Heart and lung responses to exercise in adolescents born extremely preterm

Exercise Intervention Participants will either be assigned to group 1 or group 2. Group 1 will complete the at-home exercise intervention during the first ten weeks after the initial visit. Group 2 will complete the at-home exercise intervention during the second ten weeks after a second visit. Participants will be provided with a smart bike trainer (T2400 Satori Smart Trainer, Tacx, Wassenaar, Netherlands) which attaches to the back wheel of the participants’ personal bike, converting it into a stationary bike set up. If participants already have a bike, they will be asked to utilise that bike with the smart trainer since it will already be properly sized for the participant. If the participant does not own a bike, one will be provided for the individual. Participants will also be given a heart rate arm band (Wahoo Tickr Fit Heart Rate Arm Band) which will transmit data onto the computer or smart device via Bluetooth. To aid in motivation and maintain retention rates, participants will utilise Zwift, a cycling software program which utilises virtual roads allowing participants to experience a virtual reality-like setting of biking in different locations across the world. All equipment will be provided during the pre-testing visit. In addition, there will be an example of what the stationary bike set-up will look like at RCH and the research coordinator will take the participant through the set-up of the equipment and demonstrate how to use Zwift. The participant will be taught how to mount the bike and proper cycling form will be addressed. Data, including heart rate, distance, duration, and calories will be automatically uploaded (via Zwift) onto Strava for storage, allowing a researcher to access the data from each session via the cloud. Additionally, a set up video (made by the research coordinator) will be provided which the participant can later refer to. Once the at-home bike system has been set up, the intervention will begin. The research coordinator will be able to monitor the participants adherence via the Strava app and provide positive reinforcement on each session uploaded onto Strava. Examples of positive reinforcement include commenting ‘Good job’ and ‘Keep up the great work’ or providing a ‘kudos’ (i.e. the equivalent to a ‘like’ on social media). There are a total of 28 sessions in this exercise intervention, participants must complete 75% of sessions (21 sessions) to be eligible for the study. This allows for the consideration of potential travel during the holidays and potential illness as any exercise program would have to consider. If any questions or issues with regards to the at-home set up and/or exercise intervention arise, the participant and/or patient(s) and/or guardian(s) will be able to contact the research coordinator by email or phone call. In addition, the research coordinator will send out a weekly email checking in with each participant as a means of motivation, accountability, and ensuring an open line of communication. The exercise program is as follows: Session per Week Duration per Session Intensity Mode Week 1 2 20 min 55% PHR Stationary Bike Set Up Week 2 2 20 min 55% PHR Stationary Bike Set Up Week 3 3 20 min 55% PHR Stationary Bike Set Up Week 4 3 20 min 55% PHR Stationary Bike Set Up Week 5 3 20 min 60% PHR Stationary Bike Set Up Week 6 3 20 min 60% PHR Stationary Bike Set Up Week 7 3 20 min 65% PHR Stationary Bike Set Up Week 8 3 20 min 65% PHR Stationary Bike Set Up Week 9 3 20 min 70% PHR Stationary Bike Set Up Week 10 3 20 min 70% PHR Stationary Bike Set Up *Peak Heart Rate (PHR) Justification: While exercise is important for the general population, it becomes increasingly important for those who are at an increased disease risk. The purpose of the exercise intervention is multifaceted; we wish to establish the potential cardiopulmonary benefits of aerobic training with a cohort who are likely to have reduced cardiopulmonary function and increased risk of cardiovascular disease and reduced quality of life. We also wish to establish the lasting effects of the exercise intervention once it has ended. In addition, we wish to determine if the addition of regular exercise improves quality of life, decreases the perceived barriers to exercise, and reduces stress, anxiety, and depression in adolescent extremely preterm birth/extremely low birth weights.