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Preterm birth and exercise capacity: what do we currently know?
Christopher A O'Dea1,2, Michael L Beaven2,3, Andrew C Wilson1,2,3
1Respiratory Medicine, Perth Children's Hospital, Perth, WA, Australia.
Insights
Cardiopulmonary exercise testing reveals unclear long-term outcomes in preterm children, highlighting disrupted lung development and exercise limitations. Future trials should explore exercise interventions to mitigate chronic disease risks.
Area of Science:
- Pediatric Pulmonology
- Exercise Physiology
Background:
- Preterm birth can lead to long-term cardiopulmonary issues and respiratory symptoms, especially during exertion.
- Understanding these outcomes is crucial for improving the health of preterm survivors.
Purpose of the Study:
- To review current knowledge on cardiopulmonary exercise testing (CPET) for assessing preterm children.
- To explore the pathophysiology of exertional respiratory symptoms in this population.
Main Methods:
- A narrative literature review of published manuscripts.
- Searches conducted in Medline, PubMed, and Google Scholar using terms related to preterm birth, bronchopulmonary dysplasia, and exercise.
Main Results:
- Preterm children exhibit disrupted lung development, leading to lung disease and respiratory symptoms.
- Exercise testing shows expiratory flow limitation and altered breathing patterns, but its impact on exercise capacity is poorly understood due to study heterogeneity.
Conclusions:
- CPET can enhance understanding of exercise limitation in preterm survivors.
- Further research, including randomized controlled trials, is needed to evaluate exercise interventions for reducing chronic disease and mortality risks.
Objectives:
The long-term cardiopulmonary outcomes following preterm birth during the surfactant era remain unclear. Respiratory symptoms, particularly exertional symptoms, are common in preterm children. Therefore, cardiopulmonary exercise testing may provide insights into the pathophysiology driving exertional respiratory symptoms in those born preterm. This review aims to outline the current knowledge of cardiopulmonary exercise testing in the assessment of children born preterm in the surfactant era.
Design:
This study is a narrative literature review.
Methods:
Published manuscripts concerning the assessment of pulmonary outcomes using cardiopulmonary exercise testing in preterm children (aged <18 years) were reviewed. Search terms related to preterm birth, bronchopulmonary dysplasia, and exercise were entered into electronic databases, including Medline, PubMed, and Google Scholar. Reference lists from included studies were scanned for additional manuscripts.
Results:
Preterm children have disrupted lung development with significant structural and functional lung disease and increased respiratory symptoms. The association between these (resting) assessments of respiratory health and exercise capacity is unclear; however, expiratory flow limitation and an altered ventilatory response (rapid, shallow breathing) are seen during exercise. Due to the heterogeneity of participants, treatments, and exercise protocols, the effect of the aforementioned limitations on exercise capacity in children born preterm is conflicting and poorly understood.
Conclusion:
Risk factors for reduced exercise capacity in those born preterm remain poorly understood; however, utilizing cardiopulmonary exercise testing to its full potential, the pathophysiology of exercise limitation in survivors of preterm birth will enhance our understanding of the role exercise may play. The role of exercise interventions in mitigating the risk of chronic disease and premature death following preterm birth has yet to be fully realized and should be a focus of future robust randomized controlled trials.
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