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Evidence suggests that preterm birth is associated with an impaired physical fitness later in life, but whether these effects are already visible since early childhood remains unknown. We aimed to compare the physical fitness of preterm preschoolers with that of children born at term. Children aged three to six years and born preterm (&lt;35 weeks) were recruited from a Neonatal Intensive Care Unit, and children born at term (&gt;37 weeks) were included as controls. A variety of physical fitness indicators (strength, cardiorespiratory fitness, agility, flexibility and balance) were assessed with the PREFIT battery and the adapted sit and reach test. Physical activity levels were measured through the PrePAQ questionnaire. A total of 98 preterm children (gestational age 32.4 ± 2.3 weeks, age 5.1 ± 0.8 years) and 74 controls (gestational age 39.9 ± 1.0 weeks, age 4.8 ± 0.9 years) were analysed. Despite no significant differences in physical activity levels ( p  &gt; 0.05), preterm children showed an overall poorer physical fitness compared to controls. Specifically, preterm children had an impaired handgrip strength (−13.95%,  p  &lt; 0.001), lower‐limb muscle strength (−12.67%,  p  = 0.003), agility (−14.9%,  p  = 0.001), cardiorespiratory fitness (−12.73%  p  = 0.005) and flexibility (−17.04%,  p  = 0.001) compared to controls. An inverse dose–response association was observed between the level of prematurity and physical fitness, with very preterm children (gestational age ≤32 weeks) presenting the poorest fitness levels. In summary, prematurity seems to impair physical fitness since early childhood, which might support the need for promoting preventive strategies (e.g. fitness monitoring and applying exercise interventions).   Highlights    Preterm children present an impaired physical fitness compared with peers born at term since early childhood (3–6 years), as reflected by lower muscle strength, agility, flexibility and cardiorespiratory fitness.    A greater impairment of physical fitness in observed in children born very preterm (≤32 weeks of gestation).    These findings might support the implementation of preventive strategies (e.g. fitness monitoring and exercise training) in preterm children since early childhood.

Influence of preterm birth on physical fitness in early childhood