Effect of physical activity on bone mineralization in premature infants. Maternal-administered physical activity enhances bone mineral acquisition in premature very low birth weight infants Bone mineralization and growth are enhanced in preterm infants fed an isocaloric, nutrient-enriched preterm formula through term. Physical therapy reduces bone resorption and increases bone formation in preterm infants. Daily Physical Activity Program Increases Bone Mineralization and Growth in Preterm Very Low Birth Weight Infants Diet and Bone Mineral Content at Term in Premature Infants Early diet of preterm infants and bone mineralization at age five years A 3-Year Physical Activity Intervention Program Increases the Gain in Bone Mineral and Bone Width in Prepubertal Girls but not Boys: The Prospective Copenhagen School Child Interventions Study (CoSCIS) Increased bone mineral content of preterm infants fed with a nutrient enriched formula after discharge from hospital. Effects of motor physical therapy on bone mineralization in premature infants: a randomized controlled study Diet, growth, and bone mineralization in premature infants. The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy. Physical activity increases bone mineral density in children with type 1 diabetes. Effect of a calcium and phosphorus-enriched formula on bone mineralization and bone growth in preterm infants after discharge from hospital. Increasing weight-bearing physical activity and calcium-rich foods to promote bone mass gains among 9–11 year old girls: outcomes of the Cal-Girls study Influences on skeletal mineralization in children and adolescents: evidence for varying effects of sexual maturation and physical activity. Longitudinal study of calcium intake, physical activity, and bone mineral content in infants 6-18 months of age.
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 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 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 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 . 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 Premature infants are at risk of developing metabolic bone disease mainly because of low calcium and phosphorus intake . We have examined the effect of different mineral supplements on bone mineral content at term in 127 premature infants with gestational age < 32 wk in a double-blinded r and omized trial . We used either phosphate supplementation of human milk as recommended by the European Society of Pediatric Gastroenterology and Nutrition or fortified supplementation with protein , calcium , and phosphorus or preterm formula as recommended by the American Academy of Pediatrics . The intervention period was from 1 week old until 36 wk of gestational age , and the infants were fed approximately 200 mL·kg−1·d−1 . Bone mineral content was measured at term by dual-energy x-ray absorptiometry scan . Surprisingly , neither phosphate , fortifier , nor preterm formula supplementation had any significant effect on bone mineral content at term compared with infants fed their own mother 's milk only . There was a tendency to higher total bone mineral content in infants fed preterm formula compared with infants fed their own mother 's milk only ( p = 0.05 ) , but when the bone mineral content was corrected for the size of the infant , there was no difference ( p = 0.68 ) . Infants fed preterm formula had a significantly higher weight at term compared with infants fed their own mother 's milk only ( p = 0.02 ) , but did not differ significantly in length or head circumference . In a regression analysis , the amount of supplemented phosphorus was significantly associated with weight at term ( p = 0.008 ) . We conclude that when feeding 200 mL·kg−1·d−1 , mineral supplementation of human milk or use of preterm formula does not significantly improve bone mineralization outcome at term Bone disease with significantly reduced bone mineralization is common in preterm infants , and associated with later linear growth stunting at 18 months of age . Dietary insufficiency of calcium and phosphorus is thought to be the principal aetiological factor . We studied 54 children at mean age 5 years who were born preterm and had participated in a prospect i ve multicentre study of effects of early diet on later growth and development . Diets compared were banked donor breast milk and preterm formula fed as a supplement to mother 's own milk . Increasing human milk intake was strongly positively associated with later bone mineral content . Children fed predominantly human milk had greater bone mineral content than children of similar size born at term . These data suggest that the early nutritional environment of the preterm infant could play an important role in determining later skeletal growth and mineralization The aim of this study was to evaluate the effect of increasing the amount of time spent in physical education classes on bone mineral accrual and gain in bone size in prepubertal Danish children . A total of 135 boys and 108 girls , aged 6–8 years , were included in a school-based curriculum intervention program where the usual time spent in physical education classes was doubled to four classes ( 180 min ) per week . The control group comprised age-matched children ( 62 boys and 76 girls ) recruited from a separate community who completed the usual Danish school curriculum of physical activity ( 90 min/week ) . Dual-energy X-ray absorptiometry was used to evaluate bone mineral content ( BMC ; g ) , bone mineral density ( g/cm2 ) , and bone width at the calcaneus and distal forearm before and after 3 years of intervention . Anthropometrics and Tanner stages were evaluated on the same occasions . General physical activity was measured with an accelerometer worn for 4 days . In girls , the intervention group had a 12.5 % increase ( P = 0.04 ) in distal