Physical activity programs for promoting bone mineralization and growth in preterm infants

Schulzke SM, Trachsel D, Patole SK

Published Online:

February 17, 2010

Babies born too early (premature babies) are often cared for in a fashion that minimizes physical activity in order to reduce stress and stress-related complications. However, lack of physical activity might lead to poor bone development and growth as seen in bed-ridden children and adults. It is believed that physical activity programs (moving and pressing all joints on all limbs for several minutes a day) may promote bone development and growth in premature babies. This review found that physical activity might have a small benefit on bone development and growth over a short term. There was inadequate data to assess long-term benefits and harms. Based on current knowledge, physical activity programs cannot be recommended as a standard procedure for premature babies.

Abstract (click to read)

Background:

Lack of physical stimulation may contribute to metabolic bone disease of preterm infants resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth.

Objectives:

To determine the effect of physical activity programs on bone mineralization, the risk of fractures and growth in preterm infants.

Search strategy:

The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. The search included the CENTRAL (The Cochrane Library, Issue 3, 2009), MEDLINE, EMBASE, CINAHL (1966 to September 2009), cross-references and handsearching of abstracts of the Society for Pediatric Research and the International Journal of Sports Medicine.

Selection criteria:

Randomized and quasi-randomized controlled trials comparing physical activity programs (extension and flexion, range-of-motion exercises) to no organized physical activity programs in preterm infants.

Data collection and analysis:

Data collection, study selection, and data analysis were performed according to the methods of the CNRG.

Main results:

Eight trials enrolling 214 preterm infants (gestational age 26 to 34 weeks) were included in this review. All were small (N = 16 to 49) single center studies evaluating daily physical activity for 3.5 to 8 weeks during initial hospitalization. The methodological quality and reporting of all trials was limited.

Three trials demonstrated moderate short-term benefits of physical activity on bone mineralization at completion of the physical activity program. The only trial assessing long-term effects on bone mineralization showed no effect of physical activity administered during initial hospitalization on bone mineralization at 12 months corrected age. Meta-analysis from three trials demonstrated a positive effect of physical activity on daily weight gain (Weighted Mean Difference (WMD) 2.77 g/kg/d, 95% CI 1.62, 3.92). Data from three trials showed a positive effect on linear growth (WMD 0.14 cm/week, 95% CI 0.02, 0.26) but not on head growth (WMD -0.03 cm/week, 95% CI -0.14, 0.09) during the study period. None of the trials assessed fractures or other outcomes relevant to this review.

Authors' conclusions:

There is some evidence that physical activity programs might promote short-term weight gain and bone mineralization in preterm infants. Data is inadequate to assess harm or long-term effects. Current evidence does not support the routine use of physical activity programs in preterm infants. Further trials incorporating infants with a high baseline risk of osteopenia are required. These trials should address adverse events, long-term outcomes, and the effects of nutritional intake (calories, protein, calcium, phosphorus).

This record should be cited as:

Schulzke SM, Trachsel D, Patole SK. Physical activity programs for promoting bone mineralization and growth in preterm infants. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005387. DOI: 10.1002/14651858.CD005387.pub2

Assessed as up to date:

November 26, 2009

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Physical activity programs for promoting bone mineralization and growth in preterm infants

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