title: Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Randomized trial of nutrient-enriched formula versus standard formula for postdischarge preterm infants. The Effects of Exercise on Body Weight and Circulating Leptin in Premature Infants Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys. Sequential bone mineral content in small preterm infants with and without fractures and rickets. Assisted Exercise and Bone Strength in Preterm Infants Tactile/kinesthetic stimulation (TKS) increases tibial speed of sound and urinary osteocalcin (U-MidOC and unOC) in premature infants (29-32weeks PMA). Physical Activity Combined with Massage Improves Bone Mineralization in Premature Infants: A Randomized Trial Maternal-administered physical activity enhances bone mineral acquisition in premature very low birth weight infants Evidence for exercise-induced bone formation in premature infants. Daily Physical Activity Program Increases Bone Mineralization and Growth in Preterm Very Low Birth Weight Infants Assisted exercise improves bone strength in very low birthweight infants by bone quantitative ultrasound. Massage with kinesthetic stimulation improves weight gain in preterm infants Early physical activity intervention prevents decrease of bone strength in very low birth weight infants. Physical therapy reduces bone resorption and increases bone formation in preterm infants. Effects of motor physical therapy on bone mineralization in premature infants: a randomized controlled study Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures National Institute of Child Health and Human Development Role of physical activity in the development of skeletal mass in children. Effect of physical activity on bone mineralization in premature infants.
abstract: BACKGROUND Because recent data on the effects of mineral concentrations in preterm infant formula on bone mineralization are lacking , recommendations for the mineral content of preterm infant formula differ greatly between committees . OBJECTIVE The goal of the study was to assess the effects of an isocaloric , nutrient-enriched preterm formula , which was fed from the age when full enteral feedings were tolerated through expected term , on bone mineralization in preterm infants . DESIGN We conducted a prospect i ve , r and omized , double-blind study in healthy , preterm infants ( gestational age of 28 - 32 wk ) who were fed either a control preterm formula ( n=20 ) or an isocaloric , nutrient-enriched preterm formula ( n=21 ) until 3 mo of age ( ie , approximate expected term ) .  Serum calcium indexes were taken throughout the study , and bone mass was determined by using dual-energy X-ray absorptiometry at hospital discharge and expected term . RESULTS A total of 37 infants ( experimental formula , n=19 ; control formula , n=18 ) completed the study . Compared with control subjects , infants fed the experimental formula had 25 % and 40 % higher intakes of calcium and phosphorus , respectively . Serum calcium , phosphorus , osteocalcin , and alkaline phosphatase concentrations and urinary collagen type I cross-linked N-telopetide concentrations were not significantly different between the groups at any time point . The bone mineral content of infants fed the experimental formula was 23 % ( P=0.039 ) and 35 % ( P=0.002 ) higher at hospital discharge and expected term , respectively . CONCLUSIONS Bone mineralization at hospital discharge and expected term was significantly higher in preterm infants fed the isocaloric , nutrient-enriched formula than in those fed control formula . Continuation of the experimental formula beyond hospital discharge , through expected term , further improved bone mineralization OBJECTIVES Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood . In a large efficacy and safety trial , we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes . PARTICIPANTS AND INTERVENTION Two hundred eighty-four infants ( mean gestation : 30.9 weeks ) were studied ; 229 were r and omly assigned a  protein , energy , mineral , and micronutrient-enriched postdischarge formula ( PDF ; N = 113 ) or st and ard term formula  ( TF ; N = 116 ) from discharge ( mean 36.5 weeks ' postmenstrual age ) . A reference group ( N = 65 ) was  breastfed until at least 6 weeks ' postterm . Outcome measures . Anthropometry was performed at 6 weeks and 3 , 6 , 9 , and 18 months . Development was measured at 9 months ( Knobloch , Passamanick , and Sherrard 's developmental screening inventory ) and 18 months ( Bayley Scales of Infant Development II ; primary outcome ) postterm . RESULTS At 9 months , compared with the TF group , those fed PDF were heavier ( difference 370 g ; 95 % confidence interval [ CI ] : 84 - 660 ) and longer ( difference 1.1 cm ; 95 % CI : 0.3 - 1.9 ) ; the difference in length persisted at 18 months ( difference 