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

Winok Lapidaire; Afifah Mohamed; Wilby Williamson; Odaro J Huckstep; Maryam Alsharqi; Cheryl M J Tan; Samuel Burden; Cameron Dockerill; William Woodward; Annabelle McCourt; Holger Burchert; Yvonne Kenworthy; Luca Biasiolli; Helen Dawes; Charlie Foster; Paul Leeson; Adam J Lewandowski

doi:10.1016/j.jacadv.2025.101721

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

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

Authors

Winok Lapidaire¹, Afifah Mohamed², Wilby Williamson³, Odaro J Huckstep⁴, Maryam Alsharqi⁵, Cheryl M J Tan⁶, Samuel Burden⁷, Cameron Dockerill⁸, William Woodward¹, Annabelle McCourt¹, Holger Burchert⁹, Yvonne Kenworthy¹, Luca Biasiolli¹, Helen Dawes¹⁰, Charlie Foster¹¹, Paul Leeson¹, Adam J Lewandowski¹²

Affiliations

¹ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
² Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Faculty of Health Sciences, The National University of Malaysia, Kuala Lumpur, Malaysia.
³ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; School of Medicine, Trinity College Dublin, Dublin, Ireland.
⁴ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Biology, United States Air Force Academy, Air Force Academy, Colorado, USA.
⁵ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
⁶ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Ludwig Institute for Cancer Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
⁷ Department of Women and Children's Health, King's College London, London, United Kingdom.
⁸ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
⁹ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
¹⁰ NIHR Exeter BRC, University of Exeter, Exeter, United Kingdom.
¹¹ Centre for Exercise, Nutrition & Health Sciences, School of Policy Studies, University of Bristol, Bristol, United Kingdom.
¹² Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. Electronic address: adam.lewandowski@ndph.ox.ac.uk.

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.