pubertal development and physical activity on plasma ghrelin concentration in boys. J Endocrinol Invest 32: 18-22.
28. Derman O, Cinemre A, Kanbur N, Dogan M, Kilic M, et al. (2008) Effect of swimming on bone metabolism in adolescents. Turk J Pediatr 50: 149-154.
29. Dias Quiterio AL, Carnero EA, Baptista FM, Sardinha LB, (2011) Skeletal mass in adolescent male athletes and nonathletes: relationships with high-impact sports. J Strength Cond Res 25: 3439-3447.
30. Duncan CS, Blimkie CJR, Cowell CT, Burke ST, Briody JN, et al. (2002) Bone mineral density in adolescent female athletes: Relationship to exercise type and muscle strength. Med Sci Sports Exerc 34: 286-294.
31. Duncan CS, Blimkie CJR, Kemp A, Higgs W, Cowell CT, et al. (2002) Mid-femur geometry and biomechanical properties in 15- to 18-yr-old female athletes. Med Sci Sports Exerc 34: 673-681.
32. McCulloch RG, Bailey DA, Whalen RL, Houston CS, Faulkner RA, et al. (1992) Bone Density and Bone Mineral Content of Adolescent Soccer Athletes and Competitive Swimmers. Pediatr Exerc Sci 4: 319-330.
33. Silva CC, Goldberg TB, Teixeira AS, Dalmas JC, (2011) The impact of different types of physical activity on total and regional bone mineral density in young Brazilian athletes. J Sports Sci 29: 227-234.
34. Dlugole{ogonek}cka B, Czeczelewski J, Raczyńska B, (2011) Bone mineral content and bone mineral density in female swimmers during the time of peak bone mass attainment. Biol Sport 28: 69-74.
35. Velez NF, Zhang A, Stone B, Perera S, Miller M, et al. (2008) The effect of moderate impact exercise on skeletal integrity in master athletes. Osteoporos Int 19: 1457-1464.
36. Fehling PC, Alekel L, Clasey J, Rector A, Stillman RJ, (1995) A comparison of bone mineral densities among female athletes in impact loading and active loading sports. Bone 17: 205-210.
37. Greenway KG, Walkley JW, Rich PA, (2012) Does long-term swimming participation have a deleterious effect on the adult female skeleton? Eur J Appl Physiol 112: 3217-3225.
38. Kearney KD (2000) Comparison of bone mineral density in 10- to 13-year-old female gymnasts and swimmers. Eugene, Or.; United States: Microform Publications, University of Oregon.
39. Maimoun L, Lumbroso S, Manetta J, Paris F, Leroux JL, et al. (2003) Testosterone is significantly reduced in endurance athletes without impact on bone mineral density. Horm Res 59: 285-292.
40. Maimoun L, Mariano-Goulart D, Couret I, Manetta J, Peruchon E, et al. (2004) Effects of physical activities that induce moderate external loading on bone metabolism in male athletes. J Sports Sci 22: 875-883.
41. Taaffe DR, Suominen H, Ollikainen S, Cheng S, (2001) Calcaneal bone mineral and ultrasound attenuation in male athletes exposed to weight-bearing and nonweight-bearing activity: a cross-sectional report. J Sports Med Phys Fitness 41: 243-249.
42. Jacobson PC, Beaver W, Grubb SA, Taft TN, Talmage RV, (1984) Bone density in women: college athletes and older athletic women. J Orthop Res 2: 328-332.
43. Orwoll ES, Ferar J, Oviatt SK, McClung MR, Huntington K, (1989) The relationship of swimming exercise to bone mass in men and women. Arch Intern Med 149: 2197-2200.
44. Dook JE, James C, Henderson NK, Price RI, (1997) Exercise and bone mineral density in mature female athletes. Med Sci Sports Exerc 29: 291-296.
45. Andreoli A, Celi M, Volpe SL, Sorge R, Tarantino U, (2012) Long-term effect of exercise on bone mineral density and body composition in post-menopausal ex-elite athletes: a retrospective study. Eur J Clin Nutr 66: 69-74.
46. Magkos F, Kavouras SA, Yannakoulia M, Karipidou M, Sidossi S, et al. (2007) The bone response to non-weight-bearing exercise is sport-, site-, and sex-specific. Clin J Sport Med 17: 123-128.
47. Lima F, De Falco V, Baima J, Carazzato JG, Pereira RM, (2001) Effect of impact load and active load on bone metabolism and body composition of adolescent athletes. Med Sci Sports Exerc 33: 1318-1323.
48. Gnudi S, Sitta E, Fiumi N, (2007) Relationship between body composition and bone mineral density in women with and without osteoporosis: relative contribution of lean and fat mass. J Bone Miner Metab 25: 326-332.