0.82 cm ; 95 % CI : -0.04 - 1.7 ) . There was no effect on head circumference . The effect of diet was greatest in males ; at 9 months length deficit with TF was 1.5 cm ( 95 % CI : 0.3 - 2.7 ) , and this remained at 18 months ( 1.5 cm [ 95 % CI : 0.3 - 2.7 ] ) . There was no significant difference in developmental scores at 9 or 18 months , although PDF infants had a 2.8 ( -1.3 - 6.8 ) point advantage in Bayley motor score scales . At 6 weeks ' postterm , exclusively breastfed infants were already 513 g ( 95 % CI : 310 - 715 ) lighter and 1.6 cm ( 95 % CI : 0.8 - 2.3 ) shorter than the PDF group , and they remained smaller up to 9 months ' postterm . CONCLUSIONS 1 ) Improving postdischarge nutrition in the first 9 months may " reset " subsequent growth-at least until 18 months for body length . We intend to follow-up the children at older ages . The observed efficacy of PDF was not associated with adverse safety outcomes . 2 ) We can not reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study . 3 ) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation , currently under investigation OBJECTIVE : To assess the effect of daily movements on weight gain , serum leptin , and insulin-like growth factor I ( IGF-I ) in premature infants . STUDY DESIGN : Twenty very-low-birth-weight premature infants were matched and r and omized to a daily movement ( n=10 ) and control groups ( n=10 ) . Daily movement consisted of passive range of motion with gentle compression of both the upper and lower extremities 5 days per week for 4 weeks . RESULTS : Daily movements led to a significant increase in weight gain ( 784±51 vs 608±26 g in movements and controls , respectively , p<0.02 ) , and to a significant increase in leptin ( 0.60±0.19 vs 0.13±0.06 ng/ml in movements and controls , respectively , p<0.05 ) . Changes in body weight correlated with changes in serum leptin ( r=0.48 , p<0.03 ) . IGF-I also increased following daily movements ( 18.8±4.1 vs 9.2±4.1 ng/ml in movements and controls , respectively ) ; however , this increase was not statistically significant . CONCLUSION : A relatively brief range of motion daily movement intervention was associated with greater weight gain and increased leptin levels in very-low-birth-weight premature infants . This may suggest that at least part of the daily movements associated with increase in body weight result ed from an increase in adipose tissue Exercise during growth has a positive influence on bone mineral accrual , yet little is known about how bone geometry and strength adapt to loading during growth . Our primary objective was to compare changes in proximal femur bone geometry and strength between 31 prepubertal ( Tanner Stage 1 ) boys who participated in a school-based , high-impact circuit intervention ( 12 min , three times a week ) for 20 months and 33 maturity-matched controls . Our secondary objective was to compare changes in total body ( TB ) , proximal femur ( PF ) , and lumbar spine ( LS ) bone mineral content ( BMC ) and bone area ( BA ) in these groups . We assessed geometric variables and bone strength at the narrow neck ( NN ) , intertrochanteric ( TR ) region , and femoral shaft regions by applying the Hip Structure Analysis program to proximal femur dual energy X-ray absorptiometry scans ( DXA , Hologic QDR 4500 ) . Further , we assessed total body , lumbar spine , and proximal femur BMC and BA by DXA and derived total body lean mass and fat mass from total body scans . Intervention ( 10.2 + /- 0.5 years ) and control boys ( 10.1 + /- 0.5 years ) had similar baseline height ( 140.8 vs. 141.3 cm ) and weight ( 36.9 vs. 35.4 kg ) , and average 20-month physical activity scores ( Physical Activity Question naire for Children , PAQ-C ) and calcium intakes ( 861 vs. 852 mg/day , food frequency question naire ) . Twenty-month height and weight changes were not significantly different between groups ; lean mass changed more ( P < 0.05 ) in intervention boys ( 22.8 % ) than control boys ( 18.6 % ) . At the NN region , intervention boys had greater bone expansion on both the periosteal ( + 2.6 % , P = 0.1 ) and endosteal ( + 2.7 % , P = 0.2 ) surfaces , result ing in significantly greater changes in section modulus ( bone bending strength ) ( + 7.5 % , P = 0.02 , ANCOVA , adjusting for height change , final Tanner Stage , and baseline bone values ) . Changes at the intertrochanteric and femoral shaft regions were not significantly different between groups . Femoral neck ( FN ) BMC changes were significantly greater in intervention boys ( + 4.3 % , P < 0.01 ) ; changes in BA and BMC for other regions were not significantly different between groups . In summary , a school-based , high-impact exercise intervention implemented three times a week for 12 min is an effective strategy for site-specific gains in bone strength at the narrow neck region of the proximal femur Seventy-four infants with birth weights 1009 + /- 28 grams and gestational age 28.6 + /- 0.3 weeks ( M + /- SEM ) were studied prospect ively to test the hypotheses that bone mineral content ( BMC ) measured by photon absorptiometry , would be : ( 1 ) lower in very low birth weight ( VLBW ) infants with radiographic evidence of fractures and /or rickets ( F/R ) , and ( 2 ) will continue to be lower over the first year when compared to VLBW infants without F/R. BMC and bone width ( BW ) of the distal one-third of left radius and ulna were measured at 5 weeks ( n = 8) , 14 weeks ( n = 61 ) , 26 weeks ( n = 58 ) , 40 weeks ( n = 59 ) , and 1 year ( n = 52 ) .  