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. 2025 May;4(5):101721.
doi: 10.1016/j.jacadv.2025.101721. Epub 2025 Apr 28.

Exercise Improves Myocardial Deformation But Not Cardiac Structure in Preterm-Born Adults: A Randomized Clinical Trial

Winok Lapidaire  1 , Afifah Mohamed  2 , Wilby Williamson  3 , Odaro J Huckstep  4 , Maryam Alsharqi  5 , Cheryl M J Tan  6 , Samuel Burden  7 , Cameron Dockerill  8 , William Woodward  1 , Annabelle McCourt  1 , Holger Burchert  9 , Yvonne Kenworthy  1 , Luca Biasiolli  1 , Helen Dawes  10 , Charlie Foster  11 , Paul Leeson  1 , Adam J Lewandowski  12
Affiliations

Exercise Improves Myocardial Deformation But Not Cardiac Structure in Preterm-Born Adults: A Randomized Clinical Trial

Winok Lapidaire et al. JACC Adv. 2025 May.

Abstract

Background: People born preterm (<37 weeks' gestation) have a potentially adverse cardiac phenotype that progresses with blood pressure elevation.

Objectives: The authors investigated whether preterm-born and term-born adults exhibit similar cardiac structural and functional remodeling following a 16-week aerobic exercise intervention.

Methods: We conducted a randomized controlled trial in 203 adults (aged 18-35 years) with elevated blood pressure or stage 1 hypertension. Participants were randomized 1:1 to a 16-week aerobic exercise intervention or to a control group. In a prespecified cardiovascular magnetic resonance imaging (CMR) substudy, CMR was performed at 3.0-Tesla to assess left and right ventricular (LV and RV) structure and function before and after intervention.

Results: A total of 100 participants completed CMR scans at baseline and after the 16-week intervention, with n = 47 in the exercise intervention group (n = 26 term-born; n = 21 preterm-born) and n = 53 controls (n = 32 term-born; n = 21 preterm-born). In term-born participants, LV mass to end-diastolic volume ratio decreased (-3.43; 95% CI: -6.29 to -0.56; interaction P = 0.027) and RV stroke volume index increased (5.53 mL/m2; 95% CI: 2.60, 8.47; interaction P = 0.076) for those in the exercise intervention group vs controls. No significant effects were observed for cardiac structural indices in preterm-born participants. In preterm-born participants, LV basal- and mid-ventricular circumferential strain increased (-1.33; 95% CI: -2.07 to -0.60; interaction P = 0.057 and -1.54; 95% CI: -2.46 to -0.63; interaction P = 0.046, respectively) and RV global longitudinal strain increased (1.99%; 95% CI: -3.12 to -0.87; interaction P = 0.053) in the exercise intervention group vs controls. No significant effects were observed for myocardial deformation parameters in term-born participants.

Conclusions: Aerobic exercise training induces improved myocardial function but not cardiac structure in preterm-born adults.

Keywords: blood pressure; cardiac remodeling; cardiovascular disease; exercise intervention; hypertension; preterm birth.

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Conflict of interest statement

Funding support and author disclosures This work was supported by funding from the Wellcome Trust, British Heart Foundation (BHF), the Oxford BHF Centre for Research Excellence, and the National Institute for Health Research Oxford Biomedical Research Centre; a Medical Research Council Programme grant (MR/W003686/1 to Drs Lapidaire, Leeson, and Lewandowski); a St. Hilda's College Oxford Stipendiary Junior Research Fellowship (Dr Lapidaire); a BHF Intermediate Research Fellowship (FS/18/3/33292 to Dr Lewandowski); a Wellcome Trust Clinical Research Training Fellowship (105741/Z/14/Z to Dr Williamson); and the U.S. Air Force Institute of Technology (Dr Huckstep); the National Institute for Health and Care Research Exeter Biomedical Research Centre (Dr Dawes). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The contents of this paper solely reflect the views of the authors and do not reflect or represent the views of the U.S. Air Force, the Department of Defense, or the U.S. government. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Trial Profile for the Cardiovascular Magnetic Resonance Imaging (CMR) Substudy
Figure 2
Figure 2
Cardiac Structure Differences between exercise intervention and control groups for preterm-born (red) and term-born (blue) participants for LV and RV structural parameters after the 16-week intervention. Change is presented as adjusted mean in the outcome of interest, in the units for that outcome, with 95% CI error bars. LV mass end-diastolic volume values are multiplied by 100 for graphical purposes. LV = left ventricular; RV = right ventricular.
Figure 3
Figure 3
Cardiac Volumetric Function Differences between exercise intervention and control groups for preterm-born (red) and term-born (blue) participants for LV and RV functional parameters after the 16-week intervention. Change is presented as adjusted mean in the outcome of interest, in the units for that outcome, with 95% CI error bars. Abbreviations as in Figure 2.
Central Illustration
Central Illustration
Trial Overview and Key Findings Abbreviations as in Figure 2.
Figure 4
Figure 4
Myocardial Deformation Differences between exercise intervention and control groups for preterm-born (red) and term-born (blue) participants for LV and RV myocardial deformation parameters after the 16-week intervention. Change is presented as adjusted mean in the outcome of interest, in the units for that outcome, with 95% CI error bars. Abbreviations as in Figure 2.
See this image and copyright information in PMC

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