49. Czeczuk A, Huk-Wieliczuk E, Michalska A, Bylina D, Soltan J, et al. (2012) The effect of menopause on bone tissue in former swimmers and in non-athletes. Adv Clin Exp Med 21: 645-652.
50. Carbuhn AF, Fernandez TE, Bragg AF, Green JS, Crouse SF, (2010) Sport and training influence bone and body composition in women collegiate athletes. J Strength Cond Res 24: 1710-1717.
51. Magkos F, Yannakoulia M, Kavouras SA, Sidossis LS, (2007) The type and intensity of exercise have independent and additive effects on bone mineral density. Int J Sports Med 28: 773-779.
52. Morel J, Combe B, Francisco J, Bernard J, (2001) Bone mineral density of 704 amateur sportsmen involved in different physical activities. Osteoporos Int 12: 152-157.
53. Mudd LM, Fornetti W, Pivarnik JM, (2007) Bone mineral density in collegiate female athletes: comparisons among sports. J Athl Train 42: 403-408.
54. Risser WL, Lee EJ, LeBlanc A, Poindexter HB, Risser JM, et al. (1990) Bone density in eumenorrheic female college athletes. Med Sci Sports Exerc 22: 570-574.
55. Grimston SK, Willows ND, Hanley DA, (1993) Mechanical loading regime and its relationship to bone mineral density in children. Med Sci Sports Exerc 25: 1203-1210.
56. Gruodyte R, Jurimae J, Cicchella A, Stefanelli C, Passariello C, et al. (2010) Adipocytokines and bone mineral density in adolescent female athletes. Acta Paediatr 99: 1879-1884.
57. Creighton DL, Morgan AL, Boardley D, Gunnar Brolinson P, (2001) Weight-bearing exercise and markers of bone turnover in female athletes. J Appl Physiol 90: 565-570.
58. Lee EJ, Long KA, Risser WL, Poindexter HBW, Gibbons WE, et al. (1995) Variations in bone status of contralateral and regional sites in young athletic women. Med Sci Sports Exerc 27: 1354-1361.
59. Morgan A, Weiss Jarrett J, (2011) Markers of bone turnover across a competitive season in female athletes: a preliminary investigation. J Sports Med Phys Fitness 51: 515-524.
60. Taaffe DR, Robinson TL, Snow CM, Marcus R, (1997) High-impact exercise promotes bone gain in well-trained female athletes. J Bone Miner Res 12: 255-260.
61. Taaffe DR, Snow-Harter C, Connolly DA, Robinson TL, Brown MD, et al. (1995) Differential effects of swimming versus weight-bearing activity on bone mineral status of eumenorrheic athletes. J Bone Miner Res 10: 586-593.
62. Courteix D, Lespessailles E, Loiseau-Peres S, Obert P, Ferry B, et al. (1998) Lean tissue mass is a better predictor of bone mineral content and density than body weight in prepubertal girls. Revue du Rhumatisme (English Edition) 65: 328-336.
63. Seeman E, (2002) An exercise in geometry. J Bone Miner Res 17: 373-380.
64. Kanis JA, Johnell O, (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16: 229-238.
65. Taaffe DR, Marcus R, (1999) Regional and total body bone mineral density in elite collegiate male swimmers. J Sports Med Phys Fitness 39: 154-159.
66. Czeczelewski J, Dlugolecka B, Czeczelewska E, Raczynska B, (2013) Intakes of selected nutrients, bone mineralisation and density of adolescent female swimmers over a three-year period. Biology of Sport 30: 17-20.
67. Hind K, Gannon L, Whatley E, Cooke C, Truscott J, (2012) Bone cross-sectional geometry in male runners, gymnasts, swimmers and non-athletic controls: a hip-structural analysis study. Eur J Appl Physiol 112: 535-541.
68. Bellew JW, Gehrig L, (2006) A comparison of bone mineral density in adolescent female swimmers, soccer players, and weight lifters. Pediatr Phys Ther 18: 19-22.
69. Dambacher MA, Neff M, Kissling R, Qin L, (1998) Highly precise peripheral quantitative computed tomography for the evaluation of bone density, loss of bone density and structures. Consequences for prophylaxis and treatment. Drugs Aging 12Suppl 1: 15-24.
70. Lehmann R, Wapniarz M, Kvasnicka HM, Baedeker S, Klein K, et al. (1992) Reproducibility of bone density measurements of the distal radius using a high resolution special scanner for peripheral quantitative computed tomography (Single Energy PQCT). Radiologe 32: 177-181.
