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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 15-19

Early Physical Activity Intervention Prevents Decrease of Bone Strength in Very Low Birth Weight Infants

Ita Litmanovitz, MD*, Tzipora Dolfin, MD*, Orit Friedland, MD{ddagger}, Shmuel Arnon, MD*, Rivka Regev, MD*, Ruth Shainkin-Kestenbaum, PhD§, Monika Lis, MSc§ and Alon Eliakim, MD{ddagger}

* Departments of Neonatology
{ddagger} Pediatrics
§ Biochemistry, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel

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 randomly 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.

Key Words: premature • osteopenia • exercise • quantitative ultrasound • speed of sound

Abbreviations: VLBW, very low birth weight • DEXA, dual-energy x-ray absorptiometry • QUS, quantitative ultrasound • SOS, speed of sound • BSAP, bone-specific alkaline phosphate • ICTP, carboxy terminal cross-links telopeptide of type-I collagen • CV, coefficient of variation

Received for publication May 14, 2002; Accepted Oct 14, 2002.




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