The KOMOtini BONE Study: Evaluation of the Osteogenic Potential of Sports

Not Applicable

• Conditions: Bone Mineral Content; Bone Density; Bone Turnover Markers; Athletic Performance
• Interventions: Other: Dance; Other: Wrestling; Other: Martial arts; Other: School physical education class; Other: Taekwondo; Other: Football (soccer); Other: Combination of activities 2; Other: Volleyball; Other: Track and field; Other: Tennis; Other: Combination of activities 1; Other: Climbing; Other: Artistic gymnastics; Other: Swimming; Other: Basketball; Other: Rhythmic gymnastics

• Registration Number: NCT03201302
• Lead Sponsor: Ioannis G. Fatouros

Brief Summary

Bone mass develops throughout childhood and adolescence until a peak bone mass is achieved during early adulthood. Fracture risk later in life can be predicted at a large extent by peak bone mass. Occurence of sarcopenia and osteoporosis (i.e. loss of mone mass) during late adulthood has been strongly associated with the degree of bone mineralization during early life. Nearly 50% of total bone mineral content (BMC) reached during adulthood is obtained during pre-adolescence rendering this period critical for skeletal health and is considered as an optimal period for bone/skeletal growth since during this time bones are more adaptable to osteogenic stimuli such as exercise-induced mechanical loading. Organized sport activities and/or nutrition appear to affect profoundly bone mineral density (BMD), BMC, bone geometry, and overall skeletal health during preadolescence offering an effective type of prevention of osteoporosis, a condition very difficult to treat later in life. Evidence suggest that some modes of exercise activities may be more effective (osteogenic) for bone development due to the magnitude and type of mechanical strain placed on long bones causing them to be more dense. Weight-bearing activities (e.g. running, jumping etc.) are believed to be more osteogenic than non-weight bearing activities. However, more research is required in order to determine: i) whether weight-bearing activities are more osteogenic than non weight -bearing activities during childhood and ii) the osteogenic potential of a large number of sport activities used by school-children as compared to a control treatment of no participation in organized sport activities. The present trial attempted to compare a large number of different sport activities in respect to their osteogenic potential based on training variables that are thought to affect osteogenesis while at the same time allows direct comparison of exercise modes that are entirely different. Therefore, the goal of this investigation was to determine the osteogenic potential of a large number of exercise training activities in boys and girls of 8-12 years of age during an entire primary school season.

Detailed Description

Healthy, previously untrained, pre-pubertal boys and girls (N=335) were assigned to 16 different groups: 1) physical education, i.e. children participated only school in physical education classes (control group), 2) football (soccer) training, 3) basketball training, 4) volleyball training, 5) wrestling training, 6) martial arts training, 7) tennis training, 8) track and field training, 9) taekwondo training, 10) rhythmic gymnastics training, 11) artistic gymnastics training, 12) dance training, 13) swimming training, 14) climbing training, 15) two weight-bearing training modes, and 16) one weight-bearing and one non-weight bearing activity. Exercise training was performed three times per week for nine months and each training session had a 60-minute duration (except for the physical education classes at school in the control group). Anthropometric measurements (body height, body mass, and length and circumferences of various body segments), blood sampling, measurements of body composition (using dual X-ray energy absorptiometry or DEXA and skinfold calibers), bone measurements (bone density and bone mineral content at lumbar spine, both hips, both wrists and whole body using DEXA), and performance (cardiorespiratory fitness, muscle strength, muscle power, flexibility and motor ability) were performed at baseline and after the completion of a 9-month training intervention. Nutritional intake and habitual physical activity were measured at baseline, mid-training and post-training (using diet recalls and accelerometry, respectively). Intensity and volume of training was measured once every three months using heart rate monitoring, accelerometry, Global Positioning System (GPS) devices and jump measurement. Furthermore, two other studies were also performed as a part of this project: a) assessment of physical activity during physical education classes for primary school (using accelerometry, GPS instrumentation and jump measurement) and b) a smaller number of participants in the football, track and field, swimming and tennis training groups provided blood samples before and after a training session at baseline.

Study Timeline

• Study Start: 2013-04
• Primary Completion: 2014-06
• Study First Submitted: 2017-01-02
• Status Verified: 2017-06
• Study First Submitted QC: 2017-06-27
• Last Update Submitted: 2017-06-27
• Study First Posted: 2017-06-28
• Last Update Posted: 2017-06-28
• Study Completion: 2017-12

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 335

Inclusion Criteria

Not provided

Exclusion Criteria

• had prior bone fractures or related surgical operation
• had been involved in organized sport activities previously
• their body fat was >30%
• had history of growth irregularities
• were receiving agents or drugs that affect bone tissue (e.g. GnRH agonists, antiresorptive, bisphosphonates, etc.)
• missed more than 10% of training sessions

