Impact of Exercise on Body Composition in Premature Infants: New Approaches

描述(由申请人提供)：这项研究包括一种新的干预措施，旨在增加早产儿第一年的体力活动。增加的体力活动对1)身体成分，2)生长和炎症的相关生化和细胞机制，以及3)产妇护理质量的潜在有益影响将被测量。在美国，早产被认为是母婴健康中最重要的健康问题。矛盾的是，现在已知发育迟缓和肥胖都与早产有关，骨量减少和骨折风险增加，以及晚年心血管疾病风险增加也是如此。我们缺乏协调一致的方法来减轻这些对健康的严重威胁。尽管有希望的新研究表明，即使在宫内生活期间，体育活动也可以刺激肌肉和骨骼的生长(可能是通过代谢编程)，但在早产儿中实施和研究体育活动干预的尝试很少。挑战是巨大的，包括：测量身体成分；评估体力活动；让照顾者作为干预的合作伙伴；确定可信和可测试的生物机制；以及设计实际增加体力活动并与生命早期运动发育的快速步伐相匹配的干预措施。这支调查团队已经应对了这些挑战。已经设计了一种发育动态的体力活动干预措施，并进行了试点测试--一种让照顾者成为伴侣的干预措施。使用广泛的技术和工具，如DXA、智能手机、双重标记水和专门为此目的开发的轻型无线加速计，工作假设是，为期一年的干预将增加瘦体重(主要结果变量)，并改善骨矿化和瘦/脂肪组织比率(次要结果变量)。这项研究将评估体力活动干预对循环合成代谢介质(胰岛素样生长因子-I和生长激素结合蛋白)和炎症相关细胞因子(白介素6和白介素1受体拮抗剂)之间平衡的影响，炎症相关细胞因子可以对抗肌肉和骨骼的生长。此外，我们还将：1)开始探索体育活动如何影响循环内皮祖细胞，循环内皮祖细胞越来越被视为生命早期血管健康的标志；2)利用这项前瞻性的干预性研究，探索早产婴儿生长的潜在遗传决定因素。最后，任何涉及早产儿的研究和与之相关的数据都必须考虑到母婴之间的关键关系。早期生活干预的潜在广泛影响最近已被“重返睡眠”运动在减轻婴儿猝死综合症方面的成功所证明。如果增加锻炼对身体成分的积极影响得到支持，那么我们将预期在以相对较低的成本预防早产的长期健康后果方面会有广泛的好处。

DESCRIPTION (provided by applicant): This research consists of a novel intervention designed to increase physical activity of premature babies in their first year of life. The potential beneficial impact of augmented physical activity on 1) body composition, 2) associated biochemical and cellular mechanisms of growth and inflammation, and 3) quality of maternal care will be measured. Premature birth is recognized as the single most important health problem in maternal- child health in the US. Paradoxically, both failure to thrive and obesity are now known to be associated with prematurity, as are osteopenia and increased risk of fracture, and increased risk of cardiovascular disease later in life. We lack cohesive approaches to mitigate these profound threats to health. Despite promising new research demonstrating that physical activity can stimulate the growth of muscle and bone even during intrauterine life (perhaps through metabolic programming), there have been very few attempts to implement and study physical activity interventions in the premature baby. The challenges are substantial and include: measuring body composition; assessing physical activity; engaging caregivers as partners in the intervention; identifying plausible and testable biological mechanisms; and designing interventions that actually increase physical activity and match the rapid pace of motor development early in life. This team of investigators has addressed these challenges. A developmentally dynamic physical activity intervention has been designed and pilot tested-one that engages the caregiver as a partner. Using techniques and tools as far-ranging as DXA, smartphones, doubly labeled water, and lightweight, wireless accelerometers developed specifically for this purpose, the working hypothesis is that the one-year intervention will augment lean body mass (primary outcome variable) and improve bone mineralization and the ratio of lean to fat tissue (secondary outcome variables). The study will gauge the impact of the physical activity intervention on the balance between circulating anabolic mediators (insulin-like growth factor-I and growth hormone binding protein) and inflammation-associated cytokines (interleukin-6, and interleukin-1 receptor antagonist), which antagonize muscle and bone growth. We will additionally: 1) begin to explore how physical activity influences circulating endothelial progenitor cells, which are increasingly viewed as markers of vascular health very early in life, and 2) take advantage of this prospective, interventional study to explore potential genetic determinants of growth in babies born prematurely. Finally, any study involving the premature infant and the data associated with it must be viewed in light of the critical relationship between the mother and baby. The potential broad impact of early life interventions has been recently demonstrated by the success of the "Back-To-Sleep" campaign in mitigating sudden infant death syndrome. Should the positive effects of augmented exercise on body composition be supported, we would then anticipate widespread benefit in preventing long-term health consequences of prematurity at relatively low cost.