St and ardized radiographs of both forearms , and weight , length , and head circumference were also determined at each study age . Investigators and technicians involved in the photon absorptiometry measurements were unaware of the radiographic findings and vice versa . Twenty-three of 74 infants were found to have F/R. BMC of studied infants remained markedly below our previously determined range of " intrauterine bone mineralization , " even at 26 weeks after birth . There was no significant difference in BMC or BW between infants with and without F/R , either at the time of confirmation of F/R or during early follow-up ; however , BMC was lower at greater than or equal to 6 months and BW was lower at greater than or equal to 9 months in infants with F/R. We suggest that the extremely low BMC measurements in early infancy predispose all VLBW infants to fractures and rickets Studies have previously demonstrated that brief ( 4 weeks ) passive range-of-motion exercise is beneficial for bone development in very low birth weight ( VLBW ) preterm infants . However , the optimal duration of exercise for bone development in preterm infants is yet unknown . The aim of the present study was to examine the effect of 8 weeks of assisted exercise on bone strength and metabolism in VLBW premature infants . Sixteen infants ( mean ± st and ard error of the mean birth weight 1,009 ± 55 g and gestational age 27.3 ± 0.3 weeks ) were r and omly assigned into exercise ( n = 8) and control ( n = 8) groups . The intervention started at the first week of life and involved 8 weeks of daily passive extension and flexion range-of-motion exercise of the upper and lower extremities . Biochemical markers of bone turnover were measured at enrollment and after 8 weeks . Bone strength was measured weekly by quantitative ultrasound measurement of tibial bone speed of sound ( SOS ) . Bone SOS decreased significantly in the control group ( −108.1 ± 33.7 m/second , P < 0.0001 ) during the study period , while remaining stable in the exercise group ( 11.3 ± 22.8 m/second ) . The main beneficial effect of exercise occurred in the first 4 weeks of the intervention . There were no significant differences in the bone turnover marker changes between the groups . There is a significant postnatal decrease in bone SOS in VLBW preterm infants . Eight weeks of assisted range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia in premature infants Preterm delivery ( < 37 weeks post-menstrual age ) is associated with suboptimal bone mass . We hypothesized that tactile/kinesthetic stimulation ( TKS ) , a form of infant massage that incorporates kinesthetic movement , would increase bone strength and markers of bone accretion in preterm infants . Preterm , AGA infants ( 29 - 32 weeks ) were r and omly assigned to TKS ( N=20 ) or Control ( N=20 ) . Twice daily TKS was provided 6 days per week for 2 weeks . Control infants received the same care without TKS treatment . Treatment was masked to parents , health care providers , and study personnel . Baseline and week two measures were collected for tibial speed of sound ( tSOS , m/sec ) , a surrogate for bone strength , by quantitative ultrasound ( Sunlight8000 ) and urine markers of bone metabolism , pyridinium crosslinks and osteocalcin ( U-MidOC and unOC ) . Infant characteristics at birth and study entry as well as energy/nutrient intake were similar between TKS and Control . TKS intervention attenuated the decrease in tSOS observed in Control infants ( p<0.05 ) . Urinary pyridinium crosslinks decreased over time in both TKS and CTL ( p<0.005 ) . TKS infants experienced greater increases in urinary osteocalcin ( U-MidOC , p<0.001 and unOC , p<0.05 ) . We conclude that TKS improves bone strength  in premature infants by attenuating the decrease that normally follows preterm birth . Further , biomarkers of bone metabolism suggest a modification in bone turnover in TKS infants in favor of bone accretion . Taken together , we speculate that TKS improves bone mineralization 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 Objective : To determine if physical activity