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Dance	Dance	Children who participated in organized dance training for the entire school year.
Wrestling	Wrestling	Children who participated in organized wrestling training for the entire school year.
Martial arts	Martial arts	Children who participated in organized Martial arts training for the entire school year.
School physical education class	School physical education class	Children who participated only in their school physical activity classes only for the entire school year.
Taekwondo	Taekwondo	Children who participated in organized Taekwondo training for the entire school year.
Football (soccer)	Football (soccer)	Children who participated in organized football (soccer) training for the entire school year.
Combination of activities 2	Combination of activities 2	Children who participated in one weight-bearing and in one non weight-bearing activity for the entire school year.
Volleyball	Volleyball	Children who participated in organized volleyball training for the entire school year.
Track and field	Track and field	Children who participated in organized track and field training for the entire school year.
Tennis	Tennis	Children who participated in organized tennis training for the entire school year.
Combination of activities 1	Combination of activities 1	Children who participated in two different weight-bearing activities for the entire school year.
Climbing	Climbing	Children who participated in organized climbing training for the entire school year.
Artistic gymnastics	Artistic gymnastics	Children who participated in organized artistic gymnastics training for the entire school year.
Swimming	Swimming	Children who participated in organized swimming training for the entire school year.
Basketball	Basketball	Children who participated in organized basketball training for the entire school year.
Rhythmic gymnastics	Rhythmic gymnastics	Children who participated in organized rhythmic gymnastics training for the entire school year.

Primary Outcome Measures

Name	Time	Method
Changes in stature (cm)	At baseline and 9 months.
Changes in seated height (cm)	At baseline and 9 months.
Changes in bone density	At baseline and 9 months.	Using a whole body, hip (left and right), lumbar spine, and wrist (left and right) scans performed by a dual-energy x-ray absorptiometry scanner.
Changes in muscle strength	At baseline and immediately after the completion of training.	Using handgrip dynamometry (left and right arm)
Changes in motor performance	At baseline and 9 months.	Using a standard motor ability test battery
Changes in bone mineral content	At baseline and 9 months.	Using a whole body, hip (left and right), lumbar spine, and wrist (left and right) scans performed by a dual-energy x-ray absorptiometry scanner.
Changes in area of different regions and sub-regions	At baseline and 9 months.	Using a whole body, hip (left and right), lumbar spine, and wrist (left and right) scans performed by a dual-energy x-ray absorptiometry scanner.
Changes in bone resorption	At baseline and 9 months.	By measuring blood levels of sclerostin, calcium, phosphorus, magnesium, creatinine, alkaline phosphatase (ALP), vitamin D (if budget allows), serum procollagen type 1 aminoterminal propeptide (P1NP, if budget allows) and isomer of the Carboxy-terminal telopeptide of type 1 collagen (CTX-1, if budget allows).
Changes in muscle power performance of the lower limbs	At baseline and 9 months.	Using long jump test, standing long jump test, countermovement jump test and the Abalakov jump.
Changes in cardiorespiratory performance	At baseline and 9 months.	Using a shuttle run test
Changes in flexibility performance	At baseline and 9 months.	Using the sit and reach test
Changes in body mass (kg)	At baseline and 9 months.
Changes in arm span	At baseline and 9 months.
Changes in forearm length	At baseline and 9 months.
Changes in body mass index (BMI)	At baseline and 9 months.	Calculated as body mass (kg) divided by the height (m) squared.
Changes in tibia length	At baseline and 9 months.
Changes in biacromial length	At baseline and 9 months.
Changes in chest width	At baseline and 9 months.
Changes in waist circumference	At baseline and 9 months.
Changes in hip circumference	At baseline and 9 months.
Changes in hand length	At baseline and 9 months.
Changes in body fat mass	At baseline and 9 months.	Body composition was measured using a dual-energy x-ray absorptiometry scanner (DEXA). DEXA instrumentation allowed the measurement of regional (legs, arms, trunk) weight, body fat (%), and fat mass (kg).
Changes in lean body mass	At baseline and 9 months.	Body composition was measured using a dual-energy x-ray absorptiometry scanner (DEXA). DEXA instrumentation allowed the measurement of regional (legs, arms) weight, lean mass (kg).

Secondary Outcome Measures

Name	Time	Method
Changes in sexual maturation	At baseline and 9 months.	Sexual maturation was assessed using the Tanner scale with stages of sexual maturation, orchidometer for boys. Potentially sexual maturation will be assessed also using measurement of hormonal concentration in the blood (if budget allows).
Changes in diet intake	At baseline, after 4,5 months of training and after 9 months of training.	Food intake was measured using diet recalls. Participants and their parents were instructed how to record the type and the quantity of solid and liquid foods consumed daily. Daily caloric intake as well daily intake of all nutrients was estimated using a nutritional software.
Changes in habitual physical activity	At baseline, after 4,5 months of training and after 9 months of training.	Daily habitual physical activity was measured using an accelerometer.
Changes in training intensity	At baseline, after 4,5 months of training and after 9 months of training.	Training intensity was measured in two consecutive training sessions for each sport activity at three time points during the intervention. Training intensity was assessed using the following: a) heart rate responses using heart rate monitors, b) accelerometry (except for swimming), c) GPS instrumentation (global positioning system) for outdoor activities only.
Changes in training volume	At baseline, after 4,5 months of training and after 9 months of training.	Training volume was measured in two consecutive training sessions for each sport activity at three time points during the intervention. Training volume was measured using the following: a) total distance covered using GPS instrumentation and accelerometry for outdoor activities, b) accelerometry for indoor activities, c) recording of total meters covered during a session for swimming and d) total vertical jump number.

Trial Locations

Locations (1)

Laboratory of Physical Education and Sports, Democritus University of Thrace, School of Physical Education & Sports Sciences; 🇬🇷 Komotini, Greece