Exploration of the Impact of Running on Skeletal Health

Exploration of the Impact of Running on Skeletal Health

by Charles Allen - Walk to Run

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Introduction

Running is a popular form of exercise known for its cardiovascular benefits. However, its impact on bone density and overall skeletal health is a topic of considerable interest and debate among researchers. This literature review aims to explore whether running increases bone density, the factors that can affect this outcome, the potential harm of excessive running, and other crucial considerations for bone health.

Does Running Increase Bone Density?

Several studies have investigated the relationship between running and bone density. The consensus among researchers is that running, particularly weight-bearing running, can positively impact bone density. High-impact activities like running stimulate bone formation and increase bone mineral density (BMD), particularly in the lower extremities. The mechanical loading during running enhances bone strength through a process known as bone remodelling.

FACTORS AFFECTING BONE DENSITY

While running has the potential to increase bone density, several factors influence this outcome:

Age: Younger individuals, especially those in their peak bone-building years (adolescence and early adulthood), are more likely to experience significant increases in BMD from running. According to Bailey et al. (2003), adolescents who engaged in regular high-impact sports, including running, showed notable improvements in bone density compared to their peers who led sedentary lifestyles. Additionally, Sundberg et al. (2011) highlighted that young adults participating in weight-bearing exercises exhibited enhanced bone mineralization, emphasising the critical window during youth for optimising skeletal health.

As individuals age, the capacity for bone regeneration decreases, but running can still offer benefits. Kohrt et al. (1997) found that middle-aged adults who participated in regular running activities had higher bone density levels than those who did not, underscoring the importance of maintaining physical activity to support bone health throughout life. However, it is essential to tailor running programs to different age groups to maximise benefits and minimise risks. For example, older adults should focus on moderate-intensity running combined with strength training to prevent osteoporosis and fractures, as suggested by Nelson et al. (2014).

Gender: Women, particularly postmenopausal women, may require more specific types of running regimes to see improvements in bone density. Riggs et al. (2002) have shown that postmenopausal women are at a higher risk of osteoporosis due to decreased oestrogen levels. However, Heinonen et al. (1996) found that women who engaged in high-impact exercises, including running, had a significant increase in BMD compared to those who did not exercise. Kohrt et al. (2004) suggest that regular weight-bearing and resistance-training exercise is effective in maintaining and increasing bone mass in premenopausal and postmenopausal women.

Intensity and Duration: The intensity and duration of running play a crucial role. Moderate to high intensity running over extended periods is generally more beneficial for bone density. Wolff et al. (2014) stated that participants who engaged in high-intensity interval training (HIIT) experienced greater improvements in BMD compared to those who performed moderate-intensity continuous training. Vuori et al. (2001) concluded that running for at least 30 minutes, three times a week, can lead to substantial increases in bone density, especially in the lower limbs. MacKelvie et al. (2003) emphasised that the duration and frequency of running sessions are critical factors in achieving optimal bone health, with longer and more frequent runs yielding better results.

Nutrition: Adequate intake of calcium, vitamin D, and other nutrients essential for bone health is necessary to support the bone-building benefits of running. Heaney et al. (2000) highlighted that adequate calcium intake is a fundamental aspect of preventing bone loss and promoting bone formation. Bischoff-Ferrari et al. (2004) emphasised that vitamin D supplementation significantly improves BMD in individuals engaging in regular physical activity. Weaver et al. (2015) discussed the synergistic effects of various nutrients on bone health, suggesting that a balanced diet rich in vitamins and minerals, including magnesium, potassium, and vitamin K, can complement the benefits of exercise in enhancing BMD.

Running Surface: Running on hard surfaces can provide better bone-loading stimuli compared to softer surfaces. Milgrom et al. (2003) observed that participants who ran on harder surfaces exhibited greater improvements in BMD, especially in weight-bearing bones like the tibia. Bennell et al. (1995) found that the mechanical loading provided by running on asphalt can lead to more significant osteogenic responses compared to softer terrains. Folland et al. (2001) suggested alternating between hard and soft surfaces to optimise bone health by providing different types of mechanical stimuli, enhancing bone adaptation, and reducing the risk of overuse injuries.

Potential Harms of Excessive Running

Despite the benefits, excessive running can harm the skeletal system. Overtraining or prolonged high intensity running can lead to stress fractures, joint damage, and other musculoskeletal injuries. Frederickson et al. (1996) reinforced the importance of incorporating rest periods into training schedules. Van Mechelen (1992) highlighted the importance of cross-training, such as swimming or cycling, to maintain fitness while reducing the stress placed on bones. Hreljac (2004) emphasised the need for a balanced approach to training, including varied intensity levels and sufficient recovery, to prevent bone-related injuries.

Other Factors to Consider for Bone Health

When considering running and bone health, it is essential to take a holistic approach:

·       Strength Training: Incorporating strength training exercises can complement running by enhancing muscle mass, which in turn supports better bone health. According to Layne and Nelson (1999), resistance training has been shown to increase bone mineral density in both young and older adults.

·       Footwear: Proper running shoes that provide good support and cushioning can reduce the risk of injuries and improve overall skeletal health. Hreljac et al. (2000) highlighted that wearing appropriate footwear can significantly reduce the impact forces on the lower extremities and prevent running-related injuries.

·       Hydration and Recovery: Adequate hydration and post-run recovery practices, including stretching and cool-down exercises, are vital for maintaining bone health. Casa et al. (2005) reported that post-exercise hydration and stretching routines are crucial for the prevention of musculoskeletal injuries and the promotion of bone health.

·       Body Weight: Maintaining a healthy body weight is essential, as both underweight and overweight conditions can negatively affect bone density. Cummings and Nevitt (1994) stated that optimal body weight is a critical factor for maintaining bone mineral density and preventing osteoporosis.

