Cardiorespiratory fitness in women after severe pre-eclampsia

ABSTRACT

Aims

To objectively study cardiorespiratory fitness (CRF) and physical activity (PA) and to evaluate limiting factors of exercise intolerance associated with poor CRF after severe pre-eclampsia.

Methods

In this single-centre, cross-sectional study, CRF was measured as peak oxygen uptake (VO_2peak) during a cardiopulmonary exercise test (CPET) on a treadmill in women 7 years after severe pre-eclampsia. Ninety-six patients and 65 controls were eligible to participate. Cardiac output (CO) was measured by impedance cardiography. PA was measured using accelerometers.

Results

In 62 patients and 35 controls (mean age 40 ± 3 years), the VO_2peak (in mL·kg–1·min–1) values were 31.4 ± 7.2 and 39.1 ± 5.4, respectively (p<0.01). In the patients, the COpeak was (9.6 L·min-1), 16% lower compared to controls (p<0.01). Twelve patients (19%) had a cardiac limitation to CPET. Twenty-three (37%) patients and one (3%) control were classed as unfit, with no cardiopulmonary limitations. The patients demonstrated 25% lower PA level (in counts per minute; p<0.01) and 14% more time being sedentary (p<0.01), compared with the controls. Twenty-one patients (34%) compared with four (17%) controls did not meet the World Health Organization’s recommendations for PA (p=0.02). Body mass index and PA level accounted for 65% of the variability in VO_2peak.

Conclusion

Significantly lower CRF and PA levels were found in patients on long-term follow-up after severe pre-eclampsia. CPET identified cardiovascular limitations in one third of patients. One third appeared unfit, with adiposity and lower PA levels. These findings highlight the need for clinical follow-up and exercise interventions after severe pre-eclampsia.

KEYWORDS:

• Preeclampsia
• hypertension
• left ventricular dysfunction
• cardiopulmonary exercise testing
• physical activity

Article highlights

• The study provides a detailed insight into cardiorespiratory fitness and physical activity from long-term follow-up on women after preeclamptic pregnancies.

• The strength of this study is the comprehensive cardiopulmonary evaluations with methods that allowed us to identify organ-specific impairments, including a high-technology cardiopulmonary exercise test and measure of cardiac output.

• The findings highlight the need for targeted clinical follow-up and physical activity interventions after severe pre-eclampsia.

Acknowledgements

The authors would like to thank all the study , Karine Udahl and physiologist Silje Rustad for technical assistance during the cardiopulmonary exercise testing. Mari Bratteteig contributed to the analyses of the accelerometer data.

Contributorship statement

LG, EE, MEE, and EL designed the study. LG acquired the data. LG and EE analyzed the data. LG, MEE, and EE interpreted the data. LG and EE drafted the manuscript. All authors have critically reviewed the manuscript and approved the final version.

Competing Interest

The authors report no relationships that could be construed as a conflict of interest.

Disclosure statement

The authors declare no conflicts of interest.

Data availability statement

No additional data is available.

Ethics approval

The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK Southeast, No. 2013-585b) and the local institutional board at Oslo University Hospital. Written informed consent was obtained from all study participants following the Declaration of Helsinki (13).

Additional information

Funding

The study has not received any economic foundation from the university hospital nor financial support from any commercial source. The authors have no financial interests, which could create a conflict of interest.