BEAT OSTEOPOROSIS: NOURISH & EXERCISE SKELETONS (BONE)

骨质疏松症影响了2800多万美国人，每年造成150多万例骨折，造成的损失达5138亿美元。预防骨质疏松症最有效的方法之一是在成长期间建立一个强壮、致密的骨骼，作为以后生活的储备。此外，幼儿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，从而提供最佳的骨骼健康。本研究的主要目的是开发，实施和评估一个多方面的干预课外项目，将增加骨骼增生和肌肉力量的早期小学儿童。干预措施将包括负重体育活动和为儿童提供富含钙的零食，以及与年龄相适应的、以行为为重点的主动学习，以促进技能建设和自我能力。它还将包括一个家长/照料者交流模块，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。吉祥物和标志将用于培养对富含钙的食物和体育活动的积极态度；激励和目标设定将用于鼓励持续的行为。来自马萨诸塞州多达10个不同社区的60个课后项目的1800名一年级和二年级儿童将被随机抽取，并进行为期24个月的研究。匹配的项目组将接受The BONES项目（n=24）， The BONES项目加上家长/护理人员部分（n=12）；或者他们将作为对照（n=24）。干预期结束后将继续随访12个月。主要的结果是骨骼质量和肌肉力量。次要结果将包括身体活动水平、钙消耗、身体组成、对身体能力和外表的自我认知，以及相关健康生活方式行为的影响因素，如知识和态度。在为期36个月的研究结束后，对照组将接受“延迟”干预。在开始之前，与课后项目负责人、家长/照顾者和儿童进行焦点小组研究将为优化活动设计提供信息。本研究的结果将促进我们对幼儿健康行为以及父母参与对这些行为的影响的理解。在这些广泛多样的社区中实施同样的干预措施，将指导适当的文化、社区和社会经济特定的修改，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国家复制和可持续性提供一个适当的模型，通过在生命早期滋养和锻炼骨骼来对抗骨质疏松症。

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.