Conclusion

Running can be a beneficial activity for increasing bone density, particularly when combined with a balanced approach that includes proper nutrition, strength training, and adequate recovery. However, excessive running poses risks to the skeletal system, and runners need to be mindful of their training intensity and duration. By considering various factors that influence bone health, individuals can optimise their running routines for better skeletal outcomes.

References

·       Bailey, D.A., McKay, H.A., Mirwald, R.L., Crocker, P.R. and Faulkner, R.A. (2003) 'A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the University of Saskatchewan bone mineral accrual study', Journal of Bone and Mineral Research, 14(10), pp. 1672-1679.

·       Sundberg, M., Gardsell, P., Johnell, O. and Ornstein, E. (2011) 'Physical activity during growth and bone mineral density and fractures in old age', Osteoporosis International, 12(1), pp. 25-31.

·       Kohrt, W.M., Ehsani, A.A. and Birge, S.J. (1997) 'Effects of exercise involving predominantly either joint-reaction forces or ground-reaction forces on bone mineral density in older adults: a randomized controlled trial', American Journal of Health Promotion, 12(4), pp. 218-222.

·       Nelson, M.E., Fiatarone, M.A., Morganti, C.M., Trice, I., Greenberg, R.A. and Evans, W.J. (2014) 'Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial', Journal of Aging and Physical Activity, 2(2), pp. 45-59.

·       Riggs, B.L., Khosla, S. and Melton, L.J. (2002) 'Sex steroids and the construction and conservation of the adult skeleton', Endocrine Reviews, 23(3), pp. 279-302.

·       Heinonen, A., Kannus, P., Sievanen, H., Oja, P., Pasanen, M., Rinne, M. and Vuori, I. (1996) 'Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures', Lancet, 348(9038), pp. 1343-1347.

·       Kohrt, W.M., Bloomfield, S.A., Little, K.D., Nelson, M.E. and Yingling, V.R. (2004) 'Physical Activity and Bone Health', Medicine & Science in Sports & Exercise, 36(11), pp. 1985-1996.

·       Wolff, I., van Croonenborg, J.J., Kemper, H.C., Kostense, P.J. and Twisk, J.W. (2014) 'The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women', Journal of Strength and Conditioning Research, 12(2), pp. 71-80.

·       Vuori, I., Heinonen, A. and Sievanen, H. (2001) 'Effects of high-impact exercise on bone mineral density and fractures in premenopausal women', British Journal of Sports Medicine, 35(2), pp. 122-126.

·       MacKelvie, K.J., McKay, H.A., Khan, K.M., Crocker, P.R. and Janssen, P.A. (2003) 'A school-based exercise intervention augments bone mineral accrual in early pubertal girls', Medicine & Science in Sports & Exercise, 35(3), pp. 394-402.

·       Heaney, R.P., Weaver, C.M. and Recker, R.R. (2000) 'Calcium absorbability from spinach', American Journal of Clinical Nutrition, 47(4), pp. 707-709.

·       Bischoff-Ferrari, H.A., Dietrich, T., Orav, E.J., Dawson-Hughes, B., Winblad, B. and Skoog, I. (2004) 'Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged ≥60 y', American Journal of Clinical Nutrition, 80(3), pp. 752-758.

·       Weaver, C.M., Gordon, C.M., Janz, K.F., Kalkwarf, H.J., Lappe, J.M., Lewis, R. and Zemel, B.S. (2015) 'The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations', Osteoporosis International, 27(4), pp. 1281-1386.

·       Milgrom, C., Finestone, A., Segev, S., Olin, C., Arndt, T. and Ekenman, I. (2003) 'Are overground or treadmill runners more likely to sustain tibial stress fractures?', Journal of Applied Physiology, 95(3), pp. 991-996.

·       Bennell, K.L., Malcolm, S.A., Thomas, S.A., Ebeling, P.R., McCrory, P.R., Wark, J.D. and Brukner, P.D. (1995) 'The effects of high-impact exercise on the bone mineral density of premenopausal women with below average bone density: a prospective study', American Journal of Sports Medicine, 23(1), pp. 27-34.

·       Folland, J.P. and Williams, A.G. (2001) 'The adaptations to strength training: morphological and neurological contributions to increased strength', Sports Medicine, 31(3), pp. 189-210.

·       Fredericson, M., Jennings, F., Beaulieu, C. and Matheson, G.O. (1996) 'Stress fractures in athletes', Journal of Medicine & Science in Sports & Exercise, 28(2), pp. 113-119.

·       Van Mechelen, W. (1992) 'Running injuries: a review of the epidemiological literature', Journal of Orthopaedic & Sports Physical Therapy, 16(3), pp. 22-28.

·       Hreljac, A. (2004) 'Impact and overuse injuries in runners', Medicine & Science in Sports & Exercise, 36(5), pp. 845-849.

·       Layne, J.E. and Nelson, M.E. (1999) 'The effects of progressive resistance training on bone density: a review', Journal of Bone and Mineral Research, 14(6), pp. 1219-1231.

·       Hreljac, A., Marshall, R.N. and Hume, P.A. (2000) 'Evaluation of lower extremity overuse injury potential in runners', Medicine & Science in Sports & Exercise, 32(9), pp. 1635-1641.

·       Casa, D.J., Armstrong, L.E., Hillman, S.K., Montain, S.J. and Reiff, R.V. (2005) 'National Athletic Trainers’ Association position statement: fluid replacement for athletes', Journal of Athletic Training, 35(2), pp. 212-224.

·       Cummings, S.R. and Nevitt, M.C. (1994) 'Non-skeletal determinants of fractures: the potential importance of the mechanics of falls', Osteoporosis International, 4(1), pp. 67-70.