Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants .
Current evidence does not support the routine use of physical activity programs in preterm infants .
BACKGROUND Lack of physical stimulation may contribute to metabolic bone disease of preterm infants , result ing in poor bone mineralization and growth .
Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth .
OBJECTIVES The primary objective was to assess whether physical activity programs in preterm infants  improve bone mineralization and growth and reduce the risk of fracture .
Subgroup analysis : • Given that the smallest infants are most vulnerable for developing osteopenia ( Bishop 1999 ) , a subgroup analysis was planned for infants with birth weight < 1000 g.•  Calcium and phosphorus intake may affect an infant 's ability to increase bone mineral content ( Kuschel 2004 ) .
Physical Activity Combined with Massage Improves Bone Mineralization in Premature Infants: A Randomized Trial
BACKGROUND : Osteopenia of prematurity is a known source for morbidity in preterm infants . Premature infants have shown favorable outcomes in response to massage and physical activity . Whether such intervention can stimulate bone formation or decrease bone resorption is yet to be determined . OBJECTIVE : To test the hypothesis that massage combined with physical activity can stimulate bone formation and ameliorate bone resorption in premature infants . DESIGN / METHODS : A prospect i ve double-blinded r and omized trial was conducted at the Neonatal Intensive Care Unit of Ain Shams University in Cairo , Egypt . Thirty preterm infants ( 28 to 35 weeks ' gestation ) were r and omly assigned to either control group ( Group I , n=15 ) or intervention group ( Group II , n=15 ) . Infants in the intervention group received a daily protocol of combined massage and physical activity .  Serum type I collagen C-terminal propeptide ( PICP ) and urinary pyridinoline crosslinks of collagen ( Pyd ) were used as indices for bone formation and resorption , respectively . PICP and Pyd were measured at enrollment and at discharge for all subjects . t-Test , ANOVA and linear regression analysis were used for statistical analyses . RESULTS : There was no difference between groups I and II in gestational age ( 32.1±1.8 vs 31.5±1.4 weeks ) or birth weight ( 1.429±0.148 vs 1.467±0.132 g ) . In the control group , serum PICP decreased over time from 82.3±8.5 to 68.78±14.6 ( p<0.01 ) , while urinary Pyd increased from 447.7±282.8 to 744.9±373.6 ( p<0.01 ) indicating decreased bone formation and increased bone resorption , respectively . In the intervention group , serum PICP increased over time from 62.5±13.8 to 73.84±12.9 ( p<0.01 ) . Urinary Pyd also increased over time from 445.7±266.5 to 716.8±301.8 ( p<0.01 ) . In a linear regression model including gestational age and intervention , serum PICP increased significantly in the intervention group ( regression coefficient 18.8±4.6 , p=0.0001 ) while urinary Pyd did not differ between groups ( regression coefficient=5.6±114.3 , p=0.961 ) . CONCLUSIONS : A combined massage and physical activity protocol improved bone formation ( PICP ) but did not affect bone resorption ( Pyd ) . Pyd increased over time in both groups , possibly due to continuous bone resorption and Ca mobilization
Some evidence suggests that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants .
Current evidence does not support the routine use of physical activity programs in preterm infants .
BACKGROUND Lack of physical stimulation may contribute to metabolic bone disease of preterm infants , result ing in poor bone mineralization and growth .
Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth .
OBJECTIVES The primary objective was to assess whether physical activity programs in preterm infants  improve bone mineralization and growth and reduce the risk of fracture .
Subgroup analysis : • Given that the smallest infants are most vulnerable for developing osteopenia ( Bishop 1999 ) , a subgroup analysis was planned for infants with birth weight < 1000 g.•  Calcium and phosphorus intake may affect an infant 's ability to increase bone mineral content ( Kuschel 2004 ) .