forearm BMC and a 13.2 % increase ( P = 0.005 ) in distal forearm scanned area compared with girls in the control group . No differences were found between the intervention and control groups in boys . Increasing the frequency of physical education classes for prepubertal children is associated with a higher accrual of bone mineral and higher gain in bone size after 3 years in girls but not in boys Bone disease with persistent reduced bone mineralisation is common in premature infants . To test the hypothesis that enhancement of nutritional intake after discharge from hospital improves bone mineralisation , 31 formula fed preterm infants were r and omly assigned to receive st and ard or multinutrient enriched milk from the time of discharge . The calcium and phosphorus contents of the enriched milk were 70 and 35 mg/100 ml v 35 and 29 mg/100 ml for the st and ard formula . Bone mineral content was measured before discharge from hospital in 21 of the infants ; there was no difference in the bone mineral content between the groups at that time ( 35 mg/cm for the two groups ) . There was a significant increase in bone mineral content for those infants receiving the enriched v st and ard formula at 3 and 9 months corrected postnatal age : at 3 months the bone mineral content was 83 v 63 mg/cm and at 9 months 115 v 95 mg/cm . The difference between the groups was thus maintained although not increased at a corrected age of 9 months , when the bone mineral content of infants fed the enriched but not the st and ard formula was no longer significantly different from that of normal infants after adjusting for body size . The difference was not explained by the larger body size in infants fed the enriched formula . The results suggest that the use of a special nutrient enriched postdischarge formula has a significant positive effect on bone growth and mineralisation during a period of rapid skeletal development 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 Energy , protein , and mineral requirements in premature infants are high , hence increasing the risk of poor growth and development of metabolic bone disease . This double-blind study included 127 consecutive premature infants with gestational age below 32 weeks . Both sick and healthy infants participated . Average duration of ventilator treatment : 2 days , CPAP treatment : 10 days ( range , 0 - 50d ) . Infants were r and omized to 3 groups from 1 week old to 37 weeks of gestational age and fed the following : a ) human milk ( their own mother 's milk or banked milk ) supplemented with phosphate , b ) human milk fortified with protein , calcium , and phosphate , or c ) unsupplemented mother 's milk or preterm formula . Infants r and omized to preterm formula were fed formula only if their own mother 's milk was not available , hence there were 2 subgroups of infants fed either unsupplemented human milk or preterm formula . Volume of intake was 191+/-14mL/kg/d ( mean + /- SD ) ; linear growth was measured weekly by knemometry ; head circumference was measured weekly ; and growth rate was calculated by linear regression for each infant . Bone mineralization and body composition were measured by DEXA-scan ( Hologic 1000/W ) at term . There was a tendency toward slower growth and less bone mineral content in infants fed unsupplemented human milk but , surprisingly , the difference was small and not significant After an 8-month physical activity intervention in children with cerebral palsy , increases in femoral neck bone mineral content ( BMC ) ( 9.6 % ) , volumetric bone mineral density ( v BMD ) ( 5.6 % ) , and total proximal femur BMC ( 11.5 % ) were observed in the intervention group ( n = 9 ) compared with control subjects ( n = 9 ; femoral neck BMC , -5 . 8 % ; v BMD , -6.3 % ; total proximal femur BMC , 3.5 % ) INTRODUCTION Osteoporosis is a growing health problem in patients with type 1 diabetes mellitus ( T1DM ) . The aim of this study was to determine the effects of a 9-month weight-bearing physical activity program on bone mineral density ( BMD ) and bone biomarkers in T1DM compared with healthy children . METHODS This was a r and omized controlled trial including 27 diabetic and 32 healthy children ( mean age = 10.5 ± 2.5 yr ) . Both T1DM and healthy participants were r and omized to either an exercise or a control group ( i.e. , four groups ) . At baseline and 9 months , total body ( TB ) , lumbar spine ( LS2-LS4 ) , femoral neck , and greater trochanter areal BMD ( aBMD ) and serum bone biomarkers ( osteocalcin , type 1 collagen cross-linking ) were measured . The intervention consisted of two 90-min sessions per week of weight-bearing physical activity ( ball games , jumping , rope skipping , and gymnastics ) . RESULTS Baseline variables were similar among groups . At 9 months , changes in TB ( T1DM = 0.035 ± 0.022 g·cm(-2 ) , healthy = 0.031 ± 0.017 g·cm(-2 ) ) and LS2-LS4 ( T1DM = 0.046 ± 0.038 g·cm(-2 ) , healthy = 0.063 ± 0.034 g·cm(-2 ) ) aBMD were statistically significant in the intervention groups and of similar magnitude between T1DM and healthy subjects . The level of type 1 collagen cross-linking ( T1DM = -0.12 ± 0.32 ng·mL(-1 ) , healthy = -0.36 ± 0.11 ng·mL(-1 ) ) decreased in the intervention groups but was not associated with TB aBMD changes . CONCLUSIONS Regular weight-bearing physical activity ( 180 min·wk(-1 ) , including ball games , jumping activities , and gymnastics )  improves total and LS2-LS4 bone mineral accretion in children with T1DM , in a similar magnitude to healthy subjects . We conclude that children with T1DM should be encouraged to practice regular physical activity to enhance peak bone mass and prevent osteoporosis later in life At discharge from hospital , 36 preterm infants ( birthweight < 1,800 g ) were r and omized to be given either a st and ard formula or an identical formula enriched with calcium ( 47 vs. 80 mg/100 ml ) and phosphorus ( 30 vs. 45 mg/100 ml ) exclusively until they reached a corrected age of 3 months , thereafter beikost and other formulas were introduced into the diet . Weight , head circumference and radial and body length were measured and radial bone mineral content ( BMC ) and bone width ( BW ) determined by single photon absorptiometry at discharge , at 3 and at 6 months of corrected age . Additionally , an X-ray of the wrist was taken and serum alkaline phosphatase activity determined at discharge , and the latter repeated at 3 months . Bone mineral content , bone width , and the individual increments of both parameters were significantly higher in infants fed the enriched formula at 3 months of age , but these differences were less pronounced at 6 months Background A two-year , community-based , group-r and omized trial to promote bone mass gains among 9–11 year-old girls through increased intake of calcium-rich foods and weight-bearing physical activity was evaluated . Methods Following baseline data collection , 30 5th- grade Girl Scout troops were r and omized to a two-year behavioral intervention program or to a no-treatment control group . Evaluations were conducted at baseline , one year , and two years . Measures included bone mineral content , density , and area ( measured by DXA ) , dietary calcium intake ( 24-hour recall ) , and weight-bearing physical activity ( physical activity checklist interview ) . Mixed-model regression was used to evaluate treatment-related changes in bone mineral content ( g ) for the total body , lumbar spine ( L1-L4 ) , proximal femur , one-third distal radius , and femoral neck . Changes in eating and physical activity behavioral outcomes were examined . Results Although the intervention was implemented with high fidelity , no significant intervention effects were observed for total bone mineral content or any specific bone sites . Significant intervention effects were observed for increases in dietary calcium . No significant intervention effects were observed for increases in weight-bearing physical activity . Conclusion Future research needs to identify the optimal dosage of weight-bearing physical activity and calcium-rich dietary behavior change required to maximize bone mass gains in pre-adolescent and adolescent girls OBJECTIVE To establish rates of skeletal mineralization in children and adolescents , and to identify factors that influence these rates . DESIGN Three-year observational study . SETTING University hospital . SUBJECTS Ninety white children , aged 6 to 14 years . MEASUREMENTS Bone mineral density of the radius , spine , and hip was measured at baseline and 3 years later .  Physical activity  was assessed by question naires at 6-month intervals and dietary calcium intake by diet diary 1 day per month for 36 months . Sexual maturation ( Tanner stage ) was determined by an endocrinologist at 6-month intervals , as necessary to classify children as prepubertal , peripubertal , or postpubertal . RESULTS Skeletal mineralization accelerated markedly at puberty in the spine ( 0.077 vs 0.027 gm/cm2 per year , peripubertal vs prepubertal ) and greater trochanter ( 0.050 vs 0.027 gm/cm2 per year ) , less markedly in the femoral neck ( 0.047 vs 0.030 gm/cm2 per year ) , and only slightly in the radius . Nearly one third ( 15 gm ) of the total skeletal mineral in the lumbar spine of adult women ( approximately 52 gm ) was accumulated in the 3 years around the onset of puberty . Increases in height and weight were the strongest correlates of skeletal mineralization : weight changes were more strongly correlated with trabecular bone sites and changes in height with cortical bone sites . Increases in calf muscle area were strongly associated with mineralization , particularly in peripubertal children , and physical activity was associated with more rapid mineralization in prepubertal children . CONCLUSIONS Puberty has varying effects on skeletal mineralization depending on skeletal site ; trabecular bone is apparently more sensitive to changing hormone concentrations . Physical activity and normal growth are also positively associated with skeletal mineralization , also depending on skeletal site and sexual maturation Although increased physical activity early in life is recommended for optimizing bone health , no controlled trials on the effect of activity on bone mass accretion during periods of rapid growth have been reported . The purpose of this study was to determine whether infants r and omized to a 1 year gross motor activity program  had a greater bone mass accretion than infants r and omized to a fine motor activity program .  The gross motor program included activities that focused on loading the skeleton and were performed for 15 - 20 minutes/day , 5 days/week by study personnel . Infants ( n = 72 ) were enrolled at 6 months of age , and total body bone mineral content ( BMC ) , 3-day diet records , and activity levels were obtained at 6 , 9 , 12 , 15 , and 18 months . BMC was associated with weight , length , and bone area at all ages and correlated with earlier calcium intakes . Calcium intake appeared to modify the effect of  gross motor activity  on bone mass accretion ; infants in both groups had similar bone accretion at moderately high calcium intakes , but at low calcium intakes infants in the gross motor program had less bone accretion than infants in the fine motor program . Compliant infants in the gross motor group had lower BMC at 18 months compared with noncompliant infants . These results indicate that BMC in infants is related to calcium intake , and we speculate that participation in a gross motor program during rapid bone growth may lead to reduced bone accretion in the presence of a moderate to moderately low calcium intake
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 ) .