Esport i massa òssia (II). Característiques de l'exercici físic que condicionen el modelatge i el remodelatge ossis

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Característiques de l'exercici físic que condicionen el modelatge i el remodelatge ossis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "92" "paginaFinal" => "98" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Caritat Bagur Calafat" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Caritat" "apellidos" => "Bagur Calafat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Departament de Fisioteràpia. Facultat de Ciències de la Salut. Universitat Internacional de Catalunya. Barcelona. Espanya." "etiqueta" => "a" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sports activity and bone mas (II). The characteristics of physical activity that affect bone formation and remodeling" ] ] "textoCompleto" => " IntroduccióEl modelatge i el remodelatge ossis presenten unes característiques individuals en funció de la raça i l'herència. Estan condicionats per una sèrie de factors nutricionals, mecànics i hormonals. La incidència sobre aquests factors condicionants pot predisposar a la pèrdua o a la millora i/o al manteniment, en funció de l'etapa de la vida, de la qualitat i quantitat d'os.Respecte del pes, l'activitat física estimula l'augment ossi, mentre que la immobilitat du a patir-ne una pèrdua accelerada1,2. Cal tenir presents les característiques de l'exercici per poder-lo correlacionar amb la quantitat dels beneficis. La intensitat i el tipus d'exercici tenen repercussions importants sobre la massa òssia, les quals són específiques de la regió anatòmica principalment implicada en el treball.Característiques de la càrrega mecànica que influencien la massa òssiaLa resposta de l'esquelet a una força depèn de la magnitud, la velocitat, la distribució i la repetició de la deformació en un determinat os. La magnitud de la deformació es podria definir com el canvi, en percentatge, de la longitud de l'os que se sotmet a una força mecànica. Les activitats que provoquen forces màximes elevades, o gran magnitud de deformació, sembla que influencien més sobre la massa òssia que no pas les activitats que apliquen un nombre elevat de cicles o repeticions3,4. La velocitat de la deformació és la rapidesa amb què aquesta apareix i s'allibera. Les deformacions ràpides són les més eficaces a l'hora d'obtenir de l'os una resposta d'adaptació màxima5. Sobre aquesta afirmació, Umemura et al6, en un treball de laboratori amb rates, van comparar l'entrenament de salt amb l'entrenament de cursa i van observar que el salt s'associava amb més velocitat i magnitud de deformació, a més de desencadenar una resposta òssia positiva de més eficàcia que la cursa. La distribució de la deformació descriu la manera com aquesta s'ordena en una secció de l'os. Hi ha la teoria que les deformacions anòmales de distribució heterogènia tenen més possibilitats d'estimular l'osteogènesi que no les deformacions repetitives produïdes per les activitats quotidianes7. Els cicles de la deformació expressen el nombre de repeticions de la força que canvien les dimensions de l'os amb una magnitud determinada. Malgrat que fa falta un nombre mínim de cicles de força per obtenir una resposta positiva de l'os, la transcendència del nombre de cicles de deformació sembla menor que la velocitat o la magnitud de la deformació8-10.Tipus d'exercici realitzat i la seva influència sobre la massa òssiaPel que es desprèn del que s'ha exposat fins aquí, les característiques de la càrrega mecànica que tenen una influència més gran sobre la densitat òssia són la magnitud, la velocitat i la distribució heterogènia de la deformació. En l'os, l'estímul més important es produeix quan les càrregues excedeixen les habituals, i hi és més important la intensitat que no la durada11,12. Principalment, les càrregues de distribució inusual (en relació amb la versatilitat dels moviments), en alta proporció i magnitud, semblen particularment estimulants de l'osteogènesi si es comparen amb càrregues més lleus, malgrat que aquestes últimes siguin aplicades d'una manera repetida13. Així doncs, l'exercici acíclic que suposi una càrrega mecànica i/o un impacte musculoesquelètic important té un efecte especialment osteotròfic, com s'ha pogut constatar en treballs amb diversos grups d'edat, tal com s'esmentarà en aquest article. L'exercici físic que sembla tenir més potencial osteogènic és el que inclou salts no estereotipats, en trajectòries diferents.L'activitat física de baix impacte, que implica una sobrecàrrega mecànica escassa, no sembla tenir cap avantatge en la consecució d'una major massa òssia en grups de subjectes que no fan cap mena d'activitat. L'acumulació en el temps d'activitat física de baix impacte tampoc no sembla que tingui repercussions favorables en la massa òssia. Així ho demostren estudis que comparen la massa òssia d'esportistes de disciplines aquàtiques en relació amb controls inactius14-16. Com a contrapartida, alguns autors, com Bailey et al17, han constatat que els valors de massa òssia de nedadors, en zones de càrrega, és fins i tot inferior a la dels controls inactius.Cal esmentar que Matkin et al18, van observar diferències de sexe en l'associació entre diversos tipus d'activitats físiques i la massa òssia en localitzacions diferents en una població amb un rang d'edat entre els 9 i els 25 anys. En les nenes i dones joves, només l'activitat amb càrrega del pes corporal es correlacionà positivament amb la densitat mineral òssia (DMO), mentre que en els nois i homes aquesta correlació es va manifestar també en les activitats físiques en què no hi havia càrrega del pes corporal.Es pot acceptar, segons la bibliografia que es revisarà en l'apartat d'esport i massa òssia, que l'entrenament d'alt impacte proporciona un estímul més gran per augmentar el contingut mineral ossi que no els esports aeròbics com la natació i l'atletisme. De totes maneres, tal com apunten Alfredson et al19, l'entrenament aeròbic es pot considerar una alternativa a l'exercici físic d'alt impacte (normalment de predomini anaeròbic), ja que, malgrat que les conseqüències d'aquest tipus de treball són inferiors per a la DMO, es poden trobar beneficis en zones que tenen un valor clínic important, com ara el maluc i la columna lumbar, sobretot si l'entrenament aeròbic es fa mitjançant una activitat com és la cursa, que comporta una càrrega vertical sobre l'extremitat inferior, en haver de suportar el pes del cos. Per tant, dins l'àmplia gamma d'activitats i/o exercicis que es fan movent la càrrega del propi cos i que són beneficiosos per a l'adquisició òssia, els d'alt impacte són els que repercuteixen amb un benefici més gran per a la massa òssia i la geometria de l'os20.A més, s'ha de tenir present que l'entrenament aeròbic habitualment es fa mitjançant diversos tipus de desplaçament que representen una activitat cíclica i que, per tant, no comporta una distribució anòmala i heterogènia de la deformació, que suposaria un efecte osteogènic més gran.Quant al tipus de contracció muscular, està ben establert que calen càrregues dinàmiques a fi d'influir sobre la massa òssia21; així doncs, el treball muscular de predomini dinàmic serà el que tindrà més repercussió sobre l'os davant el treball muscular de predomini isomètric. En l'estudi de Woitge22 es va constatar, a més a més, que la contracció muscular dinàmica excèntrica produïa un benefici més gran per a la massa òssia que no pas la contracció muscular