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Physiological responses to exercise in survivors of preterm birth: a meta-analysis
Michael L Beaven1,2, James T D Gibbons1,2,3, Christopher W Course4
1Curtin School of Allied Health, Curtin University, Perth, Australia.
Insights
Survivors of preterm birth exhibit reduced aerobic fitness, including lower oxygen uptake and impaired cardiorespiratory responses during exercise. Prioritizing exercise interventions is crucial for improving their long-term health outcomes.
Area of Science:
- Cardiorespiratory Physiology
- Neonatal Medicine
- Exercise Science
Background:
- Preterm birth survivors often have reduced peak oxygen uptake, a key indicator of aerobic fitness linked to higher morbidity and mortality.
- Limited understanding exists regarding other cardiopulmonary exercise responses in individuals born preterm.
Purpose of the Study:
- To systematically review and meta-analyze cardiopulmonary exercise testing data in preterm survivors.
- To investigate abnormal respiratory, cardiovascular, and metabolic responses to exercise following preterm birth.
Main Methods:
- Systematic search of six databases up to November 2024 (PROSPERO: CRD42022320775).
- Inclusion of studies with standardized exercise tests in preterm-born and matched term-born individuals.
- Random-effects models used for meta-analysis to calculate standardized mean difference (SMD).
Main Results:
- 47 cohorts (2149 preterm, 1650 term) analyzed.
- Preterm survivors showed significantly lower peak oxygen uptake (SMD -0.39), work rate (SMD -0.53), and minute ventilation (SMD -0.43).
- Impairments also observed in tidal volume, oxygen pulse, heart rate, anaerobic threshold, and gas exchange efficiency.
Conclusions:
- Preterm birth survivors experience cardiorespiratory and metabolic deficits during exercise, beyond reduced peak oxygen uptake.
- These findings underscore the need for targeted exercise interventions to enhance cardiorespiratory fitness throughout life for preterm survivors.
- Prioritizing exercise interventions is essential for mitigating long-term morbidity and mortality risks in this population.
Rationale:
Survivors of preterm birth (<37 weeks' gestation) have low peak oxygen uptake, a global measure of aerobic fitness and an established predictor of increased morbidity and mortality. However, little is known about other cardiopulmonary outcome measures in this population. We addressed the hypothesis that preterm birth is associated with abnormal respiratory, cardiovascular and metabolic responses to exercise, as assessed by cardiopulmonary exercise testing, via a systematic review and meta-analysis.
Methods:
Six databases were systematically searched up to 29 November 2024 (PROSPERO: CRD42022320775). Studies reporting cardiopulmonary outcome measures obtained during a standardised exercise test were included if they had preterm-born participants and matched term-born controls. The standardised mean difference (SMD) between pooled preterm-born and term-born cohorts was calculated using random-effects models for the meta-analysis.
Results:
Of the 12 143 records identified, 47 cohorts were included in the final meta-analysis. At peak exercise, the preterm-born cohort (n=2149) demonstrated lower oxygen uptake (SMD -0.39, 95% CI -0.52 to -0.26), work rate (SMD -0.53, 95% CI -0.70 to -0.35), minute ventilation (SMD -0.43, 95% CI -0.60 to -0.26), tidal volume (SMD -0.38, 95% CI -0.62 to -0.15), oxygen pulse (SMD -0.47, 95% CI -0.75 to -0.19), heart rate (SMD -0.18, 95% CI -0.28 to -0.07), anaerobic threshold (SMD -0.29, 95% CI -0.49 to -0.08) and gas exchange efficiency (SMD 0.22, 95% CI 0.04 to 0.41), compared to the term-born cohort (n=1650).
Conclusions:
In addition to a reduced peak oxygen uptake, survivors of preterm birth have impairments in the respiratory, cardiovascular and metabolic domains during cardiopulmonary exercise testing. Given that reduced aerobic capacity is associated with increased morbidity and mortality, exercise interventions that target cardiorespiratory fitness should be prioritised across the lifespan in those born preterm.
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