Parent/Child training to increase preteens' calcium, physical activity, and bone density: a controlled trial

Abstract

Purpose: To test effects of parent/child training designed to increase calcium intake, bone-loading physical activity (PA), and bone density.

Design: Two-group randomized controlled trial.

Setting: Family-based intervention delivered at research center.

Subjects: 117 healthy children aged 10-13 years (58.1% female, 42.7% Hispanic, 40.2% White). Ninety-seven percent of participants had at least one parent graduate from high school and 37.2 % had at least one parent graduate from a 4-year university.

Intervention: Children and parents were randomly assigned to diet and exercise (experimental) or injury prevention (control) interventions. Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries. Parents were taught behavior management techniques to modify children's behaviors.

Measures: Measures at baseline and at 3, 9, and 12 months included 24-hour diet and PA recalls, and bone mineral density (BMD) by dual-energy x-ray absorptiometry.

Analysis: Analysis of variance and generalized estimating equations (GEE) assessed group by time differences. Comparisons were conducted separately for boys and girls.

Results: For boys, cross-sectional differences between experimental and control groups were achieved for 3- and 9-month calcium intake (1352 vs. 1052 mg/day, 1298 vs. 970 mg/day, p < .05). For girls, marginal cross-sectional differences were achieved for high-impact PA at 12 months (p < .10). For calcium intake, a significant group by time interaction was observed from pretest to posttest for the full sample (p = .008) and for girls (p = .006) but not for boys. No significant group by time differences in calcium were observed across the follow-up period. No group by time differences were observed for high-impact PA. Among boys, longitudinal group by time differences reached significance for total hip BMD (p = .045) and femoral neck BMD (p = .033), even after adjusting for skeletal growth. Similar differential increases were observed among boys for bone mineral content (BMC) at the hip (p = .068) and total body (p = .054) regions. No significant group by time interaction effects were observed for girls at any bone site for BMD. For BMC, control girls showed a significant increase (p = .03) in spine BMC compared to intervention girls.

Conclusion: This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA. Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during preadolescent years.

Figures

Figure 1. Flow diagram of participants through trial

Figure 2. Log of Calcium Intake by Group and Gender

For graphical purposes, extreme values for the number of days between baseline and the final follow-up were recoded to two standard deviations from the mean number of days for the group. The original number of days was retained in the longitudinal GEE analyses.

Figure 3. High-Impact Physical Activity by Group and Gender

For graphical purposes, extreme values for the number of days between baseline and the final follow-up were recoded to two standard deviations from the mean number of days for the group. The original number of days was retained in the longitudinal GEE analyses.