concèntrica, ben segur en relació amb la capacitat de generar més força i, per tant, imprimir més deformació a la zona d'inserció muscular.Influència de les activitats de salt sobre la massa òssiaLes activitats que inclouen salts sembla que tenen un potencial osteogènic més elevat, el qual es manifesta principalment en les etapes en què l'organisme és més receptiu als beneficis de l'exercici físic.Diverses proves controlades han mostrat que diversos períodes d'activitat de salt augmenten la massa i l'àrea òssia a l'edat prepuberal o peripuberal. Subjectes que saltaven tan sols alguns minuts (entre 10 i 25 min, segons els estudis) 3 vegades a la setmana durant 7-8 mesos, guanyaven més massa òssia al maluc i a la columna lumbar que d'altres en el grup control23-26. Els guanys observats en aquest període curt d'estudi es mantenen o augmenten si la intervenció s'allarga en el temps (fins a 2 cursos escolars) amb la mateixa pauta de treball27. En aquesta etapa, especialment sensible, la inclusió de programes de salt de curta durada, fàcilment incorporables en el currículum d'educació física a l'escola, pot contribuir a incrementar els guanys ossis.En l'etapa postpuberal també s'observen els beneficis de programes d'exercici físic en els quals es fan diverses activitats de salt amb pautes comparables a les exposades28 i amb l'ús de càrregues addicionals en l'execució dels exercicis29.Els beneficis per a l'os dels exercicis de salt vertical també s'han pogut constatar, però en menor quantitat, en dones premenopàusiques, amb un increment de la DMO femoral del 2,8%. No obstant això, un programa equivalent d'exercicis breus d'alt impacte es va observar que no produïa beneficis en el període postmenopàusic30.Magnitud de la càrrega de treball i durada de l'exposicióEn determinar la influència dels components de la càrrega d'entrenament sobre l'os, queda palès que la intensitat de l'exercici té una major relació amb la massa òssia que no el volum de treball. Tot i això, cal plantejar-se quin és el volum de treball setmanal necessari perquè es produeixin adaptacions en la massa òssia, tenint en compte que sempre han d'estar en relació amb la intensitat de la càrrega aplicada. Estudis controlats en els quals es volia constatar l'eficàcia de l'aplicació d'un programa de força-resistència van trobar que 3 sessions setmanals d'uns 45 min, si s'aplicaven durant un any, eren suficients per estimular l'adaptació de l'os31. En canvi, programes semblants seguits durant menys temps (entre 20 i 26 setmanes)32,33 no eren suficients per incrementar la massa òssia. Estudis d'intervenció amb diverses activitats de salt23-26 troben beneficis en l'aplicació d'un programa amb un volum de treball sensiblement inferior, 3 sessions setmanals entre 10 i 25 min de durada, però amb una activitat de molt alta intensitat.Karlsson et al34, en un estudi amb jugadors de futbol van comprovar que els beneficis més grans per a la massa òssia es constataven quan la càrrega setmanal estava per sota de les 6 h d'entrenament. En el rang de 0-6 h d'entrenament setmanal van trobar que els guanys de DMO al coll femoral eren del 3,3% per hora d'entrenament; en canvi, per sobre de les 6 h els guanys només eren del 0,7% per hora d'entrenament.Quan l'exercici esdevé molt extenuant, els beneficis per a l'os es poden veure minimitzats o fins i tot anul·lats35,36. Massa exercici, especialment en les noies, pot tenir efectes negatius sobre el creixement ossi, especialment quan l'activitat física s'acompanya de pèrdua de pes corporal i reducció de les hormones sexuals que porten a la interrupció de la menstruació.D'altra banda, queda per determinar amb certesa quin pot ser l'efecte acumulatiu sobre l'os de l'exercici d'alt impacte, ja que els estudis controlats en la majoria de casos no superen l'any de durada. En aquest sentit, cal esmentar els treballs de Nurmi-Lawton37, Laing38 i Gustavsson39, que en diversos estudis prospectius, tots de 3 anys de seguiment, van observar que es mantenien (o fins i tot milloraven) els beneficis de l'entrenament intens en disciplines d'impacte (gimnàstica esportiva, hoquei sobre gel i bàdminton).A més, es pot arribar a intuir un benefici a llarg termini en valorar els resultats d'estudis transversals que comparen els valors de massa òssia d'esportistes de diferents disciplines, i amb diferents nivells d'impacte, amb una història prèvia d'exposició a aquest tipus de treball15,20,40.Esport i massa òssiaEn un estudi de revisió41 de treballs fets amb esportistes d'elit i persones que feien molt d'exercici que inclogués l'entrenament de la força, i en absència d'amenorrea o d'escassa nutrició, s'ha pogut constatar que s'arribava a obtenir fins a un 10-30% més de densitat òssia a les zones de càrrega que en els subjectes inactius. Igualment, esportistes de disciplines en què són freqüents els salts en trajectòries diferents, com és el cas de voleibol, bàsquet, bàdminton, gimnàstica esportiva, etc., obtenen un benefici més elevat en l'increment de la massa òssia, especialment a les zones de càrrega42-44.Entre els esports competitius, hi ha diversos estudis que donen suport a la tesi que les disciplines que inclouen activitats d'impacte vertical, en les quals s'ha de suportar el pes del cos, són més beneficioses per a la massa òssia que no aquelles en què no hi ha impacte, com la natació. En la majoria d'aquests estudis es valoren en un moment determinat les conseqüències, per a l'os, de l'exposició prèvia a un programa d'entrenament de disciplines esportives d'impacte diferent15,43,45-48. Ja el 1990, Risser et al44, comparant la DMO d'esportistes de diverses especialitats (jugadores de voleibol, bàsquet i nedadores) i controls inactives, van poder relacionar uns registres més elevats de DMO amb la pràctica d'activitats esportives que suposaven impacte vertical (bàsquet i voleibol), mentre que la DMO de les nedadores no era més elevada que la de les components del grup control, inactiu físicament. Igualment, s'ha pogut constatar que esportistes d'elit de disciplines aquàtiques no tenen una massa òssia més gran a les zones de càrrega que altres persones no atletes del grup control15,16,45. Aquestes observacions remarquen la importància de l'alt impacte de l'activitat com a estímul per a la formació òssia.Hi ha un gran nombre de treballs publicats que estudien les repercussions sobre la massa òssia de la pràctica de la gimnàstica esportiva36,38,49-53. Aquesta disciplina reporta beneficis per a l'esquelet axial i apendicular, tant al tren superior52 com a l'inferior. Però de vegades els beneficis queden modulats per la influència negativa de programes d'entrenament molt intensius36 i per les alteracions hormonals i menstruals que ocasionalment pateixen aquestes esportistes.Efectes de l'exercici en relació amb la regió òssiaLa resposta de l'os a la càrrega mecànica sol ser local i no generalitzada en tot l'esquelet, i en aquest sentit hi ha un cert paral·lelisme amb les adaptacions musculars derivades de l'entrenament de la força que també es manifesten a nivell local. Les activitats amb recolzament del propi pes corporal, que suposen una major implicació del tren inferior, tenen una repercussió més important en la columna lumbar i al maluc. Com a contrapartida, les activitats que exigeixen d'una manera específica el tren superior o l'extremitat i/o el costat dominant obtenen beneficis només en aquestes localitzacions.En un estudi transversal amb una mostra d'esportistes de diverses disciplines54 es va comparar la DMO de l'extremitat