The impact on children's bone health of a school-based physical education program and participation in leisure time sports: the Childhood Health, Activity and Motor Performance School (the CHAMPS) study, Denmark

The Effects of a Physical Education Intervention Program on the Bone Properties of Second- and Third-Grade Pupils: A Cluster Randomized Controlled Trial

BACKGROUND

Many young children do not participate in sufficient physical activity for promoting optimal bone growth. The objective of this study was to investigate the effect of young children who participated in a school-based intervention program on bone properties. The program included structured physical activity, with a focus on the application of mechanical loads on the upper and lower limbs.

METHODS

A cluster randomized controlled trial was conducted, in which classes were randomly assigned to the intervention or control groups. A total of 295 (50.17% girls) children from the second and third grades from 12 classes in Israel were randomly allocated to an intervention consisting of three 10-minute weekly medium- to high-intensity activities throughout one academic year or to a treatment as usual control group. Bone properties were measured at the distal radius and tibia shaft using speed of sound, before and after the intervention.

RESULTS

Distal radius properties improved significantly for both boys and girls in the intervention group (boys: meanpre = 3769.95, meanpost = 3875.08, Δ = 2.80%; girls: meanpre = 3766.27, meanpost = 3890.83, Δ = 3.30%; d = 1.03); whereas, tibia shaft properties only significantly improved for boys (meanpre = 3663.98, meanpost = 3732.75, Δ = 1.90%; d = 1).

CONCLUSIONS

These findings indicate that distal radius properties of children can be positively affected by a short, easy to implement intervention program that does not require special resources.

Effects of physical activity on quality of life in overweight and obese children

Introduction

Background: in recent years the prevalence of obesity in infants, children, and adolescents has increased alarmingly, which may affect their health, educational level, and quality of life. Objectives: the aim of this study was to determine whether a program with physical activity and nutritional recommendations may improve health-related quality of life (HRQL) in overweight and obese children. Material and methods: the design of this study was that of a randomized clinical trial (RCT). The sample consisted of 54 children with a median age of 10.65 years, all of them overweight or obese. They were divided into a study (SG) and a control (CG) group, with 27 children each. The study group received physical activity and nutritional advice, while the control group only received theoretical-practical sessions on nutrition during 9 months. Families participated in the workshops on nutritional recommendations in both groups. Results: there was a significant difference in fat percentage before and after the intervention in the study group compared to the children who did not engage in sports activity. In the SF-10 quality-of-life perception questionnaire, statistically significant differences in both the physical and mental components may be seen at the end of the study between both groups (p < 0.001). Conclusions: an educational intervention with physical activity based on play and nutritional advice improved quality of life in overweight and obese children. Family involvement is vital for children to improve their life habits, and achieve favorable results in the reduction of overweight and obesity.

Association of Physical Education With Improvement of Health-Related Physical Fitness Outcomes and Fundamental Motor Skills Among Youths: A Systematic Review and Meta-analysis

IMPORTANCE

Whether quality- or quantity-based physical education (PE) interventions are associated with improvement of health-related physical fitness outcomes and fundamental motor skills (FMSs) in children and adolescents is unknown.

OBJECTIVE

To examine the association of interventions aimed at optimizing PE in terms of quality (teaching strategies or fitness infusion) or quantity (lessons per week) with health-related physical fitness and FMSs in children and adolescents.

DATA SOURCES

For this systematic review and meta-analysis, studies were identified through a systematic search of Ovid MEDLINE, Embase, Cochrane Controlled Trials Registry, and SPORTDiscus databases (from inception to October 10, 2019) with the keywords physical education OR PE OR P.E. AND fitness AND motor ability OR skills. Manual examination of references in selected articles was also performed.

STUDY SELECTION

Studies that assessed the association of quality- or quantity-based PE interventions with improvement in physical fitness and/or FMSs in youths (aged 3-18 years) were included.

DATA EXTRACTION AND SYNTHESIS

Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Random-effects models were used to estimate the pooled effect size (Hedges g).

MAIN OUTCOMES AND MEASURES

Health-related physical fitness outcomes and FMSs.

RESULTS

Fifty-six trials composed of 48 185 youths (48% girls) were included in the meta-analysis. Quality-based PE interventions were associated with small increases in health-related physical fitness (cardiorespiratory fitness [Hedges g = 0.24; 95% CI, 0.16-0.32] and muscular strength [Hedges g = 0.19; 95% CI, 0.09-0.29]) and FMSs (Hedges g = 0.38; 95% CI, 0.27-0.49). Subgroup analyses found stronger associations for quality-based PE interventions on body mass index (Hedges g = -0.18; 95% CI, -0.26 to -0.09), body fat (Hedges g = -0.28; 95% CI, -0.37 to -0.18), cardiorespiratory fitness (Hedges g = 0.31; 95% CI, 0.23-0.39), and muscular strength (Hedges g = 0.29; 95% CI, 0.18-0.39). Quantity-based PE interventions were associated with small increases in only cardiorespiratory fitness (Hedges g = 0.42; 95% CI, 0.30-0.55), muscular strength (Hedges g = 0.20; 95% CI, 0.08-0.31), and speed agility (Hedges g = 0.29; 95% CI, 0.07-0.51).

