BEAT OSTEOPOROSIS: NOURISH & EXERCISE SKELETONS (BONE)

骨质疏松症影响着2800多万美国人，每年导致150多万人骨折，造成5138亿美元的损失。预防骨质疏松症最有效的方法之一是在成长过程中建立一个强壮、致密的骨骼，作为晚年的储备。此外，年幼儿童的个人行为和生活方式偏好的变化可能会持续到关键的青春期，并持续到成年，提供一生最佳的骨骼健康。这项研究的主要目的是开发、实施和评估在课外项目中的多方面干预措施，以增加小学早期儿童的骨骼生长和肌肉力量。干预措施将包括为儿童提供负重体力活动和富钙零食，以及适合年龄的、注重行为的主动学习，以促进技能建设和自我能力。它还将包括父母/照顾者交流模块，通过提供具体活动和实用信息来补充和加强对儿童的直接干预。吉祥物和标志将被用来培养人们对富钙食物和体育活动的积极态度；激励和目标设定将被用来鼓励持续的行为。来自马萨诸塞州10个不同社区的60个课后项目的1,800名一年级和二年级儿童将被随机分组并进行为期24个月的研究。匹配的项目组将接受骨骼项目(n=24)、骨骼项目加上父母/照顾者组件(n=12)；或者它们将作为对照(n=24)。干预期结束后，随访将持续12个月。主要结果将是骨骼质量和肌肉力量。次要结果将包括身体活动水平、钙摄入量、身体成分、对身体能力和外表的自我感知，以及相关健康生活方式行为的影响因素，如知识和态度。对照组在36个月的研究结束后将接受“延迟”干预。在启动之前，与课后计划负责人、家长/照顾者和儿童进行的焦点小组研究将为优化活动设计提供信息。这项研究的发现将促进我们对幼儿健康行为的理解，以及父母参与对这些行为的影响。在这一广泛不同的社区中实施同样的干预措施，将指导适当的文化、社区和社会经济方面的修改，并允许更容易地复制该计划。由于干预利用了现有的课后框架，因此可以接触到大量儿童。这项研究的结果将为通过在生命早期滋养和锻炼骨骼来抗击骨质疏松症的计划的全国复制和可持续性提供适当的模式。

Osteoporosis affects more than 28 million Americans and accounts for more than 1.5 million fractures annually, at a cost of 513.8 billion. One of the most effective ways to prevent osteoporosis is to build a strong, dense skeleton during the growing years to act as a reserve in later life. Furthermore, changes in individual behaviors and lifestyle preferences in younger children may last through the critical adolescent period and continue into adulthood, providing a lifetime of optimal bone health. The primary aim of this study is to develop, implement and evaluate a multi-faceted intervention in after-school programs that will increase bone accretion and muscular strength in early elementary school children. The intervention will include weight loading physical activity and calcium-rich snacks for children as well as age- appropriate, behaviorally focused active learning to promote skill building and self-competence. It will also include a parent/caregiver communications module that by provides specific activities and practical information to complement and reinforce the direct intervention with the children. A mascot and logo will be used to foster positive attitudes about calcium-rich foods and physical activity; incentives and goal setting will be used to encourage sustained behavior. One thousand eight hundred first and second grade children from 60 after-school programs in up to 10 diverse communities throughout Massachusetts will be randomized and studied for 24 months. Matched program groups will receive either The BONES Project (n=24), The BONES Project plus a parent/caregiver component (n=12); or they will serve as controls (n=24). Follow-up will continue for 12 months after the intervention period. The primary outcomes will be bone quality and muscular strength. Secondary outcomes will include physical activity levels, calcium consumption, body composition, self-perception of physical abilities and appearance, and influencing factors toward relevant healthy lifestyle behaviors, such as knowledge and attitudes. The control group will receive a "delayed" intervention after termination of the 36-month study. Focus group research with after-school program leaders, parents/caregivers, and children prior to initiation will provide information to optimize the campaign design. Findings from this study will promote our understanding of health behaviors in young children and the effect of parental involvement on these behaviors. Implementation of the same intervention within this widely diverse set of communities will guide appropriate cultural, community and socioeconomic-specific modifications and permit easier replication of the program. Because the intervention utilizes the existing after-school framework large numbers of children can be reached. Results from this study will provide an appropriate model for national replication and sustainability of a program to beat osteoporosis by nourishing and exercising skeletons early in life.