delivered by an infant 's mother would be as effective in promoting bone mineral acquisition in preterm very low birth weight ( VLBW ) infants as the same intervention administered by a trained therapist . Patients and methods : Preterm VLBW infants were r and omized to receive daily physical activity administered by the infant 's mother  ( MOM , n=11 ) or a trained therapist ( OT , n=11 ) , or control ( n=11 ) . Physical activity consisted of range of motion movements against passive resistance to all extremities for 5 to 10 min daily . All infants were fed mother 's milk with fortification to 24 kcal oz−1 . Dual energy x-ray of the forearm bone area ( BA , cm2 ) , mineral content ( BMC , g ) , and density ( BMD , g/cm2 ) and measurement of bone formation ( bone-specific alkaline phosphatase , BAP ) and resorption ( urine pyridinium crosslinks of collagen , Pyd ) were obtained at study entry and at 2.0 kg of body weight . Result : Forearm BA and BMC gains were greater in MOM and OT infants compared to the control infants despite similar postnatal growth rate and nutrient intake . Serum BAP levels decreased in controls but remained unchanged in MOM and OT infants . Urine Pyd levels were similar at baseline to 2.0 kg for all groups . These findings suggest greater bone growth and mineral acquisition in MOM and OT infants than control infants . Conclusion : This study demonstrates that a physical activity program administered by the infant 's own mother is as equally effective as therapist-administered physical activity in promoting greater bone growth and mineral acquisition in preterm VLBW infants We assessed the effect of a four weeks exercise training intervention on bone turnover markers in premature infants . Twenty-four very low birth weight premature infants were matched for gestational age , birth weight , gender , as well as for corrected age and weight at initiation of the study . Then the subjects were r and omly divided into an exercise ( n = 12 ) and a control group ( n = 12 ) . Exercise consisted of passive range of motion exercise with gentle compression of both the upper and lower extremities lasting 5 - 10 minutes each day , 5 days per week for 4 weeks . This protocol has been shown to increase bone mineral density in premature infants . Bone formation was assessed by measurements of circulating bone specific alkaline phosphatase ( BSAP ) and the C-terminal procollagen peptide ( PICP ) . Bone resorption was determined by serum measurements of C- terminal cross-links telopeptide of type-I collagen ( ICTP ) . Training led to a significant ( P < 0.05 ) increase in weight gain ( 767 + /- 49 versus 586 + /- 24 gr in trained and control premature infants , respectively ) ; and to a significant increase in BSAP ( 37.2 + /- 14.6 versus 4.1 + /- 8.4 % in trained and control premature infants , respectively ) . PICP increased also following exercise ( 34.6 + /- 18.9 versus 5.4 + /- 9.1 % in trained and control subjects , respectively ) , however , this increase was not statistically significant . Exercise led to a significant decrease in ICTP ( -24.7 + /- 3.1 versus -5.5 + /- 5.4 % in trained and control subjects , respectively ) . A relatively brief exercise intervention was associated with a biochemical evidence of bone formation in very low birth weight premature infants Objective . A study of daily physical activity was performed with 32 preterm infants to evaluate changes in body weight and bone mineralization . Study Design . Subjects were matched by birth weight and gestational age and r and omly assigned to the  physical activity ( PA;n = 16 ) or to the control  ( C ; n= 16 ) program . PA consisted of range of motion against passive resistance to all extremities for 5 to 10 minutes daily . Peripheral dual-energy x-ray of the right forearm ( ulna and radius ) ; biomarkers of bone formation ( serum type I collagen C-terminal propeptide [ PICP ] ) and resorption ( urine pyridinoline cross-links of collagen [ Pyd ] ) ; serum calcium , phosphate , alkaline phosphatase , parathyroid hormone ( PTH ) , and 1,25-(OH)2 vitamin D ; and urine levels of calcium , phosphate , and creatinine were obtained . All measurements were made at study entry and at 2.0 kg of body weight . Results . Despite a similar nutrient intake at advised levels for preterm infants , gains in body weight ( g ) and forearm bone length ( cm ) , bone area ( BA ; cm2 ) , bone mineral content ( BMC ; mg ) , and fat-free mass ( g ) were greater in PA infants . Forearm bone mineral density and fat mass gains did not differ between groups . Serum PICP levels remained constant in PA infants but decreased in C infants suggesting a slower rate of bone formation . Urine Pyd or bone resorption activity was similar between groups . A higher level of serum PTH was observed in PA infants at 2.0 kg of body weight ; however , the change from study entry to completion did not differ between groups . All other serum and urine values were similar and within normal limits . Conclusion . A daily PA program promotes greater gains in body weight , forearm length , BA , BMC , and fat-free mass in premature infants AIM To evaluate whether assisted exercise could prevent the development of osteopenia of prematurity , we performed assisted exercise in the study group of very low birthweight ( VLBW ) premature infants . METHODS Sixteen premature infants with birthweight below 1500 g were enrolled in this study and r and omly assigned into the exercise ( n = 8) and control ( n = 8) groups . Assisted exercise involved full extension and flexion range of motion of the upper and lower extremities by a trained nurse with a schedule of 5 days a week for a total of 4 weeks . Bone strength was determined by quantitative ultrasound measurement of tibial bone speed of sound every 2 weeks during the study period . RESULTS No difference in gender , birthweight , and gestation age between the exercise and control groups was noted . There was statistically significant less tibial bone speed of sound decrease in the exercise group on the sixth and eighth week of life . During the study period , there were no statistically significant differences in blood biochemistry data , including calcium , phosphorus , magnesium , alkaline phosphatase , osteocalcin and osteoprotegerin , between the two groups . CONCLUSIONS This study revealed that early assisted exercise could improve bone strength in very low birthweight infants . The biochemical markers of bone metabolism , osteocalcin and osteoprotegerin , could not be the indicators for early diagnosis of osteopenia of prematurity Objective : The aim of this study was to evaluate the effects of massage with or without kinesthetic stimulation on weight gain and length of hospital stay in the preterm infant . Study Design : A prospect i ve r and omized clinical trial was conducted evaluating the effects of massage with or without kinesthetic stimulation ( KS ) on weight gain and length of stay ( LOS ) in medically stable premature ( < 1500 g and /or ⩽32 weeks gestational age ) neonates . Infants were r and omized either to receive no intervention ( control ) , massage therapy alone ( massage ) , or massage therapy with KS ( M/KS ) . Linear regression analysis was performed to evaluate differences in the primary outcomes between the groups after controlling for covariates . Post hoc analysis with stratification by birthweight ( BW > and < 1000 g ) was also performed . Result : A total of 60 premature infants were recruited for this study ; 20 infants in each group . Average daily weight gain and LOS were similar between the groups after controlling for covariates . For infants with BW>1000 g , average daily weight gain was increased in the intervention groups compared to control . This effect was mainly attributable to the M/KS group . Conclusion : Massage with KS is a relatively simple and inexpensive intervention that can improve weight gain in selected preterm infants . Length of hospital stay is not impacted by massage with or without KS . Further studies are needed to evaluate the effect of massage in the extremely low BW(<1000 g ) infant OBJECTIVE To evaluate the effect of early range-of-motion intervention on bone strength and bone turnover in very low birth weight infants . METHODS Twenty-four infants ( mean birth weight : 1135 + /- 247 g ; mean gestational age : 28.5 + /- 2.3 weeks ) were matched for gestational age and birth weight and then r and omly assigned into exercise ( n = 12 ) and control ( n = 12 ) groups . Exercise protocol started at the first week of life and involved daily extension and flexion range of motion against passive resistance of the upper and lower extremities ( 5 minutes per day , 5 days per week , 4 weeks ) . Growth parameters , bone strength , and biochemical markers of bone homeostasis were measured at enrollment and after 4 weeks . Bone strength was determined using quantitative ultrasound measurement of bone speed of sound ( SOS ) at the middle left tibial shaft . RESULTS Bone SOS decreased significantly in the control group during the study period ( from 2892 + /- 30 m/sec to 2799 + /- 26 ) , whereas bone SOS of the exercise group remained stable ( 2825 + /- 32 m/sec and 2827 + /- 26 m/sec at baseline and 4 weeks , respectively ) . This significant difference in bone SOS was not expressed in the biochemical markers of bone homeostasis . CONCLUSIONS There is a significant postnatal decrease in the bone SOS of very low birth weight infants . A brief range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia AIM To evaluate bone metabolism in newborn preterm infants before and after a physical therapy protocol . METHOD This r and