CONCLUSIONS AND RELEVANCE

The findings suggest that quality-based PE interventions are associated with small increases in both student health-related physical fitness components and FMSs regardless of frequency or duration of PE lessons. Because PE aims to improve more than health, high levels of active learning time may need to be balanced with opportunities for instruction, feedback, and reflection.

Sports participation and muscle mass affect sex-related differences in bone mineral density between male and female adolescents: A longitudinal study

BACKGROUND

Sports participation plays an important role in bone gain during childhood and adolescence. The aim here was to identify sex-related determinants of bone mineral density (BMD) differences between male and female adolescents, with emphasis on the role of sports participation.

DESIGN AND SETTING

Longitudinal study conducted in a public university in Presidente Prudente, Brazil.

METHODS

The sample comprised 48 adolescents aged 11-17 years, of both sexes, who were matched according to sex, age and sports participation. BMD was the main outcome, while muscle mass, sports participation, calendar age and biological maturation were treated as covariates. Participants were followed up after nine months.

RESULTS

At baseline, BMD values were similar between the sexes. However, adjustment for covariates showed that BMD was higher among girls at all sites, with a contribution from lean soft tissue (LST) in the model (partial eta-squared, ES-r = 0.619 in upper limbs; 0.643 in lower limbs; 0.699 in spine; and 0.599 in whole body). Sports participation only explained the upper-limb variance (ES-r = 0.99). At the follow-up, the results resembled the baseline except in the lower limbs (P = 0.109), in which BMD was similar between the groups. BMD gain over time was similar between girls and boys in all segments, and baseline LST affected upper-limb and whole-body BMD accrual (ES-r = 0.396 and 0.107, respectively).

CONCLUSION

Whole-body and specific-site BMD differed between baseline and follow-up. However,BMD accrual was similar between the sexes, given that muscle mass constituted the most relevant determinant of the difference between them.

Bone Mass Development in Childhood and Its Association with Physical Activity and Vitamin D Levels. The CHAMPS-Study DK

This longitudinal study examined associations of bone mass with physical activity and vitamin D level over more than 6 years through puberty. A total of 663 participants (320 boys) with mean age 9.6 years at baseline (10-17 years at follow-up), underwent dual energy X-ray absorptiometry, anthropometry and blood samples for vitamin D at least twice during the study period (with three possible time-points). Physical activity was assessed using accelerometers at follow-up. A positive association was found between percent time spent at vigorous physical activity and total-body less head bone mineral content (β = 5.8, p = 0.002). The magnitude of this association increased with maturational development; thus physical activity may have a greater influence on bone mass in the more mature participants. The vitamin D levels were also positively associated with bone mass. A high degree of tracking was observed with changes in anthropometric Z scores predictive of deviation from tracking. No environmental factor predicted deviation from tracking.

High-intensity intermittent "5-10-15" running reduces body fat, and increases lean body mass, bone mineral density, and performance in untrained subjects

The present study examined the effect of intense intermittent running with 5 s sprints on body composition, fitness level, and performance in untrained subjects aged 36-53 years. For 7 weeks, the subjects carried out 3 days a week 5-10-15 training consisting of 3-9 blocks of 4 repetitions of 15, 10, and 5 s low-, moderate-, and high-speed running, respectively. Body fat mass was 4.3% lower (P < 0.01), and lean body mass and bone mineral density was 1.1 and 0.9% higher (P < 0.01), respectively, after compared to before the intervention period (INT). The plasma bone turnover markers osteocalcin increased (P < 0.01) by 147%, and procollagen-type I N propeptide and carboxy-terminal collagen crosslinks increased (P < 0.05) by 84 and 76%, respectively. Furthermore, the training improved performance in 1500 m (P < 0.001), 3 km (P < 0.001), Yo-Yo intermittent endurance test (P < 0.01), and incremental treadmill running (P < 0.001) by 8.1, 9.9, 17.2, and 23.9%, respectively. Furthermore, blood lactate after running at 85% of maximal aerobic speed was lower (P < 0.01) after compared to before the INT. Thus, 7 weeks of 5-10-15 training resulted in significant health beneficial changes and better performance in untrained subject.

Relationship between total and segmental bone mineral density and different domains of physical activity among children and adolescents: cross-sectional study

BACKGROUND

This study aimed to investigate the relationship between total and segmental bone mineral density (BDM) and physical activity (PA) in different domains (school, leisure and sports) among adolescents and children.