inferior i superior (la dominant i la contralateral), i es van poder observar diferències en la DMO de l'extremitat dominant i la contralateral d'una manera generalitzada. Aquestes diferències es feien més evidents en les disciplines que implicaven una pràctica unilateral (tennis, beisbol, futbol) respecte de les que tenien una activitat més simètrica (cursa, bàsquet, voleibol). Les diferències en l'adaptació òssia entre l'un i l'altre costat, en relació amb l'especificitat esportiva, augmenten en funció del nivell d'entrenament de l'esportista55.En estudis en què es valoren les diferències entre la massa òssia d'una extremitat i la seva contralateral, en disciplines esportives unilaterals, com poden ser els esports de raqueta, s'ha pogut contrastar que els beneficis per a la massa òssia també són unilaterals, tot confirmant les adaptacions específiques segons l'àrea majoritàriament implicada en l'exercici56. Haapasalo et al57, van confirmar que aquests beneficis, a més de ser unilaterals, no s'evidenciaven clarament fins al pic de creixement de l'adolescència o l'estadi III de Tanner, i sempre condicionats per la durada de la carrera esportiva i la freqüència dels entrenaments.Aquestes adaptacions òssies diferenciades entre un costat i l'altre resulten més evidents si l'inici de la pràctica esportiva asimètrica és precoç58. Les adaptacions específiques en relació amb l'exercici depenen de l'estat de maduració òssia de la regió59.En diversos estudis amb esportistes amb disfuncions menstruals que poden repercutir negativament en la massa òssia, la majoria d'autors consideren que el contingut mineral ossi és normal a les zones de càrrega (columna lumbar i maluc). Es pot intuir, doncs, que la càrrega mecànica d'alguna manera compensaria, localment, l'efecte deleteri sobre l'os de les alteracions menstruals i hormonals60-62.Força i massa òssiaLa resposta òssia local no sols està en relació amb la càrrega mecànica de cada regió específica, sinó que també es relaciona amb la força muscular. L'associació entre força muscular i massa òssia és un aspecte controvertit, ja que els resultats de treballs que han intentat establir aquesta associació són molt dispars.Diversos estudis relacionats amb la pràctica de diverses disciplines esportives no troben que els guanys en força muscular vagin emparellats amb els increments de la massa òssia local42,63-66. Heinonen et al67, van concloure que un programa d'entrenament de força unilateral d'un any de durada no proporcionava un efecte osteogènic suficient, malgrat els increments significatius de força produïts.D'altra banda, hi ha treballs que troben associació entre la força muscular i les adaptacions locals de la massa òssia68-71 i amb la composició corporal regional i la DMO de l'àrea72,73. Seria una manera indirecta de relacionar les àrees més sol·licitades en les diverses disciplines esportives i la força muscular i la DMO de la mateixa àrea.Nichols et al31, en un estudi controlat, van arribar a la conclusió que l'entrenament de la força es pot preveure com un mètode potencial per incrementar la massa òssia dels adolescents, en trobar que l'aplicació d'un programa de força-resistència de 30 a 45 min de durada, 3 vegades a la setmana durant 15 mesos, incrementava significativament la força al tren inferior i la DMO al coll femoral. Blimkie et al32, en un treball també amb noies adolescents (14-18 anys), amb una intervenció de característiques semblants a l'anterior però d'una durada de només 26 setmanes, van trobar que, malgrat els guanys significatius de força, no hi havia increments significatius de massa òssia. Uns resultats semblants va trobar Chilibeck33, que en aplicar un programa de força de 2 sessions setmanals durant 20 setmanes, va observar millores en els registres de força i de percentatge muscular, però no va ser suficient per millorar la DMO i el contingut mineral ossi. De la valoració d'aquests estudis es podria intuir que calen intervencions amb programes d'entrenament de llarga durada per poder establir relació entre els guanys de força i de massa òssia.<hr></hr>Correspondència: Caritat Bagur Calafat. Universitat Internacional de Catalunya (UIC). Josep Trueta, s/n. 08195 Sant Cugat del Vallès. Barcelona. Espanya. Correu electrònic: <a href="mailto:cbagur@csc.uic.es" class="elsevierStyleCrossRefs">cbagur@csc.uic.es</a>" "pdfFichero" => "278v42n154a13108860pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec938021" "palabras" => array:5 [ 0 => "Massa òssia" 1 => "Exercici físic" 2 => "Càrrega mecànica" 3 => "Esport" 4 => "Salt" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec938020" "palabras" => array:5 [ 0 => "Bone mass" 1 => "Physical activity" 2 => "Mechanical load" 3 => "Sports" 4 => "Jump" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "L'exercici físic és un dels factors que condicionen el modelatge i el remodelatge ossi. En l'os, l'estímul més important es produeix quan les càrregues, inherents a l'exercici físic, excedeixen les habituals i tenen una distribució inusual; aleshores és més important la intensitat que no la durada d'aquestes. L'exercici físic que sembla que té més potencial osteogènic és el que inclou salts no estereotipats, en trajectòries diferents. L'activitat física de baix impacte, que implica escassa sobrecàrrega mecànica, no sembla que tingui cap avantatge. Així doncs, les disciplines esportives que inclouen activitats d'impacte vertical, en les quals cal suportar el pes del cos, són més favorables per a la massa òssia que no pas aquelles en què no hi ha impacte, com la natació. Aquests beneficis seran específics de les àrees especialment implicades en l'exercici, ja que la resposta de l'os a la càrrega mecànica acostuma de ser local i no generalitzada." ] "en" => array:1 [ "resumen" => "Physical activity is one of the factors affecting bone formation and remodeling. The most important stimuli taking place in bone structure occurs when a mechanical load, inherent to physical activity, is heavier and has a different distribution than usual. The intensity of the load is more important than the duration. The type of physical activity with the greatest osteogenic potential seems to be activity that includes non-stereotyped jumps in different directions. Low impact physical activity, which involves little mechanic stress, seems not to benefit bone mass. Therefore, sports that include vertical impact activities in which body weight must be borne are more beneficial for bone mass than those in which there is no impact, such as swimming. These benefits are specific to the area most heavily involved in the activity, given that the response of bone structure to mechanical load tends to be local rather than general." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliograf¿a" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:73 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "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. J Bone Miner Res. 1999;14:1672-9." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "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." 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Esport i massa òssia (II). Característiques de l'exercici físic que condicionen el modelatge i el remodelatge ossis

Sports activity and bone mas (II). The characteristics of physical activity that affect bone formation and remodeling

Caritat Bagur Calafata

a Departament de Fisioteràpia. Facultat de Ciències de la Salut. Universitat Internacional de Catalunya. Barcelona. Espanya.

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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold"> Introducci&#243;</span></p><p class="elsevierStylePara">El modelatge i el remodelatge ossis presenten unes caracter&#237;stiques individuals en funci&#243; de la ra&#231;a i l&#39;her&#232;ncia&#46; Estan condicionats per una s&#232;rie de factors nutricionals&#44; mec&#224;nics i hormonals&#46; La incid&#232;ncia sobre aquests factors condicionants pot predisposar a la p&#232;rdua o a la millora i&#47;o al manteniment&#44; en funci&#243; de l&#39;etapa de la vida&#44; de la qualitat i quantitat d&#39;os&#46;</p><p class="elsevierStylePara">Respecte del pes&#44; l&#39;activitat f&#237;sica estimula l&#39;augment ossi&#44; mentre que la immobilitat du a patir-ne una p&#232;rdua accelerada<span class="elsevierStyleSup">1&#44;2</span>&#46; Cal tenir presents les caracter&#237;stiques de l&#39;exercici per poder-lo correlacionar amb la quantitat dels beneficis&#46; La intensitat i el tipus d&#39;exercici tenen repercussions importants sobre la massa &#242;ssia&#44; les quals s&#243;n espec&#237;fiques de la regi&#243; anat&#242;mica principalment implicada en el treball&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Caracter&#237;stiques de la c&#224;rrega mec&#224;nica que influencien la massa &#242;ssia</span></p><p class="elsevierStylePara">La resposta de l&#39;esquelet a una for&#231;a dep&#232;n de la magnitud&#44; la velocitat&#44; la distribuci&#243; i la repetici&#243; de la deformaci&#243; en un determinat os&#46;</p><p class="elsevierStylePara">&#173; La <span class="elsevierStyleItalic"> magnitud de la deformaci&#243;</span> es podria definir com el canvi&#44; en percentatge&#44; de la longitud de l&#39;os que se sotmet a una for&#231;a mec&#224;nica&#46; Les activitats que provoquen forces m&#224;ximes elevades&#44; o gran magnitud de deformaci&#243;&#44; sembla que influencien m&#233;s sobre la massa &#242;ssia que no pas les activitats que apliquen un nombre elevat de cicles o repeticions<span class="elsevierStyleSup">3&#44;4</span>&#46;</p><p class="elsevierStylePara">&#173; La <span class="elsevierStyleItalic"> velocitat de la deformaci&#243;</span> &#233;s la rapidesa amb qu&#232; aquesta apareix i s&#39;allibera&#46; Les deformacions r&#224;pides s&#243;n les m&#233;s eficaces a l&#39;hora d&#39;obtenir de l&#39;os una resposta d&#39;adaptaci&#243; m&#224;xima<span class="elsevierStyleSup">5</span>&#46; Sobre aquesta afirmaci&#243;&#44; Umemura et al<span class="elsevierStyleSup">6</span>&#44; en un treball de laboratori amb rates&#44; van comparar l&#39;entrenament de salt amb l&#39;entrenament de cursa i van observar que el salt s&#39;associava amb m&#233;s velocitat i magnitud de deformaci&#243;&#44; a m&#233;s de desencadenar una resposta &#242;ssia positiva de m&#233;s efic&#224;cia que la cursa&#46;</p><p class="elsevierStylePara">&#173; La <span class="elsevierStyleItalic"> distribuci&#243; de la deformaci&#243;</span> descriu la manera com aquesta s&#39;ordena en una secci&#243; de l&#39;os&#46; Hi ha la teoria que les deformacions an&#242;males de distribuci&#243; heterog&#232;nia tenen m&#233;s possibilitats d&#39;estimular l&#39;osteog&#232;nesi que no les deformacions repetitives produ&#239;des per les activitats quotidianes<span class="elsevierStyleSup">7</span>&#46;</p><p class="elsevierStylePara">&#173; Els <span class="elsevierStyleItalic"> cicles de la deformaci&#243;</span> expressen el nombre de repeticions de la for&#231;a que canvien les dimensions de l&#39;os amb una magnitud determinada&#46; Malgrat que fa falta un nombre m&#237;nim de cicles de for&#231;a per obtenir una resposta positiva de l&#39;os&#44; la transcend&#232;ncia del nombre de cicles de deformaci&#243; sembla menor que la velocitat o la magnitud de la deformaci&#243;<span class="elsevierStyleSup">8-10</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Tipus d&#39;exercici realitzat i la seva influ&#232;ncia sobre la massa &#242;ssia</span></p><p class="elsevierStylePara">Pel que es despr&#232;n del que s&#39;ha exposat fins aqu&#237;&#44; les caracter&#237;stiques de la c&#224;rrega mec&#224;nica que tenen una influ&#232;ncia m&#233;s gran sobre la densitat &#242;ssia s&#243;n la magnitud&#44; la velocitat i la distribuci&#243; heterog&#232;nia de la deformaci&#243;&#46; En l&#39;os&#44; l&#39;est&#237;mul m&#233;s important es produeix quan les c&#224;rregues excedeixen les habituals&#44; i hi &#233;s m&#233;s important la intensitat que no la durada<span class="elsevierStyleSup">11&#44;12</span>&#46; Principalment&#44; les c&#224;rregues de distribuci&#243; inusual &#40;en relaci&#243; amb la versatilitat dels moviments&#41;&#44; en alta proporci&#243; i magnitud&#44; semblen particularment estimulants de l&#39;osteog&#232;nesi si es comparen amb c&#224;rregues m&#233;s lleus&#44; malgrat que aquestes &#250;ltimes siguin aplicades d&#39;una manera repetida<span class="elsevierStyleSup">13</span>&#46; Aix&#237; doncs&#44; l&#39;exercici ac&#237;clic que suposi una c&#224;rrega mec&#224;nica i&#47;o un impacte musculoesquel&#232;tic important t&#233; un efecte especialment osteotr&#242;fic&#44; com s&#39;ha pogut constatar en treballs amb diversos grups d&#39;edat&#44; tal com s&#39;esmentar&#224; en aquest article&#46; L&#39;exercici f&#237;sic que sembla tenir m&#233;s potencial osteog&#232;nic &#233;s el que inclou salts no estereotipats&#44; en traject&#242;ries diferents&#46;</p><p class="elsevierStylePara">L&#39;activitat f&#237;sica de baix impacte&#44; que implica una sobrec&#224;rrega mec&#224;nica escassa&#44; no sembla tenir cap avantatge en la consecuci&#243; d&#39;una major massa &#242;ssia en grups de subjectes que no fan cap mena d&#39;activitat&#46; L&#39;acumulaci&#243; en el temps d&#39;activitat f&#237;sica de baix impacte tampoc no sembla que tingui repercussions favorables en la massa &#242;ssia&#46; Aix&#237; ho demostren estudis que comparen la massa &#242;ssia d&#39;esportistes de disciplines aqu&#224;tiques en relaci&#243; amb controls inactius<span class="elsevierStyleSup">14-16</span>&#46; Com a contrapartida&#44; alguns autors&#44; com Bailey et al<span class="elsevierStyleSup">17</span>&#44; han constatat que els valors de massa &#242;ssia de nedadors&#44; en zones de c&#224;rrega&#44; &#233;s fins i tot inferior a la dels controls inactius&#46;</p><p class="elsevierStylePara">Cal esmentar que Matkin et al<span class="elsevierStyleSup">18</span><span class="elsevierStyleItalic">&#44;</span> van observar difer&#232;ncies de sexe en l&#39;associaci&#243; entre diversos tipus d&#39;activitats f&#237;siques i la massa &#242;ssia en localitzacions diferents en una poblaci&#243; amb un rang d&#39;edat entre els 9 i els 25 anys&#46; En les nenes i dones joves&#44; nom&#233;s l&#39;activitat amb c&#224;rrega del pes corporal es correlacion&#224; positivament amb la densitat mineral &#242;ssia &#40;DMO&#41;&#44; mentre que en els nois i homes aquesta correlaci&#243; es va manifestar tamb&#233; en les activitats f&#237;siques en qu&#232; no hi havia c&#224;rrega del pes corporal&#46;</p><p class="elsevierStylePara">Es pot acceptar&#44; segons la bibliografia que es revisar&#224; en l&#39;apartat d&#39;esport i massa &#242;ssia&#44; que l&#39;entrenament d&#39;alt impacte proporciona un est&#237;mul m&#233;s gran per augmentar el contingut mineral ossi que no els esports aer&#242;bics com la nataci&#243; i l&#39;atletisme&#46; De totes maneres&#44; tal com apunten Alfredson et al<span class="elsevierStyleSup">19</span><span class="elsevierStyleItalic">&#44;</span> l&#39;entrenament aer&#242;bic es pot considerar una alternativa a l&#39;exercici f&#237;sic d&#39;alt impacte &#40;normalment de predomini anaer&#242;bic&#41;&#44; ja que&#44; malgrat que les conseq&#252;&#232;ncies d&#39;aquest tipus de treball s&#243;n inferiors per a la DMO&#44; es poden trobar beneficis en zones que tenen un valor cl&#237;nic important&#44; com ara el maluc i la columna lumbar&#44; sobretot si l&#39;entrenament aer&#242;bic es fa mitjan&#231;ant una activitat com &#233;s la cursa&#44; que comporta una c&#224;rrega vertical sobre l&#39;extremitat inferior&#44; en haver de suportar el pes del cos&#46; Per tant&#44; dins l&#39;&#224;mplia gamma d&#39;activitats i&#47;o exercicis que es fan movent la c&#224;rrega del propi cos i que s&#243;n beneficiosos per a l&#39;adquisici&#243; &#242;ssia&#44; els d&#39;alt impacte s&#243;n els que repercuteixen amb un benefici m&#233;s gran per a la massa &#242;ssia i la geometria de l&#39;os<span class="elsevierStyleSup">20</span>&#46;</p><p class="elsevierStylePara">A m&#233;s&#44; s&#39;ha de tenir present que l&#39;entrenament aer&#242;bic habitualment es fa mitjan&#231;ant diversos tipus de despla&#231;ament que representen una activitat c&#237;clica i que&#44; per tant&#44; no comporta una distribuci&#243; an&#242;mala i heterog&#232;nia de la deformaci&#243;&#44; que suposaria un efecte osteog&#232;nic m&#233;s gran&#46;</p><p class="elsevierStylePara">Quant al tipus de contracci&#243; muscular&#44; est&#224; ben establert que calen c&#224;rregues din&#224;miques a fi d&#39;influir sobre la massa &#242;ssia<span class="elsevierStyleSup">21</span>&#59; aix&#237; doncs&#44; el treball muscular de predomini din&#224;mic ser&#224; el que tindr&#224; m&#233;s repercussi&#243; sobre l&#39;os davant el treball muscular de predomini isom&#232;tric&#46; En l&#39;estudi de Woitge<span class="elsevierStyleSup">22</span> es va constatar&#44; a m&#233;s a m&#233;s&#44; que la contracci&#243; muscular din&#224;mica exc&#232;ntrica produ&#239;a un benefici m&#233;s gran per a la massa &#242;ssia que no pas la contracci&#243; muscular conc&#232;ntrica&#44; ben segur en relaci&#243; amb la capacitat de generar m&#233;s for&#231;a i&#44; per tant&#44; imprimir m&#233;s deformaci&#243; a la zona d&#39;inserci&#243; muscular&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Influ&#232;ncia de les activitats de salt sobre la massa &#242;ssia</span></p><p class="elsevierStylePara">Les activitats que inclouen salts sembla que tenen un potencial osteog&#232;nic m&#233;s elevat&#44; el qual es manifesta principalment en les etapes en qu&#232; l&#39;organisme &#233;s m&#233;s receptiu als beneficis de l&#39;exercici f&#237;sic&#46;</p><p class="elsevierStylePara">Diverses proves controlades han mostrat que diversos per&#237;odes d&#39;activitat de salt augmenten la massa i l&#39;&#224;rea &#242;ssia a l&#39;edat prepuberal o peripuberal&#46; Subjectes que saltaven tan sols alguns minuts &#40;entre 10 i 25 min&#44; segons els estudis&#41; 3 vegades a la setmana durant 7-8 mesos&#44; guanyaven m&#233;s massa &#242;ssia al maluc i a la columna lumbar que d&#39;altres en el grup control<span class="elsevierStyleSup">23-26</span>&#46; Els guanys observats en aquest per&#237;ode curt d&#39;estudi es mantenen o augmenten si la intervenci&#243; s&#39;allarga en el temps &#40;fins a 2 cursos escolars&#41; amb la mateixa pauta de treball<span class="elsevierStyleSup">27</span>&#46; En aquesta etapa&#44; especialment sensible&#44; la inclusi&#243; de programes de salt de curta durada&#44; f&#224;cilment incorporables en el curr&#237;culum d&#39;educaci&#243; f&#237;sica a l&#39;escola&#44; pot contribuir a incrementar els guanys ossis&#46;</p><p class="elsevierStylePara">En l&#39;etapa postpuberal tamb&#233; s&#39;observen els beneficis de programes d&#39;exercici f&#237;sic en els quals es fan diverses activitats de salt amb pautes comparables a les exposades<span class="elsevierStyleSup">28</span> i amb l&#39;&#250;s de c&#224;rregues addicionals en l&#39;execuci&#243; dels exercicis<span class="elsevierStyleSup">29</span>&#46;</p><p class="elsevierStylePara">Els beneficis per a l&#39;os dels exercicis de salt vertical tamb&#233; s&#39;han pogut constatar&#44; per&#242; en menor quantitat&#44; en dones premenop&#224;usiques&#44; amb un increment de la DMO femoral del 2&#44;8&#37;&#46; No obstant aix&#242;&#44; un programa equivalent d&#39;exercicis breus d&#39;alt impacte es va observar que no produ&#239;a beneficis en el per&#237;ode postmenop&#224;usic<span class="elsevierStyleSup">30</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Magnitud de la c&#224;rrega de treball i durada de l&#39;exposici&#243;</span></p><p class="elsevierStylePara">En determinar la influ&#232;ncia dels components de la c&#224;rrega d&#39;entrenament sobre l&#39;os&#44; queda pal&#232;s que la intensitat de l&#39;exercici t&#233; una major relaci&#243; amb la massa &#242;ssia que no el volum de treball&#46; Tot i aix&#242;&#44; cal plantejar-se quin &#233;s el volum de treball setmanal necessari perqu&#232; es produeixin adaptacions en la massa &#242;ssia&#44; tenint en compte que sempre han d&#39;estar en relaci&#243; amb la intensitat de la c&#224;rrega aplicada&#46; Estudis controlats en els quals es volia constatar l&#39;efic&#224;cia de l&#39;aplicaci&#243; d&#39;un programa de for&#231;a-resist&#232;ncia van trobar que 3 sessions setmanals d&#39;uns 45 min&#44; si s&#39;aplicaven durant un any&#44; eren suficients per estimular l&#39;adaptaci&#243; de l&#39;os<span class="elsevierStyleSup">31</span>&#46; En canvi&#44; programes semblants seguits durant menys temps &#40;entre 20 i 26 setmanes&#41;<span class="elsevierStyleSup">32&#44;33</span> no eren suficients per incrementar la massa &#242;ssia&#46; Estudis d&#39;intervenci&#243; amb diverses