Aerobic Exercise Training Response in Preterm-Born Young Adults with Elevated Blood Pressure and Stage 1 Hypertension: A Randomized Clinical Trial

Rationale: Premature birth is an independent predictor of long-term cardiovascular risk. Individuals affected are reported to have a lower rate of V^_ O₂ at peak exercise intensity (V^_ O_2PEAK) and at the ventilatory anaerobic threshold (V^_ O_2VAT), but little is known about their response to exercise training. Objectives: The primary objective was to determine whether the V^_ O_2PEAK response to exercise training differed between preterm-born and term-born individuals; the secondary objective was to quantify group differences in V^_ O_2VAT response. Methods: Fifty-two preterm-born and 151 term-born participants were randomly assigned (1:1) to 16 weeks of aerobic exercise training (n = 102) or a control group (n = 101). Cardiopulmonary exercise tests were conducted before and after the intervention to measure V^_ O_2PEAK and the V^_ O_2VAT. A prespecified subgroup analysis was conducted by fitting an interaction term for preterm and term birth histories and exercise group allocation. Measurements and Main Results: For term-born participants, V^_ O_2PEAK increased by 3.1 ml/kg/min (95% confidence interval [CI], 1.7 to 4.4), and the V^_ O_2VAT increased by 2.3 ml/kg/ min (95% CI, 0.7 to 3.8) in the intervention group versus controls. For preterm-born participants, V^_ O_2PEAK increased by 1.8 ml/kg/min (95% CI, 20.4 to 3.9), and the V^_ O_2VAT increased by 4.6 ml/kg/min (95% CI, 2.1 to 7.0) in the intervention group versus controls. No significant interaction was observed with birth history for V^_ O_2PEAK (P=0.32) or the V^_ O_2VAT (P=0.12). Conclusions: The training intervention led to significant improvements in V^_ O_2PEAK and V^_ O_2VAT, with no evidence of a statistically different response based on birth history.