71. Qin L, Au SK, Chan KM, Lau MC, Woo J, et al. (2000) Peripheral volumetric bone mineral density in pre- and postmenopausal Chinese women in Hong Kong. Calcif Tissue Int 67: 29-36.
72. Zanchetta JR, Bogado CE, Ferretti JL, Wang O, Wilson MG, et al. (2003) Effects of teriparatide [recombinant human parathyroid hormone (1-34)] on cortical bone in postmenopausal women with osteoporosis. J Bone Miner Res 18: 539-543.
73. Shaw CN, Stock JT, (2009) Habitual throwing and swimming correspond with upper limb diaphyseal strength and shape in modern human athletes. Am J Phys Anthropol 140: 160-172.
74. Nikander R, Sievanen H, Uusi-Rasi K, Heinonen A, Kannus P, (2006) Loading modalities and bone structures at nonweight-bearing upper extremity and weight-bearing lower extremity: A pQCT study of adult female athletes. Bone 39: 886-894.
75. Liu L, Maruno R, Mashimo T, Sanka K, Higuchi T, et al. (2003) Effects of physical training on cortical bone at midtibia assessed by peripheral QCT. J Appl Physiol 95: 219-224.
76. Nikander R, Kannus P, Rantalainen T, Uusi-Rasi K, Heinonen A, et al. (2010) Cross-sectional geometry of weight-bearing tibia in female athletes subjected to different exercise loadings. Osteoporos Int 21: 1687-1694.
77. Ashizawa N, Nonaka K, Michikami S, Mizuki T, Amagai H, et al. (1999) Tomographical description of tennis-loaded radius: reciprocal relation between bone size and volumetric BMD. J Appl Physiol 86: 1347-1351.
78. Haapasalo H, Kontulainen S, Sievanen H, Kannus P, Jarvinen M, et al. (2000) Exercise-induced bone gain is due to enlargement in bone size without a change in volumetric bone density: a peripheral quantitative computed tomography study of the upper arms of male tennis players. Bone 27: 351-357.
79. Narra N, Nikander R, Viik J, Hyttinen J, Sievanen H (2013) Femoral neck cross-sectional geometry and exercise loading. Clinical Physiology and Functional Imaging In press.
80. Qu X, (1992) Morphological effects of mechanical forces on the human humerus. Br J Sports Med 26: 51-53.
81. Liang MTC, Arnaud SB, Steele CR, Hatch P, Moreno A, (2005) Ulnar and tibial bending stiffness as an index of bone strength in synchronized swimmers and gymnasts. Eur J Appl Physiol 94: 400-407.
82. Barkmann R, Gluer CC, (2006) [Quantitative ultrasound]. Radiologe 46: 861-869.
83. Njeh CF, Hans D, Wu C, Kantorovich E, Sister M, et al. (1999) An in vitro investigation of the dependence on sample thickness of the speed of sound along the specimen. Med Eng Phys 21: 651-659.
84. Grampp S, Henk C, Lu Y, Krestan C, Resch H, et al. (2001) Quantitative US of the calcaneus: cutoff levels for the distinction of healthy and osteoporotic individuals. Radiology 220: 400-405.
85. Grampp S, Henk CB, Fuerst TP, Lu Y, Bader TR, et al. (1999) Diagnostic agreement of quantitative sonography of the calcaneus with dual X-ray absorptiometry of the spine and femur. AJR Am J Roentgenol 173: 329-334.
86. Falk B, Galili Y, Zigel L, Constantini N, Eliakim A, (2007) A cumulative effect of physical training on bone strength in males. Int J Sports Med 28: 449-455.
87. Ludwa IA, Falk B, Yao M, Corbett L, Klentrou P, (2010) Bone speed of sound, bone turnover and IGF-I in adolescent synchronized swimmers. Pediatr Exerc Sci 22: 421-430.
88. Falk B, Bronshtein Z, Zigel L, Constantini N, Eliakim A, (2004) Higher tibial quantitative ultrasound in young female swimmers. Br J Sports Med 38: 461-465.
89. Falk B, Bronshtein Z, Zigel L, Constantini NW, Eliakim A, (2003) Quantitative ultrasound of the tibia and radius in prepubertal and early-pubertal female athletes. Arch Pediatr Adolesc Med 157: 139-143.
90. Yung PS, Lai YM, Tung PY, Tsui HT, Wong CK, et al. (2005) Effects of weight bearing and non-weight bearing exercises on bone properties using calcaneal quantitative ultrasound. Br J Sports Med 39: 547-551.
91. Shweta Shenoy, Shadagopan SP, Jaspal Singh Sandhu, (2012) Radial and tibial bone ultrasound densitometry in weight bearing and non-weight bearing activity: A comparative analysis. Serb J Sports Sci 6: 29-35.
