50 Years of Title IX: Spanning Beyond Sports to Improve Bone Health of Girls

“No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal financial assistance.”

Title IX of the Education Amendments Act of 1972

As a nation full of soccer moms and dads can attest, the explosion of girls' and women's sports that resulted from the passage of Title IX has provided tremendous benefits for girls' physical, mental and social wellbeing. Greater confidence, higher self-esteem, a more positive body image, and an increased likelihood to succeed as a leader in future careers are all associated with participation in sports. As a result, it should come as no surprise that Title IX has led to many women gaining expertise not only on basketball courts, but also in law courts. Even today, women continue to battle to receive their fair share of the schools' athletic budgets or to be paid equally to their male counterparts.

Even for those who aren't (yet) fans of the WNBA or National Women’s Soccer League (NWSL), there are many reasons to celebrate the increased participation of girls and women in sports that was made possible by the passage of Title IX. In the last half-century, researchers have studied many health benefits associated with increased physical activity, ranging from better sleep to weight control and protection against chronic disease. One under-appreciated health benefit is the building of strong bones.

Movements that Matter

Many of the most popular interscholastic girls’ sports such as basketball, volleyball, tennis, gymnastics, softball, and soccer provide jumping, pivoting, and sprinting opportunities—movements that are critical to bone-strengthening. During the initiation of quick, dynamic movements, muscles load the bone by pulling on it. At the conclusion of these movements, there is impact with the ground and the bone is once again loaded. Higher-than-normal muscle-loading and impact-loading, especially those in non-repetitive load directions, cause bones to adapt by increasing its mass and shape; thus, making the skeleton stronger.  

In addition, there is a biochemical relationship between dynamic muscle contraction and bone loading. This helps to regulate metabolism and maintain equilibrium between muscle and bone. Osteoblasts are specialized cells that initiate bone formation. Children and adolescents have more osteoblasts on the outer surface of bones than adults. This difference means that the greatest overall proportion of bone mass accrues during the adolescent growth spurt making muscle- and impact movements particularly important during this time. In fact, one long-term research study from Canada indicated that 60% of the risk of osteoporosis can be explained by the amount of bone mass accumulated during the growing years, and that this accumulation is likely to have greater positive effects than interventions in adults after the development of osteoporosis.

Keep Playing, Keep Building Strong Bones

While the evidence is clear that muscle- and impact-loading physical activities make bones stronger in youth, simply training or exercising for strong bones can be boring. Enter sports! Girls who participate in sports are provided with ample opportunities to jump, pivot, and sprint with friends while focusing on immediate goals completely independent of down-the-road bone health. A recent Danish intervention study showed that bone mass improvements associated with a three-day-a-week small-sided soccer game were the same as circuit-strength training (that is, exercise). It is telling that we speak of playing a sport but exercise per se is a workout. The pleasure involved with sports keeps us building our bones even if we aren't aware of it.

Continue Leveling the Playing Field    

Although significantly more girls participate in sport today due to Title IX, girls still do not have the same number of participation opportunities provided to boys. Participation is also lowered by less access to playing space, playing times, quality coaching, and safe equipment. Strategies that do keep girls in the game include using female coaches (who more closely mirror the race/ethnicity of the community) along with providing various levels of competition. Parents and caregivers can sign their girls up to play and help them find an activity they enjoy. Focusing on fun should be the primary goal.

The National Youth Sports Strategy, released by the U.S. Department of Health and Human Services, set a vision for reimagining youth sports culture where all youth would have the opportunity, motivation, access to play sports. The Strategy's primary focus is underserved populations, including girls, racial and ethnic minorities, youth from lower lower-income households, and kids with a disability who have fewer opportunities to play than their peers. For example, 52% of girls participate in a sports team or take lessons; in contrast to 58% of boys. While we have come a long way since the passage of Title IX, The National Youth Sports Strategy aims to continue leveling the playing field.

On a hopeful note, post-Title IX research has provided us with the evidence that sports participation in kids builds strong bones that can keep us competing well into our Senior Games years. Now we just need to find the backbone as a society to continue expanding opportunities until all kids have equal access to participate and benefit from sports. Fortunately, thanks to Title IX, there are now many more women with very strong backbones.

Kathleen F. Janz, EdD, is an Emeritus Professor in the Department of Health and Human Physiology and Department of Epidemiology at the University of Iowa. She is also a member of the Cooper Institute FitnessGram Scientific Advisory Committee.Katrina L. Piercy, PhD, RD, is the Director of the Division of Prevention Science in the Office of Disease Prevention and Health Promotion (ODPHP) in the United States Department of Health and Human Services (HHS) and serves as a dietitian officer in the United States Public Health Service Commissioned Corps.