Heart rate recovery after maximal exercise is impaired in healthy young adults born preterm

  • Kristin Haraldsdottir
  • Andrew M. WatsonEmail author
  • Arij G. Beshish
  • Dave F. Pegelow
  • Mari Palta
  • Laura H. Tetri
  • Melissa D. Brix
  • Ryan M. Centanni
  • Kara N. Goss
  • Marlowe W. Eldridge
Original Article



The long-term implications of premature birth on autonomic nervous system (ANS) function are unclear. Heart rate recovery (HRR) following maximal exercise is a simple tool to evaluate ANS function and is a strong predictor of cardiovascular disease. Our objective was to determine whether HRR is impaired in young adults born preterm (PYA).


Individuals born between 1989 and 1991 were recruited from the Newborn Lung Project, a prospectively followed cohort of subjects born preterm weighing < 1500 g with an average gestational age of 28 weeks. Age-matched term-born controls were recruited from the local population. HRR was measured for 2 min following maximal exercise testing on an upright cycle ergometer in normoxia and hypoxia, and maximal aerobic capacity (VO2max) was measured.


Preterms had lower VO2max than controls (34.88 ± 5.24 v 46.15 ± 10.21 ml/kg/min, respectively, p < 0.05), and exhibited slower HRR compared to controls after 1 and 2 min of recovery in normoxia (absolute drop of 20 ± 4 v 31 ± 10 and 41 ± 7 v 54 ± 11 beats per minute (bpm), respectively, p < 0.01) and hypoxia (19 ± 5 v 26 ± 8 and 39 ± 7 v 49 ± 13 bpm, respectively, p < 0.05). After adjusting for VO2max, HRR remained slower in preterms at 1 and 2 min of recovery in normoxia (21 ± 2 v 30 ± 2 and 42 ± 3 v 52 ± 3 bpm, respectively, p < 0.05), but not hypoxia (19 ± 3 v 25 ± 2 and 40 ± 4 v 47 ± 3 bpm, respectively, p > 0.05).


Autonomic dysfunction as seen in this study has been associated with increased rates of cardiovascular disease in non-preterm populations, suggesting further study of the mechanisms of autonomic dysfunction after preterm birth.


Preterm birth Autonomic function Heart rate recovery Cardiovascular disease Autonomic dysfunction Prematurity Premature birth Exercise testing Maximal aerobic capacity 



Autonomic nervous system


Global Physical Activity Questionnaire


Heart rate


Maximal heart rate


Heart rate recovery


Metabolic equivalent


Maximal power


Maximal time to exhaustion


Maximal aerobic capacity


Oxygen consumption per kg of body weight at ventilatory threshold


Author contributions

KH, AMW, KNG, and MWE conceptualized and designed the study and are the guarantor of the content of the manuscript, including the data and analysis. KH, AMW, KNG, AGB, DFP, LHT, MDB, RMC, and MWE assisted with data collection. KH, AMW, KNG, AGB, MP, LHT, MDB, RMC, and MWE contributed to the analysis and interpretation of data. AMW conducted statistical analysis. KH and AMW prepared figures. KH drafted the initial manuscript. All authors reviewed, revised, and approved the final manuscript as submitted.


National Institutes of Health: NIH-NHLBI R01-HL115061, NIH-NHLBI R01Supplement-HL1150613 (PI Eldridge), T32-HL 07936 (Haraldsdottir).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Kristin Haraldsdottir
    • 1
    • 5
    return OK on get
  • Andrew M. Watson
    • 2
    Email author
  • Arij G. Beshish
    • 1
  • Dave F. Pegelow
    • 1
  • Mari Palta
    • 4
  • Laura H. Tetri
    • 1
  • Melissa D. Brix
    • 1
  • Ryan M. Centanni
    • 1
  • Kara N. Goss
    • 1
    • 3
  • Marlowe W. Eldridge
    • 1
  1. 1.Department of PediatricsUniversity of Wisconsin-MadisonMadisonUSA
  2. 2.Department of Orthopedics and RehabilitationUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Department of MedicineUniversity of Wisconsin-MadisonMadisonUSA
  4. 4.Department of Biostatistics and Medical InformaticsUniversity of Wisconsin-MadisonMadisonUSA
  5. 5.Department of KinesiologyUniversity of Wisconsin-MadisonMadisonUSA

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