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

Malte Nejst Larsen, Claus Malta Nielsen, Eva Wulff Helge, Mads Madsen, Vibeke Manniche, Lone Hansen, Peter Riis Hansen, Jens Bangsbo, Peter Krustrup, Malte Nejst Larsen, Claus Malta Nielsen, Eva Wulff Helge, Mads Madsen, Vibeke Manniche, Lone Hansen, Peter Riis Hansen, Jens Bangsbo, Peter Krustrup

Abstract

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.

Keywords: Body composition; Bone mineral density; Children; Muscle; Training load.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Participant flow chart. CONSORT, Consolidated Standards of Reporting Trials.
Figure 2
Figure 2
Pre and 10-month values of leg and whole-body BMD (A), bone mass (B) and lean mass (C) for CON and the two intervention groups performing 3×40 min/week of SSG and CST. Data are presented as mean (±SD). *Denotes significant differences in change scores compared with CON, p

References

    1. Kannus P, Niemi S, Parkkari J, et al. . Hip fractures in Finland between 1970 and 1997 and predictions for the future. Lancet 1999;353:802–5. 10.1016/S0140-6736(98)04235-4
    1. Karlsson MK, Nordqvist A, Karlsson C. Physical activity, muscle function, falls and fractures. Food Nutr Res 2008;52:1–7.
    1. Khan K. Physical activity and bone health: Human Kinetics. 2001.
    1. Sundberg M, Gärdsell P, Johnell O, et al. . Physical activity increases bone size in prepubertal boys and bone mass in prepubertal girls: a combined cross-sectional and 3-year longitudinal study. Calcif Tissue Int 2002;71:406–15. 10.1007/s00223-001-1105-z
    1. Weaver CM, Gordon CM, Janz KF, et al. . The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis Int 2016;27:1281–386. 10.1007/s00198-015-3440-3
    1. Bass S, Pearce G, Bradney M, et al. . Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. J Bone Miner Res 1998;13:500–7. 10.1359/jbmr.1998.13.3.500
    1. van Sluijs EM, McMinn AM, Griffin SJ. Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. BMJ 2007;335:703 10.1136/
    1. Dobbins M, De Corby K, Robeson P, et al. . School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst Rev 2009;(1):CD007651 10.1002/14651858.CD007651
    1. MacKelvie K, Khan K, McKay H. Is there a critical period for bone response to weight-bearing exercise in children and adolescents? A systematic review. Br J Sports Med 2002;36:250–7. 10.1136/bjsm.36.4.250
    1. Turner CH, Robling AG. Designing exercise regimens to increase bone strength. Exerc Sport Sci Rev 2003;31:45–50. 10.1097/00003677-200301000-00009
    1. Linden C, Ahlborg HG, Besjakov J, et al. . 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 2006;21:829–35. 10.1359/jbmr.060304
    1. Lindén C, Alwis G, Ahlborg H, et al. . Exercise, bone mass and bone size in prepubertal boys: one-year data from the pediatric osteoporosis prevention study. Scand J Med Sci Sports 2007;17:340–7.
    1. Hasselstrøm HA, Karlsson MK, Hansen SE, et al. . A 3-year physical activity intervention program increases the gain in bone mineral and bone width in prepubertal girls but not boys: the prospective Copenhagen School Child Interventions Study (CoSCIS). Calcif Tissue Int 2008;83:243–50. 10.1007/s00223-008-9166-x
    1. Meyer U, Romann M, Zahner L, et al. . Effect of a general school-based physical activity intervention on bone mineral content and density: a cluster-randomized controlled trial. Bone 2011;48:792–7. 10.1016/j.bone.2010.11.018
    1. Heidemann M, Jespersen E, Holst R, et al. . 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. Prev Med 2013;57:87–91. 10.1016/j.ypmed.2013.04.015
    1. Krustrup P, Aagaard P, Nybo L, et al. . Recreational football as a health promoting activity: a topical review. Scand J Med Sci Sports 2010;20(Suppl 1):1–13. 10.1111/j.1600-0838.2010.01108.x
    1. Helge EW, Aagaard P, Jakobsen MD, et al. . Recreational football training decreases risk factors for bone fractures in untrained premenopausal women. Scand J Med Sci Sports 2010;20(Suppl 1):31–9. 10.1111/j.1600-0838.2010.01107.x
    1. Uth J, Hornstrup T, Christensen JF, et al. . Football training in men with prostate cancer undergoing androgen deprivation therapy: activity profile and short-term skeletal and postural balance adaptations. Eur J Appl Physiol 2016:116:471–80. 10.1007/s00421-015-3301-y
    1. Andersen TR, Schmidt JF, Pedersen MT, et al. . The effects of 52 weeks of soccer or resistance training on body composition and muscle function in +65-year-old healthy males—a randomized controlled trial. PLoS ONE 2016;11:e0148236 10.1371/journal.pone.0148236
    1. Randers MB, Nybo L, Petersen J, et al. . Activity profile and physiological response to football training for untrained males and females, elderly and youngsters: influence of the number of players. Scand J Med Sci Sports 2010;20(Suppl 1):14–23. 10.1111/j.1600-0838.2010.01069.x
    1. Bendiksen M, Williams CA, Hornstrup T, et al. . Heart rate response and fitness effects of various types of physical education for 8- to 9-year-old schoolchildren. Eur J Sport Sci 2014;14:861–9. 10.1080/17461391.2014.884168
    1. Ferry B, Duclos M, Burt L, et al. . Bone geometry and strength adaptations to physical constraints inherent in different sports: comparison between elite female soccer players and swimmers. J Bone Miner Metab 2011;29:342–51. 10.1007/s00774-010-0226-8
