Abstract
BackgroundLifelong healthy habits developed during childhood may prevent chronic diseases in adulthood. Interventions to promote these habits must begin early. The BONES (Beat Osteoporosis – Nourish and Exercise Skeletons) project assessed whether early elementary school children participating in a multifaceted health behavior change, after-school based intervention would improve bone quality and muscular strength and engage in more bone-strengthening behaviors.MethodsThe 2-year BONES (B) intervention included bone-strengthening physical activity (85 min/week), educational materials (2 days/week), and daily calcium-rich snacks (380 mg calcium/day) delivered by after-school program leaders. BONES plus Parent (B + P) included an additional parent education component. From 1999 to 2004, n = 83 after-school programs (N = 1434 children aged 6–9 years) in Massachusetts and Rhode Island participated in a group randomized trial with two intervention arms (B only, n = 25 programs; B + P, n = 33) and a control arm (C, n = 25). Outcome measures (primary: bone quality (stiffness index of the calcaneus) and muscular strength (grip strength and vertical jump); secondary: bone-strengthening behaviors (calcium-rich food knowledge, preference, and intake; and physical activity level (metabolic equivalent time (MET) score, and weight-bearing factor (WBF) score)) were recorded at baseline, and after years one and two. Analyses followed an intent-to-treat protocol, and focused on individual subjects’ trajectories along the three time points adjusting for baseline age and race via a mixed-effects regression framework. Analyses were performed with and without sex stratification.ResultsChildren in B + P increased bone stiffness compared to C (p = 0.05); No significant changes were observed in muscle strength, food knowledge, or vertical jump. Children in B + P showed significant improvement in their MET and WBF scores compared to C (p < 0.01) with a stronger effect in boys in both B and B + P (all p < 0.01).ConclusionAfter-school programs, coupled with parental engagement, serving early elementary school children are a potentially feasible platform to deliver bone-strengthening behaviors to prevent osteoporosis in adulthood, with some encouraging bone and physical activity outcomes.Trial registrationClinicalTrials.govNCT00065247.Retrospectively registered.First posted July 22, 2003.
Highlights
Childhood is a crucial period of social, cognitive, and physiological development [1]
It was designed to test the feasibility of influencing bone health in early elementary school children by modifying health behavior through the introduction of bone-strengthening physical activity, education on nutrition and bone health, and the delivery of calcium-rich snacks in after-school programs
A group-randomized trial design was used to test the hypothesis that children attending the intervention programs (B and B + P) would exhibit greater bone quality and muscle strength, and more bone-strengthening behaviors over a two-year period than children attending an after-school program without the intervention [24]
Summary
Childhood is a crucial period of social, cognitive, and physiological development [1]. Peak bone mass is reached by most individuals during adolescence, and low accumulation of bone mineral during pre-pubertal years increases risk of fractures and the porous and weak bones which are hallmarks of osteoporosis later in life [10]. To mitigate this risk, the Surgeon General’s Report on Bone Health and Osteoporosis suggested teaching youth healthy bone-building behaviors that can be incorporated into children’s daily routines [11]. The BONES (Beat Osteoporosis – Nourish and Exercise Skeletons) project assessed whether early elementary school children participating in a multifaceted health behavior change, after-school based intervention would improve bone quality and muscular strength and engage in more bone-strengthening behaviors
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