title: The Effect of Assisted Exercise Frequency on Bone Strength in Very Low Birth Weight Preterm Infants: A Randomized Control Trial.
abstract: We aimed to assess whether a twice daily assisted exercise interventional program will have a greater effect on bone strength compared to a once daily intervention or no intervention in very low birth weight (VLBW) preterm infants. Thirty-four very VLBW preterm infants (mean BW 1217 ± 55 g and mean gestational age 28.6 ± 1.1 weeks) were randomly assigned into one of three study groups: twice daily interventions (n = 13), a once daily intervention (n = 11), and no intervention (control, n = 10). The intervention was initiated at a mean of 8 ± 2.4 days of life and continued for 4 weeks. It included passive extension and flexion range-of-motion exercise of the upper and lower extremities. Bone strength was measured at enrollment and after 2 and 4 weeks using quantitative ultrasound of tibial bone speed of sound (SOS, Sunlight Omnisense™). At enrollment, the mean bone SOS was comparable between the twice daily interventions, once daily intervention and control groups (2918 ± 78, 2943 ± 119, and 2910 ± 48 m/s, respectively). As expected, the bone SOS declined in all groups during the study period (-23.6 ± 24, -68.8 ± 28, and -115.8 ± 30 m/s, respectively, p < 0.05), with a significantly attenuated decrease in bone strength in the twice daily intervention group (p = 0.03). A twice daily intervention program of assisted range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia and future fractures in VLBW preterm infants.
authors.affiliation: Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel. litmani@clalit.org.il.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. litmani@clalit.org.il.
authors.forename: Ita
authors.initials: I
authors.lastname: Litmanovitz
authors.affiliation: Department of Physical Therapy, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Hedva
authors.initials: H
authors.lastname: Erez
authors.affiliation: Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Eliakim
authors.affiliation: Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
authors.forename: Sofia
authors.initials: S
authors.lastname: Bauer-Rusek
authors.affiliation: Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Arnon
authors.affiliation: Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Rivka H
authors.initials: RH
authors.lastname: Regev
authors.affiliation: Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
authors.forename: Gisela
authors.initials: G
authors.lastname: Sirota
authors.affiliation: Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Nemet
mesh_terms: D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000175:diagnosis / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007234:Infant, Premature / Q000254:growth & development; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D008297:Male; D013977:Tibia / Q000503:physiopathology*
keywords: Osteopenia; Physical activity; Quantitative ultrasound; Speed of sound