Thorax 65:165-172 doi:10.1136/thx.2008.107474
  • Paediatrics

The EPICure study: maximal exercise and physical activity in school children born extremely preterm

  1. 1Portex Unit: Respiratory Medicine and Physiology, UCL, Institute of Child Health, London, UK
  2. 2Cardiac Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
  3. 3School of Human Development, University of Nottingham, Nottingham, UK
  • Received 11 September 2008
  • Accepted 14 October 2009
  • Published Online First 8 December 2009


Rationale Evidence regarding exercise capacity and physical activity in children born extremely preterm (EP) is limited. Since survivors remain at high risk for developing bronchopulmonary dysplasia (BPD) and long-term pulmonary sequelae, reductions in exercise capacity and activity levels may be present.

Objectives To compare maximal exercise ventilation characteristics and physical activity levels at 11 years of age in children born EP (<25 completed weeks gestation) with those of full-term controls.

Methods Participants performed spirometry, body plethysmography and gas transfer testing. A peak exercise test was performed on a cycle ergometer. Physical activity was monitored by accelerometry for 7 days.

Results Lung function and exercise results were obtained in 38 EP children (71% prior BPD) and 38 controls. Those born EP had significantly lower Z-scores (mean (95% CI) of difference) for forced expiratory volume in 1 s (FEV1; −1.74 (−2.25 to −1.23) and gas transfer (−0.73 (−1.31 to −0.17), and significantly greater Z-scores for residual volume (RV; 0.58 (0.10 to 1.10)) and RV/total lung capacity (TLC; 0.74 (0.29 to 1.19)). EP birth was associated with a significant reduction in peak oxygen consumption. EP children employed greater breathing frequencies and lower tidal volumes during peak exercise. No differences were observed in physical activity between groups.

Conclusions The reduction in peak oxygen consumption in children born EP, and alterations in ventilatory adaptations during peak exercise were not explained by differences in physical activity, but probably reflects the long-term pathophysiological impact of EP birth.


  • Supplementary figures, tables and equations are published online only at

  • Funding The Medical Research Council.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the multicentre research ethics committee.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.