activitats de salt<span class="elsevierStyleSup">23-26</span> troben beneficis en l&#39;aplicaci&#243; d&#39;un programa amb un volum de treball sensiblement inferior&#44; 3 sessions setmanals entre 10 i 25 min de durada&#44; per&#242; amb una activitat de molt alta intensitat&#46;</p><p class="elsevierStylePara">Karlsson et al<span class="elsevierStyleSup">34</span><span class="elsevierStyleItalic">&#44;</span> en un estudi amb jugadors de futbol van comprovar que els beneficis m&#233;s grans per a la massa &#242;ssia es constataven quan la c&#224;rrega setmanal estava per sota de les 6 h d&#39;entrenament&#46; En el rang de 0-6 h d&#39;entrenament setmanal van trobar que els guanys de DMO al coll femoral eren del 3&#44;3&#37; per hora d&#39;entrenament&#59; en canvi&#44; per sobre de les 6 h els guanys nom&#233;s eren del 0&#44;7&#37; per hora d&#39;entrenament&#46;</p><p class="elsevierStylePara">Quan l&#39;exercici esdev&#233; molt extenuant&#44; els beneficis per a l&#39;os es poden veure minimitzats o fins i tot anul&#183;lats<span class="elsevierStyleSup">35&#44;36</span>&#46; Massa exercici&#44; especialment en les noies&#44; pot tenir efectes negatius sobre el creixement ossi&#44; especialment quan l&#39;activitat f&#237;sica s&#39;acompanya de p&#232;rdua de pes corporal i reducci&#243; de les hormones sexuals que porten a la interrupci&#243; de la menstruaci&#243;&#46;</p><p class="elsevierStylePara">D&#39;altra banda&#44; queda per determinar amb certesa quin pot ser l&#39;efecte acumulatiu sobre l&#39;os de l&#39;exercici d&#39;alt impacte&#44; ja que els estudis controlats en la majoria de casos no superen l&#39;any de durada&#46; En aquest sentit&#44; cal esmentar els treballs de Nurmi-Lawton<span class="elsevierStyleSup">37</span>&#44; Laing<span class="elsevierStyleSup">38</span> i Gustavsson<span class="elsevierStyleSup">39</span>&#44; que en diversos estudis prospectius&#44; tots de 3 anys de seguiment&#44; van observar que es mantenien &#40;o fins i tot milloraven&#41; els beneficis de l&#39;entrenament intens en disciplines d&#39;impacte &#40;gimn&#224;stica esportiva&#44; hoquei sobre gel i b&#224;dminton&#41;&#46;</p><p class="elsevierStylePara">A m&#233;s&#44; es pot arribar a intuir un benefici a llarg termini en valorar els resultats d&#39;estudis transversals que comparen els valors de massa &#242;ssia d&#39;esportistes de diferents disciplines&#44; i amb diferents nivells d&#39;impacte&#44; amb una hist&#242;ria pr&#232;via d&#39;exposici&#243; a aquest tipus de treball<span class="elsevierStyleSup">15&#44;20&#44;40</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Esport i massa &#242;ssia</span></p><p class="elsevierStylePara">En un estudi de revisi&#243;<span class="elsevierStyleSup">41</span> de treballs fets amb esportistes d&#39;elit i persones que feien molt d&#39;exercici que inclogu&#233;s l&#39;entrenament de la for&#231;a&#44; i en abs&#232;ncia d&#39;amenorrea o d&#39;escassa nutrici&#243;&#44; s&#39;ha pogut constatar que s&#39;arribava a obtenir fins a un 10-30&#37; m&#233;s de densitat &#242;ssia a les zones de c&#224;rrega que en els subjectes inactius&#46; Igualment&#44; esportistes de disciplines en qu&#232; s&#243;n freq&#252;ents els salts en traject&#242;ries diferents&#44; com &#233;s el cas de voleibol&#44; b&#224;squet&#44; b&#224;dminton&#44; gimn&#224;stica esportiva&#44; etc&#46;&#44; obtenen un benefici m&#233;s elevat en l&#39;increment de la massa &#242;ssia&#44; especialment a les zones de c&#224;rrega<span class="elsevierStyleSup">42-44</span>&#46;</p><p class="elsevierStylePara">Entre els esports competitius&#44; hi ha diversos estudis que donen suport a la tesi que les disciplines que inclouen activitats d&#39;impacte vertical&#44; en les quals s&#39;ha de suportar el pes del cos&#44; s&#243;n m&#233;s beneficioses per a la massa &#242;ssia que no aquelles en qu&#232; no hi ha impacte&#44; com la nataci&#243;&#46; En la majoria d&#39;aquests estudis es valoren en un moment determinat les conseq&#252;&#232;ncies&#44; per a l&#39;os&#44; de l&#39;exposici&#243; pr&#232;via a un programa d&#39;entrenament de disciplines esportives d&#39;impacte diferent<span class="elsevierStyleSup">15&#44;43&#44;45-48</span>&#46; Ja el 1990&#44; Risser et al<span class="elsevierStyleSup">44</span><span class="elsevierStyleItalic">&#44;</span> comparant la DMO d&#39;esportistes de diverses especialitats &#40;jugadores de voleibol&#44; b&#224;squet i nedadores&#41; i controls inactives&#44; van poder relacionar uns registres m&#233;s elevats de DMO amb la pr&#224;ctica d&#39;activitats esportives que suposaven impacte vertical &#40;b&#224;squet i voleibol&#41;&#44; mentre que la DMO de les nedadores no era m&#233;s elevada que la de les components del grup control&#44; inactiu f&#237;sicament&#46; Igualment&#44; s&#39;ha pogut constatar que esportistes d&#39;elit de disciplines aqu&#224;tiques no tenen una massa &#242;ssia m&#233;s gran a les zones de c&#224;rrega que altres persones no atletes del grup control<span class="elsevierStyleSup">15&#44;16&#44;45</span>&#46; Aquestes observacions remarquen la import&#224;ncia de l&#39;alt impacte de l&#39;activitat com a est&#237;mul per a la formaci&#243; &#242;ssia&#46;</p><p class="elsevierStylePara">Hi ha un gran nombre de treballs publicats que estudien les repercussions sobre la massa &#242;ssia de la pr&#224;ctica de la gimn&#224;stica esportiva<span class="elsevierStyleSup">36&#44;38&#44;49-53</span>&#46; Aquesta disciplina reporta beneficis per a l&#39;esquelet axial i apendicular&#44; tant al tren superior<span class="elsevierStyleSup">52</span> com a l&#39;inferior&#46; Per&#242; de vegades els beneficis queden modulats per la influ&#232;ncia negativa de programes d&#39;entrenament molt intensius<span class="elsevierStyleSup">36</span> i per les alteracions hormonals i menstruals que ocasionalment pateixen aquestes esportistes&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Efectes de l&#39;exercici en relaci&#243; amb la regi&#243; &#242;ssia</span></p><p class="elsevierStylePara">La resposta de l&#39;os a la c&#224;rrega mec&#224;nica sol ser local i no generalitzada en tot l&#39;esquelet&#44; i en aquest sentit hi ha un cert paral&#183;lelisme amb les adaptacions musculars derivades de l&#39;entrenament de la for&#231;a que tamb&#233; es manifesten a nivell local&#46; Les activitats amb recolzament del propi pes corporal&#44; que suposen una major implicaci&#243; del tren inferior&#44; tenen una repercussi&#243; m&#233;s important en la columna lumbar i al maluc&#46; Com a contrapartida&#44; les activitats que exigeixen d&#39;una manera espec&#237;fica el tren superior o l&#39;extremitat i&#47;o el costat dominant obtenen