omized controlled clinical trial included 30 newborn preterm infants with gestational age ≤ 35 weeks and appropriate weight for gestational age , who were r and omized into control group ( CG ) and physiotherapy group ( PG ) . The PG protocol consisted of 15 minutes of daily passive movements with gentle joint compression 5 days a week . Daily data were obtained on feeding and body weight . Measurements of bone-specific alkaline phosphatase ( BAP ) and urinary deoxypyridinoline ( DPD ) were collected before and after intervention in both groups . The analysis of covariance test was performed to compare the means of both groups . RESULTS At baseline , gestational age and corrected gestational age , birth weight , and gender were similar between both groups . Nutrient supply , length of total parenteral nutrition , and mechanical ventilation were also similar . BAP level increase in PG was 22.44 ± 3.49 U/L , whereas in CG was 2.87 ± 3.99 U/L ( p = 0.003 ) . There was a reduction of DPD levels in PG of 28.21 ± 11.05 nmol/mmol , and an increase of 49.95 ± 11.05 nmol/mmol ( p < 0.001 ) in GC . CONCLUSION The benefits of prevention and treatment of metabolic bone disease of prematurity , in addition to an adequate diet , should include these passive exercises with gentle joint compressions to improve the quality of premature infant 's bones Objective : To study the effect of physical therapy on bone mineralization , weight gain and growth in preterm infants . Method : After fulfilling the inclusion criteria , preterm infants were matched for gestational age and birth weight and then r and omly assigned to the physiotherapy group ( PG , n=15 ) and control group ( CG , n=14 ) . The PG received motor physical therapy for 15 min daily , 5 times per week until hospital discharge . Bone mineralization was measured by total body dual energy X-ray beam absorptiometry ( DEXA ) at the onset and end of the study . Statistical analysis was realized by ANCOVA and linear correlation tests . Result : The physical therapy group ( PG ) presented greater body weight gain per day ( 27.4±2.4 vs 21.01±4.4 g , P<0.001 ) and length ( 1.3±0.3 vs 0.8±0.2 cm week−1 , P<0.001 ) than did the control group ( CG ) . Body composition values verified by DEXA were greater for the PG . The mean gain in bone mineral content ( BMC ) ( mg ) was greater in the PG ( 434±247.5 vs −8.9±11.4 , P<0.001 ) , as was the mean bone mineral density ( BMD ) gain ( mg cm−2 ) ( 8.4±5.6 vs −3.1±5.5 , P<0.001 ) . The gain in bone area ( BA , cm2 ) was 10.3±5 in the PG vs 1.5 ±2 in the CG ( P<0.001 ) . The gain in lean mass ( LM ) ( g ) in the PG was also greater than in the CG ( 271.1±21.4 vs 109.1±1.0 , P<0.009 ) . The fat mass ( g ) was similar between the groups ( P=0.432 ) . Conclusion : These results showed that physiotherapy in preterm infants  produced greater gains in growth , body weight , BMC , BMD , BA and LM Underst and ing the stress/strain relationship between exercise and bone is critical to underst and ing the potential benefit of exercise in preventing postmenopausal bone loss . This study examined the effect of a 2-year exercise intervention and calcium supplementation ( 600 mg ) on bone mineral density ( BMD ) in 126 postmenopausal women ( mean age , 60 + /- 5 years ) . Assignment was by block r and omization to one of three groups : strength ( S ) , fitness ( F ) , or nonexercise control ( C ) . The two exercise groups completed three sets of the same nine exercises , three times a week . The S group increased the loading , while the F group had additional stationary bicycle riding with minimal increase in loading .  Retention at 2 years was 71 % ( 59 % in the S group , 69 % in the F group , and 83 % in the C group ) , while the exercise compliance did not differ between the exercise groups ( S group , 74 + /- 13 % ; F group , 77 + /- 14 % ) . BMD was measured at the hip , lumbar spine , and forearm sites every 6 months using a Hologic 4500 . Whole body BMD also was measured every 6 months on a Hologic 2000 . There was no difference between the groups at the forearm , lumbar spine , or whole body sites . There was a significant effect of the  strength program  at the total ( 0.9 + /- 2.6 % ; p < 0.05 ) and intertrochanter hip site ( 1.1 + /- 3.0 % ; p < 0.01 ) . There was a significant time and group interaction ( p < 0.05 ) at the intertrochanter site by repeated measures . This study shows the effectiveness of a progressive strength program in increasing bone density at the clinical ly important hip site . We concluded that a strength program could be recommended as an adjunct lifestyle approach to osteoporosis treatment or used in combination with other therapies BACKGROUND Osteoporotic fractures among the elderly are common , and without preventive measures the burden of these fractures on health-care systems