Abstract
BACKGROUND: The childhood and adolescent period represent a critical window for bone development. Mechanical loading through physical exercise effectively stimulates osteogenic responses, promoting peak bone mass accumulation-a key factor in osteoporosis prevention. OBJECTIVE: To compare the effects of high-impact jumping versus resistance exercise on bone mineral content (BMC) in children and adolescents, thereby identifying the most osteogenic exercise modality. METHODS: We systematically searched PubMed, The Cochrane Library, Web of Science, and Embase from inception to April 4, 2025 for randomized and non-randomized controlled trials investigating high-impact or resistance exercise effects on pediatric BMC. Study quality was assessed using Cochrane's risk-of-bias tool. Meta-analyses were conducted using RevMan 5.4 and Stata 17. To assess robustness, we performed sex-stratified subgroup analyses and sensitivity analyses. Meta-regression with robust variance estimation (RVE) was conducted using the robumeta package. RESULTS: A total of twelve studies involving 940 participants were included. The meta-analysis indicated that high-impact jumping significantly improved BMC in children and adolescents at the lumbar spine (MD = 0.86, 95% CI [0.27-1.45], p = 0.004) and femoral neck (MD = 0.11, 95% CI [0.04-0.18], p = 0.001). Subgroup analyses by sex demonstrated particularly pronounced improvements in girls, with significant increases in BMC at both the lumbar spine (MD = 1.40, 95% CI [0.16-2.63], p = 0.03) and femoral neck (MD = 0.11, 95% CI [0.00-0.21], p = 0.04). CONCLUSION: This study demonstrates that high-impact jumping significantly improves lumbar spine and femoral neck BMC in children and adolescents, with particularly pronounced effects observed in girls. In contrast, resistance exercise did not yield statistically significant improvements in BMC, possibly due to the limited number of studies and methodological limitations. Future research should focus on high-quality randomized controlled trials to inform and optimize bone health interventions for children and adolescents.