beneficis nom&#233;s en aquestes localitzacions&#46;</p><p class="elsevierStylePara">En un estudi transversal amb una mostra d&#39;esportistes de diverses disciplines<span class="elsevierStyleSup">54</span> es va comparar la DMO de l&#39;extremitat inferior i superior &#40;la dominant i la contralateral&#41;&#44; i es van poder observar difer&#232;ncies en la DMO de l&#39;extremitat dominant i la contralateral d&#39;una manera generalitzada&#46; Aquestes difer&#232;ncies es feien m&#233;s evidents en les disciplines que implicaven una pr&#224;ctica unilateral &#40;tennis&#44; beisbol&#44; futbol&#41; respecte de les que tenien una activitat m&#233;s sim&#232;trica &#40;cursa&#44; b&#224;squet&#44; voleibol&#41;&#46; Les difer&#232;ncies en l&#39;adaptaci&#243; &#242;ssia entre l&#39;un i l&#39;altre costat&#44; en relaci&#243; amb l&#39;especificitat esportiva&#44; augmenten en funci&#243; del nivell d&#39;entrenament de l&#39;esportista<span class="elsevierStyleSup">55</span>&#46;</p><p class="elsevierStylePara">En estudis en qu&#232; es valoren les difer&#232;ncies entre la massa &#242;ssia d&#39;una extremitat i la seva contralateral&#44; en disciplines esportives unilaterals&#44; com poden ser els esports de raqueta&#44; s&#39;ha pogut contrastar que els beneficis per a la massa &#242;ssia tamb&#233; s&#243;n unilaterals&#44; tot confirmant les adaptacions espec&#237;fiques segons l&#39;&#224;rea majorit&#224;riament implicada en l&#39;exercici<span class="elsevierStyleSup">56</span>&#46; Haapasalo et al<span class="elsevierStyleSup">57</span><span class="elsevierStyleItalic">&#44;</span> van confirmar que aquests beneficis&#44; a m&#233;s de ser unilaterals&#44; no s&#39;evidenciaven clarament fins al pic de creixement de l&#39;adolesc&#232;ncia o l&#39;estadi III de Tanner&#44; i sempre condicionats per la durada de la carrera esportiva i la freq&#252;&#232;ncia dels entrenaments&#46;</p><p class="elsevierStylePara">Aquestes adaptacions &#242;ssies diferenciades entre un costat i l&#39;altre resulten m&#233;s evidents si l&#39;inici de la pr&#224;ctica esportiva asim&#232;trica &#233;s preco&#231;<span class="elsevierStyleSup">58</span>&#46; Les adaptacions espec&#237;fiques en relaci&#243; amb l&#39;exercici depenen de l&#39;estat de maduraci&#243; &#242;ssia de la regi&#243;<span class="elsevierStyleSup">59</span>&#46;</p><p class="elsevierStylePara">En diversos estudis amb esportistes amb disfuncions menstruals que poden repercutir negativament en la massa &#242;ssia&#44; la majoria d&#39;autors consideren que el contingut mineral ossi &#233;s normal a les zones de c&#224;rrega &#40;columna lumbar i maluc&#41;&#46; Es pot intuir&#44; doncs&#44; que la c&#224;rrega mec&#224;nica d&#39;alguna manera compensaria&#44; localment&#44; l&#39;efecte deleteri sobre l&#39;os de les alteracions menstruals i hormonals<span class="elsevierStyleSup">60-62</span>&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">For&#231;a i massa &#242;ssia</span></p><p class="elsevierStylePara">La resposta &#242;ssia local no sols est&#224; en relaci&#243; amb la c&#224;rrega mec&#224;nica de cada regi&#243; espec&#237;fica&#44; sin&#243; que tamb&#233; es relaciona amb la for&#231;a muscular&#46; L&#39;associaci&#243; entre for&#231;a muscular i massa &#242;ssia &#233;s un aspecte controvertit&#44; ja que els resultats de treballs que han intentat establir aquesta associaci&#243; s&#243;n molt dispars&#46;</p><p class="elsevierStylePara">Diversos estudis relacionats amb la pr&#224;ctica de diverses disciplines esportives no troben que els guanys en for&#231;a muscular vagin emparellats amb els increments de la massa &#242;ssia local<span class="elsevierStyleSup">42&#44;63-66</span>&#46; Heinonen et al<span class="elsevierStyleSup">67</span><span class="elsevierStyleItalic">&#44;</span> van concloure que un programa d&#39;entrenament de for&#231;a unilateral d&#39;un any de durada no proporcionava un efecte osteog&#232;nic suficient&#44; malgrat els increments significatius de for&#231;a produ&#239;ts&#46;</p><p class="elsevierStylePara">D&#39;altra banda&#44; hi ha treballs que troben associaci&#243; entre la for&#231;a muscular i les adaptacions locals de la massa &#242;ssia<span class="elsevierStyleSup">68-71</span> i amb la composici&#243; corporal regional i la DMO de l&#39;&#224;rea<span class="elsevierStyleSup">72&#44;73</span>&#46; Seria una manera indirecta de relacionar les &#224;rees m&#233;s sol&#183;licitades en les diverses disciplines esportives i la for&#231;a muscular i la DMO de la mateixa &#224;rea&#46;</p><p class="elsevierStylePara">Nichols et al<span class="elsevierStyleSup">31</span><span class="elsevierStyleItalic">&#44;</span> en un estudi controlat&#44; van arribar a la conclusi&#243; que l&#39;entrenament de la for&#231;a es pot preveure com un m&#232;tode potencial per incrementar la massa &#242;ssia dels adolescents&#44; en trobar que l&#39;aplicaci&#243; d&#39;un programa de for&#231;a-resist&#232;ncia de 30 a 45 min de durada&#44; 3 vegades a la setmana durant 15 mesos&#44; incrementava significativament la for&#231;a al tren inferior i la DMO al coll femoral&#46; Blimkie et al<span class="elsevierStyleSup">32</span><span class="elsevierStyleItalic">&#44;</span> en un treball tamb&#233; amb noies adolescents &#40;14-18 anys&#41;&#44; amb una intervenci&#243; de caracter&#237;stiques semblants a l&#39;anterior per&#242; d&#39;una durada de nom&#233;s 26 setmanes&#44; van trobar que&#44; malgrat els guanys significatius de for&#231;a&#44; no hi havia increments significatius de massa &#242;ssia&#46; Uns resultats semblants va trobar Chilibeck<span class="elsevierStyleSup">33</span>&#44; que en aplicar un programa de for&#231;a de 2 sessions setmanals durant 20 setmanes&#44; va observar millores en els registres de for&#231;a i de percentatge muscular&#44; per&#242; no va ser suficient per millorar la DMO i el contingut mineral ossi&#46; De la valoraci&#243; d&#39;aquests estudis es podria intuir que calen intervencions amb programes d&#39;entrenament de llarga durada per poder establir relaci&#243; entre els guanys de for&#231;a i de massa &#242;ssia&#46;</p><hr></hr><p class="elsevierStylePara">Correspond&#232;ncia&#58; Caritat Bagur Calafat&#46; Universitat Internacional de Catalunya &#40;UIC&#41;&#46; Josep Trueta&#44; s&#47;n&#46; 08195 Sant Cugat del Vall&#232;s&#46; Barcelona&#46; Espanya&#46; Correu electr&#242;nic&#58; <a href="mailto&#58;cbagur&#64;csc&#46;uic&#46;es" class="elsevierStyleCrossRefs">cbagur&#64;csc&#46;uic&#46;es</a></p>"
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          "palabras" => array:5 [
            0 => "Massa &#242;ssia"
            1 => "Exercici f&#237;sic"
