Abstract
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 prospective double-blinded randomized 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 randomly 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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Abrams SA, Schandler RJ, Tsang RC, et al. Bone mineralization in former very low birth weight infants fed either human milk or commercial formula: one year follow up observation. J Pediatr 1989;144:1041–1044.
American Academy of Pediatrics, Committee on Nutrition. Nutritional needs of low birth weight infants. Pediatrics 1985;75:976–986.
Helm I, Landin LA, Nilsson BE . Bone mineral content in preterm infants at age 4 to 16. Acta Paediatr Scand 1985;74:264–267.
Yeh JK, Liu CC, Aloia JF . Effects of activity and immobilization on bone formation and resorption in young rats. Am J Physiol 1993;264:E182–E189.
Scafidi FA, Field TM . Massage stimulates growth in preterm infants: a replication. Infant Behav Dev 1990;13:167–188.
Scafidi F, Field T, Schanberg S . Factors that predict which preterm infants benefit most from massage therapy. J Dev Behav Pediatr 1993;14:176–180.
Moyer- Mileur L, Luetkemeier M, Boomer L, Chan GM . Effect of physical activity on bone mineralization in premature infants. J Pediatr 1995;127:620–625.
Moyer-Mileur LJ, Brunstetter V, McNaught TP, et al. Daily physical activity program increases bone mineralization and growth in preterm very low birth weight infants. Pediatrics 2000;106:1088–1092.
Litamanovitz I, Dolfin T, Friedland O, et al. Early physical activity intervention prevents decrease of bone strength in very low birth weight infants. Pediatrics 2003;112:15–19.
Rauch F, Schoenau E . Skeletal development in premature infants: a review of bone physiology beyond nutritional aspects. Arch Dis Child 2002;86:F82–F85.
Weiger K, Wollman HA, Ranke MB, Speer CP . Plasma concentrations of carboxyterminal propeptide of type I procollagen (PICP) in preterm neonates from birth to term. Pediatr Res 2000;48:104–108.
Crofton PM, Shrivastava A, Wade JC, et al. Bone and collagen markers in preterm infants: relationship with growth and bone mineral content over the first 10 weeks of life. Pediatr Res 1999;46:581–587.
Tsukahara H, Miura M, Hori C, et al. Urinary excretion of pyridium crosslinks of collagen in infancy. Metabolism 1996;45:510–514.
Ballard JL, Khoury JC, Wedig K . Assessment of gestational age using Ballard method. J Pediatr 1991;199:417.
SAS Institute Inc. SAS/STAT Software: Changes and enhancements through release 6.12. Cary, NC; 1997, 831–843.
Ogueh O, Khastgir G, Studd J, et al. The relationship of fetal serum markers of bone metabolism to gestational age. Early Hum Dev 1998;51:109–112.
Torun B, Schutz Y, Viteri F, et al. Growth, body composition and heart rate/VO2 during the nutritional recovery of children in two different physical activity levels. Bibl Nutr Dieta 1979;27:55–56.
VanWyk JJ, Underwood LE . Growth hormone, somatomedins and growth failure. Hosp Pract 1978;68:57.
Schanberg SM, Evoniuk G, Kuhn CM . Tactile and nutritional aspects of maternal care: specific regulators of neuroendocrine function and cellular development. Proc Soc Exp Biol Med 1984;175:135.
Field TM, Schanberg SM, Scafidi F, et al. Tactile/kinesthetic stimulation effects on preterm neonates. Pediatrics 1986;77:654–658.
Kurland ES, Cosman F, McMahon DJ, et al. Parathyroid hormone as therapy for idiopathic osteoporosis in men: effects on bone mineral density and bone markers. J Clin Endocrinol Metab 2000;85:3069–3076.
Ljunghall S, Joborn H, Roxin LE, et al. Increase in serum parathyroid hormone levels after prolonged activity. Med Sci Sport Exerc 1988;20:122–125.
Ljunghall S . Effects of physical activity on serum calcium and parathyroid hormone. Eur J Clin Invest 1984;14:469–473.
Specker BL, Mulligan L, Ho M . Longitudinal study of calcium intake, physical activity and bone mineral content in infants 6–18 months of age. J Bone Miner Res 1999;14:569–576.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Aly, H., Moustafa, M., Hassanein, S. et al. Physical Activity Combined with Massage Improves Bone Mineralization in Premature Infants: A Randomized Trial. J Perinatol 24, 305–309 (2004). https://doi.org/10.1038/sj.jp.7211083
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211083
This article is cited by
-
NICU sensory experiences associated with positive outcomes: an integrative review of evidence from 2015–2020
Journal of Perinatology (2023)
-
The association of stress and physical activity: Mind the ecological fallacy
German Journal of Exercise and Sport Research (2022)
-
Effect of tactile/kinesthetic massage therapy on growth and body composition of preterm infants
European Journal of Pediatrics (2021)
-
Effect of Tactile-Kinesthetic Stimulation on Weight in Preterm Neonates in Neonatal Intensive Care Unit
Indian Pediatrics (2020)
-
Enhancing sensory experiences for very preterm infants in the NICU: an integrative review
Journal of Perinatology (2017)