will increase further . The purpose of this r and omised controlled study was to evaluate , in premenopausal women , the effects of high-impact loading on several determinants osteoporotic fractures . METHODS 98 healthy , sedentary female volunteers aged 35 - 45 years were r and omly assigned to either a training ( n = 49 ) or a control group ( n = 49 ) . Progressive high-impact exercises were done three times per week for 18 months . We measured bone mineral density ( BMD ) in specific axial and lower-limb sites , by dual-energy X-ray absorptiometry , at baseline and after 12 and 18 months . Maximum isometric strength , muscular and cardiovascular performance , and dynamic balance were also assessed . FINDINGS BMD at the femoral neck , a weightbearing site , increased significantly more in the training group ( mean 1.6 % [ 95 % CI 0.8 - 2.4 ] ) than in the control group ( 0.6 % [ -0.2 to 1.4 ] , p = 0.006 ) . By contrast , at non-weightbearing sites , such as the distal radius , there was no significant difference between the training and control groups ( -1.5 % [ -2.7 to -0.3 ] vs -0.7 % [ -1.9 to -0.5 ] , p = 0.60 ) . In the training group there was a significant improvement in vertical jump and predicted oxygen consumption per min at maximum exercise compared with controls . INTERPRETATION High-impact exercises that load bones with a rapidly rising force profile in versatile movements improve skeletal integrity , muscular performance , and dynamic balance in premenopausal women . If done on a regular basis , this type of exercise may help decrease the risk of osteoporotic fractures in later life . Long-term studies are required to show whether these 18-month results can be translated into long-term benefit The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development A group of 118 children , aged 5.3 - 14 years , were enrolled in a prospect i ve study of calcium supplementation and bone mass . At entry to the study , question naires regarding the child 's usual physical activity were administered to the children and their mothers . Repeated activity assessment s at 6 month intervals indicated good within-person agreement for total activity and for most individual activities . Consistent positive associations were observed between bone mineral densities ( BMD ) in the radius , spine , and hip and most activities . A summary measure ( total hours of weight-bearing activity ) was significantly related to BMD in the radius and hip , independently of age or gender effects . Self-reported sports and play activities were associated with BMD , but neither time spent watching television nor hours of physical education classes were associated either positively or negatively with skeletal mass . These data suggest that important increments in skeletal mass may result from physical activity during childhood OBJECTIVE A 4-week pilot study was done with 26 preterm infants to evaluate whether a physical activity program would result in greater bone mineralization . DESIGN Subjects were matched by birth weight , gender , and gestational age , and r and omly assigned to the  physical activity program ( group EX ; n = 13 ) or to the  control group  ( group C ; n = 13 ) . Physical activity consisted of range of motion with passive resistance to all extremities for 5 to 10 minutes daily . Baseline and 4-week values were determined for both bone mineral analyses and serum levels of calcium , phosphate , alkaline phosphatase , parathyroid hormone , and 25-hydroxy-vitamin D. RESULTS Despite similar nutrient intake at advised levels for preterm infants , EX infants gained more weight than control subjects ( 17.8 vs 13.4 gm/kg body weight per day ; p = 0.01 ) . A difference in radial bone mass and density change as determined by single-beam photon absorptiometry ( + /- 2 % error ) was found between groups ( p = 0.006 by analysis of covariance ) . Changes in bone width and in bone mineral content and density were enhanced by physical activity . Group EX infants had 12 % , 18 % , and 34 % gains in bone width and in bone mineral density and content , respectively ; group C infants had only a 2 % gain in bone width and 11 % and 14 % losses from baseline in bone mineral content and density , respectively , during the 4-week study . Serum biochemical values were similar in the groups except for lower alkaline phosphatase levels in group EX . There was a negative association between bone mineral content and parathyroid hormone values : r = -0.83 , p = 0.01 . CONCLUSIONS A physical activity program may increase the effects of adequate nutrition in healthy preterm very low birth weight infants by promoting weight gain and bone mass and by decreasing the risk of osteopenia
target: 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: 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 ) .