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Design and participants 295 Danish school children aged 8–10 years were cluster randomised to a small-sided ball game group (SSG) (n=96, four schools, five classes), a circuit strength training group (CST) (n=83, four schools, four classes) or a control group (CON, n=116, two schools, five classes).

Child assent and written informed parental consent were obtained for all participants.

The study was approved by the committees on Biomedical Research Ethics for the Capital Region of Denmark ( The present study is part of the large-scale Frequent Intense Training—Football, Interval Running and Strength Training ‘FIT FIRST’ study with a total of 400 children (Clinical NCT02000492).

Recent investigations from our group have shown that the aerobic and musculoskeletal intensity is high in children during a variety of team sports (football, basketball and unihockey).20 21 It has been shown that, prior to puberty, footballers have superior bone health status compared with children not active in sports clubs as well as children active in sports clubs practising non-weight-bearing sports such as swimming and cycling.22–24 Moreover, longitudinal studies have shown that football participation throughout the pubertal years results in a twofold increase in femoral BMC and areal BMD (a BMD).25 28 whereas effects of CST on childhood bone health are unclear.29 Moreover, it has not yet been investigated whether specific school-based interventions with small-sided ball game activities or CST are affecting gross motor skills in young children.

Thus, the aim of the present study was to conduct a long-term cluster-randomised controlled training intervention to investigate whether the bone mineralisation and muscular fitness of children aged 8–10 years were affected by 10 months of high-intensity school-based training regimes (3×40 min/week) consisting of odd-impact small-sided football and other ball games or circuit strength training with weight-bearing exercises.

The incidence of osteoporotic fractures is increasing in the ageing population1 and the fracture risk relates, among other things, to bone strength, muscle strength and postural balance.2 It has been shown that weight-bearing activities during childhood have a positive effect on variables related to bone strength3 4 and that low bone strength in childhood is associated with a higher fracture risk in later life.5 This indicates that physical activity in childhood leads to residual benefits in bone density and strength in adulthood (tracking);2 6 thus, it is of great importance to investigate the osteogenic impact of different weight-bearing training types during childhood that may have the potential to decrease the risk of osteoporosis in later life.

The school setting is considered a favourable platform for promoting a physically active lifestyle, as there is a possibility of reaching all children and most importantly those who have low fitness levels and impaired musculoskeletal health, including low bone mineral density (BMD).

Two rounds of block randomisation were used to assign one control school and two training intervention schools in each geographical area, and to assign the 2–3 school classes in the training intervention schools to SSG or CST, with both training types represented at all training intervention schools.

Two staff members packed sets of identical, sealed, opaque envelopes with the names of the schools from the rural and urban area, and the names of the school classes, respectively, along with two sets of envelopes that contained the numbers 1–2, 3–4 and 5–6.

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