92. Tuchman S, Thayu M, Shults J, Zemel BS, Burnham JM, et al. (2008) Interpretation of biomarkers of bone metabolism in children: impact of growth velocity and body size in healthy children and chronic disease. J Pediatr 153: 484-490.
93. Prentice A, Bonjour JP, Branca F, Cooper C, Flynn A, et al. (2003) PASSCLAIM - Bone health and osteoporosis. Eur J Nutr 42Suppl 1: I28-49.
94. Matsumoto T, Nakagawa S, Nishida S, Hirota R, (1997) Bone density and bone metabolic markers in active collegiate athletes: Findings in long-distance runners, judoists, and swimmers. Int J Sports Med 18: 408-412.
95. Malm HT, Ronni-Sivula HM, Viinikka LU, Ylikorkala OR, (1993) Marathon running accompanied by transient decreases in urinary calcium and serum osteocalcin levels. Calcif Tissue Int 52: 209-211.
96. Woitge HW, Scheidt-Nave C, Kissling C, Leidig-Bruckner G, Meyer K, et al. (1998) Seasonal variation of biochemical indexes of bone turnover: results of a population-based study. J Clin Endocrinol Metab 83: 68-75.
97. Warren MP, (1980) The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 51: 1150-1157.
98. Evans RK, Antczak AJ, Lester M, Yanovich R, Israeli E, et al. (2008) Effects of a 4-month recruit training program on markers of bone metabolism. Med Sci Sports Exerc 40: S660-670.
99. Veldhuis JD, Roemmich JN, Richmond EJ, Rogol AD, Lovejoy JC, et al. (2005) Endocrine control of body composition in infancy, childhood, and puberty. Endocr Rev 26: 114-146.
100. Kanbur NO, Derman O, Kinik E, (2005) The relationships between pubertal development, IGF-1 axis, and bone formation in healthy adolescents. J Bone Miner Metab 23: 76-83.
101. Flynn MG, Pizza FX, Boone JB Jr, Andres FF, Michaud TA, et al. (1994) Indices of training stress during competitive running and swimming seasons. Int J Sports Med 15: 21-26.
102. Jurimae J, Latt E, Haljaste K, Purge P, Cicchella A, et al. (2010) A longitudinal assessment of ghrelin and bone mineral density with advancing pubertal maturation in adolescent female athletes. J Sports Med Phys Fitness 50: 343-349.
103. Garnett SP, Hogler W, Blades B, Baur LA, Peat J, et al. (2004) Relation between hormones and body composition, including bone, in prepubertal children. Am J Clin Nutr 80: 966-972.
104. Roemmich JN, Clark PA, Mantzoros CS, Gurgol CM, Weltman A, et al. (2003) Relationship of leptin to bone mineralization in children and adolescents. J Clin Endocrinol Metab 88: 599-604.
105. Emslander HC, Sinaki M, Muhs JM, Chao EYS, Wahner HW, et al. (1998) Bone mass and muscle strength in female college athletes (runners and swimmers). Mayo Clin Proc 73: 1151-1160.
106. IOM (2011) Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.
107. Courteix D, Jaffre C, Lespessailles E, Benhamou L, (2005) Cumulative effects of calcium supplementation and physical activity on bone accretion in premenarchal children: a double-blind randomised placebo-controlled trial. Int J Sports Med 26: 332-338.
108. Gunnes M, Lehmann EH, (1996) Physical activity and dietary constituents as predictors of forearm cortical and trabecular bone gain in healthy children and adolescents: a prospective study. Acta Paediatr 85: 19-25.
109. Vicente-Rodriguez G, Ezquerra J, Mesana MI, Fernandez-Alvira JM, Rey-Lopez JP, et al. (2008) Independent and combined effect of nutrition and exercise on bone mass development. J Bone Miner Metab 26: 416-424.
110. Rico H, Revilla M, Hernandez ER, Villa LF, Alvarez del Buergo M, (1992) Sex differences in the acquisition of total bone mineral mass peak assessed through dual-energy X-ray absorptiometry. Calcif Tissue Int 51: 251-254.
111. Cornelissen VA, Fagard RH, (2005) Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 46: 667-675.
112. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR, (2004) American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc 36: 1985-1996.
113. Heinrich CH, Going SB, Pamenter RW, Perry CD, Boyden TW, et al. (1990) Bone mineral content of cyclically menstruating female resistance and endurance trained athletes. Med Sci Sports Exerc 22: 558-563.
114. Nichols JF, Rauh MJ, Barrack MT, Barkai HS, (2007) Bone mineral density in female high school athletes: Interactions of menstrual function and type of mechanical loading. Bone 41: 371-377.