    1. Vicente-Rodriguez G, Jimenez-Ramirez J, Ara I, et al. . Enhanced bone mass and physical fitness in prepubescent footballers. Bone 2003;33:853–9. 10.1016/j.bone.2003.08.003
    1. Seabra A, Marques E, Brito J, et al. . Muscle strength and soccer practice as major determinants of bone mineral density in adolescents. Joint Bone Spine 2012;79:403–8. 10.1016/j.jbspin.2011.09.003
    1. Vicente-Rodriguez G, Ara I, Perez-Gomez J, et al. . Muscular development and physical activity as major determinants of femoral bone mass acquisition during growth. Br J Sports Med 2005;39:611–16. 10.1136/bjsm.2004.014431
    1. Vicente-Rodriguez G, Ara I, Perez-Gomez J, et al. . High femoral bone mineral density accretion in prepubertal soccer players. Med Sci Sports Exerc 2004;36: 1789–95. 10.1249/01.MSS.0000142311.75866.D7
    1. Faigenbaum AD, Farrell AC, Radler T, et al. . ‘Plyo Play’: a novel program of short bouts of moderate and high intensity exercise improves physical fitness in elementary school children. Phys Educ 2009;66:37.
    1. Baquet G, Guinhouya C, Dupont G, et al. . Effects of a short-term interval training program on physical fitness in prepubertal children. J Strength Cond Res 2004;18:708–13. 10.1519/13813.1
    1. Hind K, Burrows M. Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone 2007;40:14–27. 10.1016/j.bone.2006.07.006
    1. Margulies L, Horlick M, Thornton JC, et al. . Reproducibility of pediatric whole body bone and body composition measures by dual-energy X-ray absorptiometry using the GE Lunar Prodigy. J Clin Densitom 2005;8:298–304. 10.1385/JCD:8:3:298
    1. Adam C, Klissouras V, Ravazzolo M, et al. . EUROFIT: European test of physical fitness. Rome: Council of Europe; Committee for the development of sport, 1988:10–70.
    1. Fjortoft I. Motor fitness in pre-primary school children: the EUROFIT motor fitness test explored on 5-7-year-old children. PES 2010;12:424–36.
    1. Ortega FB, Artero EG, Ruiz JR, et al. . Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. Int J Obes 2008;32:S49–57. 10.1038/ijo.2008.183
    1. Castro-Piñero J, Ortega FB, Artero EG, et al. . Assessing muscular strength in youth: usefulness of standing long jump as a general index of muscular fitness. J Strength Cond Res 2010;24:1810–17. 10.1519/JSC.0b013e3181ddb03d
    1. Zahner L, Puder JJ, Roth R, et al. . A school-based physical activity program to improve health and fitness in children aged 6–13 years (‘Kinder-Sportstudie KISS’): study design of a randomized controlled trial [ISRCTN15360785]. BMC Public Health 2006;6:147 10.1186/1471-2458-6-147
    1. Essendrop M, Hansen L, Klausen KJ. Balance and co-ordination abilities related to training in youth athletes. Children and Exercise, Washington Singer Press 1997;XIX:161–6.
    1. Casamichana D, Castellano J, Calleja-Gonzalez J, et al. . Relationship between indicators of training load in soccer players. J Strength Cond Res 2013;27:369–74. 10.1519/JSC.0b013e3182548af1
    1. Boyd LJ, Ball K, Aughey RJ. The reliability of MinimaxX accelerometers for measuring physical activity in Australian football. Int J Sports Physiol Perform 2011;6:311–21.
    1. Kanis JA, Melton LJ, Christiansen C, et al. . The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137–41. 10.1002/jbmr.5650090802
    1. Bachrach LK. Acquisition of optimal bone mass in childhood and adolescence. Trends Endocrinol Metab 2001;12:22–8. 10.1016/S1043-2760(00)00336-2
    1. MacKelvie KJ, McKay HA, Petit MA, et al. . Bone mineral response to a 7-month randomized controlled, school-based jumping intervention in 121 prepubertal boys: associations with ethnicity and body mass index. J Bone Miner Res 2002;17:834–44. 10.1359/jbmr.2002.17.5.834
    1. MacKelvie KJ, McKay HA, Khan KM, et al. . A school-based exercise intervention augments bone mineral accrual in early pubertal girls. J Pediatr 2001;139:501–8. 10.1067/mpd.2001.118190
    1. Fuchs RK, Bauer JJ, Snow CM. Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res 2001;16:148–56. 10.1359/jbmr.2001.16.1.148
    1. Detter FTL, Rosengren BE, Dencker M, et al. . A 5-year exercise program in pre- and peripubertal children improves bone mass and bone size without affecting fracture risk. Calcif Tissue Int 2013;92:385–93. 10.1007/s00223-012-9691-5
    1. Löfgren B, Daly RM, Nilsson JÅ, et al. . An increase in school-based physical education increases muscle strength in children. Med Sci Sports Exerc 2013;45:997–1003. 10.1249/MSS.0b013e31827c0889
    1. Chaouachi A, Othman AB, Hammami R, et al. . The combination of plyometric and balance training improves sprint and shuttle run performances more often than plyometric-only training with children. J Strength Cond Res 2014;28:401–12. 10.1519/JSC.0b013e3182987059
    1. Balas J, Bunc V. Short-term influence of climbing activities on strength, endurance and balance within school physical education. Int J Fit 2007;3:33–42.
    1. Sheehan D, Katz L. The impact of a six week exergaming curriculum on balance with grade three school children using the Wii FIT (TM). Int J Comput Sci Sport 2012;11:5–22.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe