title: Physical activity combined with massage improves bone mineralization in premature infants: a randomized trial.
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.
  
  
  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.
authors.affiliation: Neonatology Department, The George Washington University Hospital & Children's National Medical Center, Washington, DC 20037, USA.
authors.forename: Hany
authors.initials: H
authors.lastname: Aly
authors.forename: Mohamed F
authors.initials: MF
authors.lastname: Moustafa
authors.forename: Sahar M
authors.initials: SM
authors.lastname: Hassanein
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
authors.forename: Hanna A
authors.initials: HA
authors.lastname: Amer
authors.forename: Kantilal
authors.initials: K
authors.lastname: Patel
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption / Q000517:prevention & control; D002113:Calcification, Physiologic; D002118:Calcium / Q000097:blood; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D008405:Massage; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011347:Procollagen; C042813:procollagen type I carboxy terminal peptide; D000469:Alkaline Phosphatase; D002118:Calcium