Heart rate recovery after maximal exercise is impaired in healthy young adults born preterm
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.
KeywordsPreterm 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
Maximal heart rate
Heart rate recovery
Maximal time to exhaustion
Maximal aerobic capacity
Oxygen consumption per kg of body weight at ventilatory threshold
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).
- Centers for Disease Control and Prevention (2015) Preterm Birth. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Accessed 21 June 2017
- Cleland CL, Hunter RF, Kee F, Cupples ME, Sallis JF, Tully MA (2014) Validity of the global physical activity questionnaire (GPAQ) in assessing levels and change in moderate-vigorous physical activity and sedentary behaviour. BMC Public Health. https://doi.org/10.1186/1471-2458-14-1255 Google Scholar
- Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. L. Erlbaum Associates, HillsdaleGoogle Scholar
- Davrath LR, Akselrod S, Pinhas I, Toledo E, Beck A, Elian D, Scheinowitz M (2006) Evaluation of autonomic function underlying slow postexercise heart rate recovery. Med Sci Sports Exerc 38(12):2095–2101. https://doi.org/10.1249/01.mss.0000235360.24308.c7 CrossRefGoogle Scholar
- Duke JW, Elliott JE, Laurie SS, Beasley KM, Mangum TS, Hawn JA, Gladstone IM, Lovering AT (2014) Pulmonary gas exchange efficiency during exercise breathing normoxic and hypoxic gas in adults born very preterm with low diffusion capacity. J Appl Physiol (1985). https://doi.org/10.1152/japplphysiol.00307.2014 Google Scholar
- Hautala AJ, Rankinen T, Kiviniemi AM, Makikallio TH, Huikuri HV, Bouchard C, Tulppo MP (2006) Heart rate recovery after maximal exercise is associated with acetylcholine receptor M2 (CHRM2) gene polymorphism. Am J Physiol Heart Circ Physiol 291(1):H459–H466. https://doi.org/10.1152/ajpheart.01193.2005 CrossRefGoogle Scholar
- Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6(2):65–70Google Scholar
- Jae SY, Carnethon MR, Heffernan KS, Choi YH, Lee MK, Park WH, Fernhall B (2008) Slow heart rate recovery after exercise is associated with carotid atherosclerosis. Atherosclerosis 196(1):256–261. https://doi.org/10.1016/j.atherosclerosis.2006.10.023 CrossRefGoogle Scholar
- Johansson S, Norman M, Legnevall L, Dalmaz Y, Lagercrantz H, Vanpee M (2007) Increased catecholamines and heart rate in children with low birth weight: perinatal contributions to sympathoadrenal overactivity. J Intern Med 261(5):480–487. https://doi.org/10.1111/j.1365-2796.2007.01776.x CrossRefGoogle Scholar
- Joyner MJ, Charkoudian N, Wallin BG (2010) Sympathetic nervous system and blood pressure in humans: individualized patterns of regulation and their implications. Hypertension 56(1):10–16. https://doi.org/10.1161/HYPERTENSIONAHA.109.140186 CrossRefGoogle Scholar
- Kuo HK, Gore JM (2015) Relation of heart rate recovery after exercise to insulin resistance and chronic inflammation in otherwise healthy adolescents and adults: results from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Clin Res Cardiol 104(9):764–772. https://doi.org/10.1007/s00392-015-0843-2 CrossRefGoogle Scholar
- Ostojic SM, Markovic G, Calleja-Gonzalez J, Jakovljevic DG, Vucetic V, Stojanovic MD (2010) Ultra short-term heart rate recovery after maximal exercise in continuous versus intermittent endurance athletes. Eur J Appl Physiol 108(5):1055–1059. https://doi.org/10.1007/s00421-009-1313-1 CrossRefGoogle Scholar
- Palta M, Sadek M, Barnet JH, Evans M, Weinstein MR, McGuinness G, Peters ME, Gabbert D, Fryback D, Farrell P (1998) Evaluation of criteria for chronic lung disease in surviving very low birth weight infants. Newborn Lung Project J Pediatr 132(1):57–63Google Scholar
- Palta M, Sadek-Badawi M, Evans M, Weinstein MR, McGuinnes G (2000) Functional assessment of a multicenter very low-birth-weight cohort at age 5 years. Newborn Lung Project. Arch Pediatr Adolesc Med 154(1):23–30Google Scholar
- R Development Core Team (2010) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar