Doctors recommend that young children participate in daily physical activity to promote bone
health. However, studies in adults show that physical activity and increased calcium intake
cause noticeable benefits for bone health only when both factors occur together. The goal of
this study is to find out whether calcium intake changes the response of bone to activity in
children 3 to 4 years old. Children will participate in one of two programs conducted in
childcare centers 5 days a week for 1 year. One program will involve activities that use
large muscles (gross motor activity). The other will involve activities using small muscles
(fine motor activity). We will give a calcium supplement (1 gram per day) to half of the
children in each program and give the other half an inactive pill. We will measure bone mass
and bone mineral density at the beginning and end of the study. We will take measurements 12
months after the program's completion to see if physical activity and/or calcium supplements
have long-term effects on bone mineral density and physical activity.
Participation in daily physical activity programs by young children is currently recommended
as a means of promoting bone health. Results from studies of adults indicate that beneficial
effects of either physical activity or calcium (Ca) intake may be apparent only when both
these factors are present. Our results in infants indicate that physical activity combined
with a low Ca diet may be detrimental in terms of bone mass accretion. The overall objective
of this study is to determine whether Ca intake modifies the bone response to activity in
young children 3 to 4 years of age.
Our hypotheses are that (1) the increase in bone mass resulting from a physical activity
program will be more pronounced in children randomized to receive a Ca supplement compared
to the increase in children randomized to receive a placebo; and (2) 12 months after
cessation of the activity program, bone mass will remain higher in children randomized to
gross motor activity compared to children randomized to fine motor activity, and the
beneficial effect of Ca supplementation will persist only among children randomized to gross
motor activity. We will test these hypotheses in a randomized 2 x 2 factorial trial in 3- to
4-year-old children. We will randomize children into either a gross motor or fine motor
activity program that will be conducted in childcare centers 5 days a week for 1 year. We
will further randomize each child into either a Ca supplement (1 g/d) or placebo group.
The primary outcomes of the study are bone mass accretion and changes in bone mineral
density, which we will determine by dual energy x-ray absorptiometry at the beginning and
end of the study. We will do activity assessments throughout the study period to determine
whether participation in the gross motor activity group also increases spontaneous activity
in these children. Anthropometric measurements and dietary information will allow us to
statistically control for these potential confounders. We will obtain additional bone mass
and physical activity measurements 12 months after completion of the program to determine if
these interventions have long-term effects on bone mineral density and physical activity.
A finding of beneficial effects of Ca supplementation or physical activity, either
independent of each other or in combination, will lay the groundwork for devising prevention
strategies within the educational system that optimize bone health beginning early in life.
However, we may find that increased physical activity in the presence of a low to moderate
Ca intake may have a detrimental effect on bone mass accretion during periods of rapid
- Enrolled in participating childcare center.
- Does not plan to attend kindergarten or withdraw from center in the next 12 months.
- Chronic disease that may interfere with growth and bone mass accretion (cystic
fibrosis, liver disease, asthma that is being treated with steroids, juvenile
rheumatoid arthritis, immobilization).