The adolescent years is a time when children reduce calcium intake and engage in less physical activity. Behavior change strategies aimed at pre-teen children have the potential to maximize early bone accretion while establishing habits that promote bone health. After school programs (ASP) serve millions of children and represent a novel setting for health interventions. PURPOSE To evaluate an ASP intervention that includes weight-loading games, calcium rich snacks, and interactive lessons that build knowledge and shape positive attitudes regarding bone health. METHODS Children ages 6–9 years attending ASP were recruited for “BONES”. ASP staff was trained to conduct weight-loading games 3 d/wk, learning activities 1 d/wk, and serve calcium-rich snacks every day for 25 weeks. Implementation was monitored via self-reported attendance sheets and year-end surveys. RESULTS ASP incorporated BONES activities on average 3.0 d/wk over 18 wks. Children played over 15 jumping and cooperative running games 2.0 d/wk on average. Almost 75% of the jumping games provided a ground reaction force between 4–7 times body weight as appropriate for bone accretion. Staff incorporated learning activities 1.0 d/wk and 71.5% of these days included a jumping activity. Snacks contributed 1191 mg calcium/week. Despite simple tracking forms, inconsistent reporting was common and suggests actual implementation was greater. Year-end surveys revealed higher implementation rates. Barriers included constraints on program time, staff shortages, inconsistent attendance by students and staff motivation. ASP staffs vary from high school students to certified teachers. CONCLUSION ASP staff with varied experience working in diverse program structures can implement a weight-loading physical activity intervention along with lessons on nutrition and bone health when provided with materials, training, and ongoing support. Higher rates of implementation could be achieved once the challenges inherent to this setting are addressed. More work is needed to accurately measure community-based interventions. Supported by NIH (NICHD) RO1 HD37752-01
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