DESIGN AND SETTING

Cross-sectional study in the Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP).

METHODS

The study sample consisted of 173 children and adolescents (10.31 ± 1.87 years). The BMDs for the whole body (WB) and the regions of the trunk and legs were measured using dual energy X-ray absorptiometry (DXA). PA was measured using the Baecke questionnaire. A regression model was used to analyze the relationship between all the BMDs and the different domains of PA.

RESULTS

41.5% of the adolescents had high percentages of body fat. Regarding the comparison between physically active and insufficiently active adolescents, there were no statistically significant differences in any BMD variables (P > 0.05). The BMD of the legs showed positive relationships with the total PA (β = 0.009; P = 0.013) and sports PA (β = 0.010; P = 0.049) after insertion of the confounders. Similarly, the WB BMD showed the same relationships (total PA: β = 0.005; P = 0.045; and sports PA: β = 0.008; P = 0.049). No relationship was found between leisure and school PA and any of the BMDs (P > 0.05).

CONCLUSION

The results indicated that practice of sport was related to higher BMD values, independent of sex, age and body fatness.

Positive effects on bone mineralisation and muscular fitness after 10 months of intense school-based physical training for children aged 8-10 years: the FIT FIRST randomised controlled trial

OBJECTIVES

We investigated whether musculoskeletal fitness of school children aged 8-10 years was affected by frequent intense PE sessions.

DESIGN AND PARTICIPANTS

295 Danish school children aged 8-10 years were cluster randomised to a small-sided ball game group (SSG) (n=96, four schools, five classes), a circuit strength training group (CST) (n=83, four schools, four classes) or a control group (CON, n=116, two schools, five classes).

INTERVENTION

SSG or CST was performed 3×40 min/week over 10 months. Whole-body dual-energy X-ray absorptiometry (DXA) scans were used to determine areal bone mineral density (aBMD), bone mineral content (BMC) and lean body mass (LBM). Flamingo balance, standing long jump and 20-m sprint tests were used to determine muscular fitness.

RESULTS

Analysis of baseline-to-10 months change scores showed between-group differences in favour of the interventions in whole-body aBMD (SSG vs CON: 8 mg/cm², 95% CI 3 to 13; CST vs CON: 7 mg/cm², 95% CI 2 to 13, p<0.05) and leg BMC (SSG vs CON: 11 g, 95% CI 4 to 18; CST vs CON: 11 g, 95% CI 3 to 18, p<0.05). SSG had higher change scores in leg aBMD compared with CON and CST (SSG vs CON: 19 mg/cm², 95% CI 11 to 39, p<0.05; SSG vs CST: 12 mg/cm², 95% CI 3 to 21, p<0.05), and CST had higher change scores in whole-body BMC compared with CON (CST vs CON: 25 g, 95% CI 10 to 39, p<0.05). Both training types resulted in higher change scores in postural balance (SSG vs CON: 2.4 fewer falls/min, 95% CI 0.3 to 4.5, CST vs CON: 3.6 fewer falls/min, 95% CI 1.3 to 5.9, p<0.05) and jump length (SSG vs CON: 10%, 95% CI 5 to 16%; CST vs CON: 9%, 95% CI 3 to 15%, p<0.05). No between-group differences were observed for sprint performance or LBM (p>0.05).

CONCLUSIONS

In conclusion, 3×40 min/week with SSG or CST over a full school year improves bone mineralisation and several aspects of muscular fitness of children aged 8-10 years, suggesting that well-organised intense physical education classes can contribute positively to develop musculoskeletal health in young children.

TRIAL REGISTRATION NUMBER

NCT02000492, post results.

The influence of anthropometry and body composition on children's bone health: the childhood health, activity and motor performance school (the CHAMPS) study, Denmark

Overweight, physical inactivity and sedentary behaviour have become increasing problems during the past decade. Increased sedentary behaviour may change the body composition (BC) by increasing the fat mass relative to the lean mass (LM). These changes may influence bone health to describe how anthropometry and BC predict the development of the bone accruement. The longitudinal study is a part of The CHAMPS study-DK. Children were DXA scanned at baseline and at 2-year follow-up. BC (LM, BF %) and BMC, BMD and BA were measured. The relationship between bone traits, anthropometry and BC was analysed by multilevel regression analyses. Of the invited children, 742/800 (93%) accepted to participate. Of these, 682/742 (92%) participated at follow-up. Mean (range) of age at baseline was 9.5 years (7.7-12.1). Height, BMI, LM and BF % predicted bone mineral accrual and bone size positively and independently. Height and BMI are both positive predictors of bone accruement. LM is a more precise predictor of bone traits than BF % in both genders. The effects of height and BMI and LM on bone accruement are nearly identical in the two genders, while changes in BF % have different but positive effects on bone accretion in both boys and girls.