Does a novel school-based physical activity model benefit femoral neck bone strength in pre- and early pubertal children?
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The effects of physical activity on bone strength acquisition during growth are not well understood. In our cluster randomized trial, we found that participation in a novel school-based physical activity program enhanced bone strength acquisition and bone mass accrual by 2–5% at the femoral neck in girls; however, these benefits depended on teacher compliance with intervention delivery. Our intervention also enhanced bone mass accrual by 2–4% at the lumbar spine and total body in boys.
We investigated the effects of a novel school-based physical activity program on femoral neck (FN) bone strength and mass in children aged 9–11 yrs.
We used hip structure analysis to compare 16-month changes in FN bone strength, geometry and bone mineral content (BMC) between 293 children who participated in Action Schools! BC (AS! BC) and 117 controls. We assessed proximal femur (PF), lumbar spine (LS) and total body (TB) BMC using DXA. We compared change in bone outcomes between groups using linear regression accounting for the random school effect and select covariates.
Change in FN strength (section modulus, Z), cross-sectional area (CSA), subperiosteal width and BMC was similar between control and intervention boys, but intervention boys had greater gains in BMC at the LS (+2.7%, p = 0.05) and TB (+1.7%, p = 0.03) than controls. For girls, change in FN-Z tended to be greater (+3.5%, p = 0.1) for intervention girls than controls. The difference in change increased to 5.4% (p = 0.05) in a per-protocol analysis that included girls whose teachers reported 80% compliance.
AS! BC benefits bone strength and mass in school-aged children; however, our findings highlight the importance of accounting for teacher compliance in classroom-based physical activity interventions.
KeywordsBone mass Bone strength Children DXA Hip structure analysis Physical activity
We thank the principals, teachers, parents and children from the Vancouver and Richmond School Districts for their support and participation in this research. We thank Leslie Bryant MacLean for her technical assistance with the DXA scanning and analysis, Lisa Semanick for training on the HSA program and Dr. Penny Brasher for statistical guidance. We are grateful to the BC Ministry of Health, 2010 Legacies Now, BC Ministry of Education and the Canadian Institutes of Health Research for funding support. Dr. McKay is a Michael Smith Foundation for Health Research (MSFHR) Senior Scholar.
Conflicts of interest
- 3.McKay HA, Petit MA, Schutz RW, Prior JC, Barr SI, Khan KM (2000) Augmented trochanteric bone mineral density after modified physical education classes: a randomized school-based exercise intervention study in prepubescent and early pubescent children. J Pediatr 136:156–162PubMedCrossRefGoogle Scholar
- 6.Linden C, Ahlborg HG, Besjakov J, Gardsell P, Karlsson MK (2006) A school curriculum-based exercise program increases bone mineral accrual and bone size in prepubertal girls: two-year data from the pediatric osteoporosis prevention (POP) study. J Bone Miner Res 21:829–835PubMedCrossRefGoogle Scholar
- 20.Ministry of Education (2001-2002) Satisfaction Survey. Government of British Columbia, Victoria, BC. Available at http://www.bced.gov.bc.ca/sat_survey/welcome.htm. Accessed January 12, 2003
- 21.Naylor P, Macdonald HM, Reed KE, McKay HA (2006) Action Schools! BC: A socio-ecological approach to modifying chronic disease risk factors in elementary school children. Prev Chronic Dis [serial online] Available at: http://www.cdc.gov/pcd/issues/2006/apr/05_0090.htm. Accessed May 20, 2006
- 23.Tanner JM (1978) Foetus into man. Harvard Press, CambridgeGoogle Scholar
- 25.Kowalski KC, Crocker PR, Faulkner RA (1997) Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci 9:174–186Google Scholar
- 28.Hologic (2000) Hologic QDR series user’s guide. Hologic, Inc, Bedford, MAGoogle Scholar
- 30.Khoo BC, Beck TJ, Qiao QH, Parakh P, Semanick L, Prince RL, Singer KP, Price RI (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials. Bone 37:112–121PubMedCrossRefGoogle Scholar
- 34.Donner A, Klar N (2000) Design and analysis of cluster randomized trials in health research. Arnold Publishers, LondonGoogle Scholar
- 35.Fox KR, Cooper A, McKenna J (2004) The school and promotion of children’s health-enhancing physical activity: Perspectives from the United Kingdom. J Sch Health 23:338–358Google Scholar