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            1 => "Physical activity"
            2 => "Mechanical load"
            3 => "Sports"
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    "resumen" => array:2 [
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        "resumen" => "L&#39;exercici f&#237;sic &#233;s un dels factors que condicionen el modelatge i el remodelatge ossi&#46; En l&#39;os&#44; l&#39;est&#237;mul m&#233;s important es produeix quan les c&#224;rregues&#44; inherents a l&#39;exercici f&#237;sic&#44; excedeixen les habituals i tenen una distribuci&#243; inusual&#59; aleshores &#233;s m&#233;s important la intensitat que no la durada d&#39;aquestes&#46; L&#39;exercici f&#237;sic que sembla que t&#233; m&#233;s potencial osteog&#232;nic &#233;s el que inclou salts no estereotipats&#44; en traject&#242;ries diferents&#46; L&#39;activitat f&#237;sica de baix impacte&#44; que implica escassa sobrec&#224;rrega mec&#224;nica&#44; no sembla que tingui cap avantatge&#46; Aix&#237; doncs&#44; les disciplines esportives que inclouen activitats d&#39;impacte vertical&#44; en les quals cal suportar el pes del cos&#44; s&#243;n m&#233;s favorables per a la massa &#242;ssia que no pas aquelles en qu&#232; no hi ha impacte&#44; com la nataci&#243;&#46; Aquests beneficis seran espec&#237;fics de les &#224;rees especialment implicades en l&#39;exercici&#44; ja que la resposta de l&#39;os a la c&#224;rrega mec&#224;nica acostuma de ser local i no generalitzada&#46;"
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        "resumen" => "Physical activity is one of the factors affecting bone formation and remodeling&#46; The most important stimuli taking place in bone structure occurs when a mechanical load&#44; inherent to physical activity&#44; is heavier and has a different distribution than usual&#46; The intensity of the load is more important than the duration&#46; The type of physical activity with the greatest osteogenic potential seems to be activity that includes non-stereotyped jumps in different directions&#46; Low impact physical activity&#44; which involves little mechanic stress&#44; seems not to benefit bone mass&#46; Therefore&#44; sports that include vertical impact activities in which body weight must be borne are more beneficial for bone mass than those in which there is no impact&#44; such as swimming&#46; These benefits are specific to the area most heavily involved in the activity&#44; given that the response of bone structure to mechanical load tends to be local rather than general&#46;"
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                    0 => array:3 [
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                      "autores" => array:1 [
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                          "etal" => false
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                            0 => "Bailey DA"
                            1 => "McKay HA"
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                            4 => "Faulkner RA&#46;"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1359/jbmr.1999.14.10.1672"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Miner Res"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "1672"
                        "paginaFinal" => "9"
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            1 => array:3 [
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              "identificador" => "bib3"
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                        0 => array:2 [
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                            0 => "Rubin CT"
                            1 => "Lanyon LE&#46;"
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              "referencia" => array:1 [
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                  "referenciaCompleta" => "Influence of physical activity on the regulation of bone density. J Biomech. 1988;21:825-37."
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                      "titulo" => "Influence of physical activity on the regulation of bone density&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "Whalen RT"
                            1 => "Carter DR"
                            2 => "Steele CR&#46;"
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                        "tituloSerie" => "J Biomech"
                        "fecha" => "1988"
                        "volumen" => "21"
                        "paginaInicial" => "825"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mechanotransduction in bone: role of strain rate. Am J Physiol. 1995;269:E438-42."
                  "contribucion" => array:1 [
                    0 => array:3 [
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                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Turner CH"
                            1 => "Owan I"
                            2 => "Takano Y&#46;"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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Article information

ISSN: X8866581
Original language: Català

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2024 June	87	17	104
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2022 December	68	35	103
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2020 December	31	17	48
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2019 December	27	9	36
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2019 January	38	30	68
2018 December	37	28	65
2018 November	27	24	51
2018 October	44	17	61
2018 September	34	18	52
2018 August	29	15	44
2018 July	41	14	55
2018 June	38	17	55
2018 May	14	23	37
2018 April	57	10	67
2018 March	29	14	43
2018 February	17	3	20
2018 January	27	8	35
2017 December	44	6	50
2017 November	24	7	31
2017 October	23	5	28
2017 September	23	10	33
2017 August	38	23	61
2017 July	32	19	51
2017 June	37	23	60
2017 May	49	37	86
2017 April	220	210	430
2017 March	23	21	44
2017 February	51	24	75
2017 January	30	10	40
2016 December	25	12	37
2016 November	38	9	47
2016 October	45	12	57
2016 September	32	15	47
2016 August	29	10	39
2016 July	29	7	36
2016 June	32	11	43
2016 May	42	16	58
2016 April	38	12	50
2016 March	38	9	47
2016 February	40	19	59
2016 January	43	12	55
2015 December	32	10	42
2015 November	23	8	31
2015 October	34	10	44
2015 September	32	9	41
2015 August	30	10	40
2015 July	19	5	24
2015 June	14	2	16
2015 May	26	2	28
2015 April	17	4	21
2015 March	16	5	21
2015 February	14	3	17
2015 January	23	7	30
2014 December	13	8	21
2014 November	13	7	20
2014 October	23	10	33
2014 September	81	3	84
2014 August	33	12	45
2014 July	14	14	28

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