Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-23T01:36:49.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Home- and hospital-based exercise training programme after Fontan surgery

Published online by Cambridge University Press:  28 August 2018

Nigel Sutherland Open the ORCID record for Nigel Sutherland [Opens in a new window] ,
Bryn Jones ,
Sofia Westcamp Aguero ,
Tristan Melchiori ,
Karin du Plessis ,
Igor E. Konstantinov ,
Michael M. H. Cheung  and
Yves d’Udekem
Nigel Sutherland
Affiliation:
Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Vic, Australia Murdoch Childrens Research Institute, Melbourne, Vic, Australia
Bryn Jones
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia Department of Cardiology, The Royal Children’s Hospital, Melbourne, Vic, Australia
Sofia Westcamp Aguero
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Cardiology, The Royal Children’s Hospital, Melbourne, Vic, Australia
Tristan Melchiori
Affiliation:
Department of Physiotherapy, The Royal Children’s Hospital, Melbourne, Vic, Australia
Karin du Plessis
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia
Igor E. Konstantinov
Affiliation:
Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Vic, Australia Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
Michael M. H. Cheung
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia Department of Cardiology, The Royal Children’s Hospital, Melbourne, Vic, Australia
Yves d’Udekem*
Affiliation:
Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Vic, Australia Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
*
Author for correspondence: Professor Y. d’Udekem, MD, PhD, Department of Cardiac Surgery, Royal Children’s Hospital, 50 Flemington Road, Parkville, Melbourne, Vic 3052, Australia. Tel: +61 3 9345 6410; Fax: +61 3 9345 6001; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Exercise training has been shown to increase exercise capacity in survivors of Fontan surgery. The geographic distribution of the Fontan population has been a barrier to hospital-based exercise training programmes. The objective of this study was to establish whether a home exercise training programme could achieve similar improvements to a hospital programme.

Methods

Adolescents with a Fontan circulation aged 12–19 years were prospectively recruited in a hospital or home exercise training programme. Patients underwent cardiopulmonary exercise testing and completed the Paediatric Quality of Life Inventory at initial assessment and after completion of an 8-week programme. Both groups performed two 1-hour training sessions per week. Patients in the home training programme had their first session in the hospital, and then progressed independently with one phone consult per week and one home visit by a physiotherapist.

Results

In total, 17 patients, with a mean age of 15±3 years, completed the training programme (six hospital). Characteristics and baseline performance of patients were similar in both groups. Oxygen consumption at anaerobic threshold increased from 19.3±3.8 to 21.6±6.0 ml/kg/minute (p=0.02) and peak oxygen pulse increased from 8.8±2.5 to 9.5±2.7 ml/beat (p=0.049). Total quality of life scale improved from 68 to 74% (p=0.01) and psychosocial health improved from 67 to 74% (p=0.02). No patient experienced training-related complications.

Conclusions

Exercise training is beneficial and most likely safe after Fontan, resulting in improved exercise capacity and self-reported quality of life. Home exercise training programmes are probably as effective as hospital programmes. Home exercise training programmes should be integrated in the follow-up care of patients undergoing Fontan surgery.

Keywords

Fontan procedureexercise therapyrehabilitationresistance trainingCHD
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 11 , November 2018 , pp. 1299 - 1305
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Shilling, C, Dalziel, K, Nunn, R, et al. The Fontan epidemic: population projections from the Australia and New Zealand Fontan Registry. Int J Cardiol 2016; 219: 14–19.Google Scholar
2. Kouatli, AA, Garcia, JA, Zellers, TM, et al. Enalapril does not enhance exercise capacity in patients after Fontan procedure. Circulation 1997; 96: 1507–1512.Google Scholar
3. Ohuchi, H, Hasegawa, S, Yasuda, K, et al. Severely impaired cardiac autonomic nervous activity after the Fontan operation. Circulation 2001; 104: 1513–1518.Google Scholar
4. Wilson, TG, Iyengar, A, Winlaw, DS, et al. Use of ACE inhibitors in Fontan: rational or irrational. Int J Cardiol 2016; 210: 95–99.Google Scholar
5. Hebert, A, Mikkelsen, UR, Thilen, U, et al. Bosentan improves exercise capacity in adolescents and adults after Fontan operation: the TEMPO (Treatment With Endothelin Receptor Antagonist in Fontan Patients, a Randomized, Placebo-Controlled, Double-Blind Study Measuring Peak Oxygen Consumption) study. Circulation 2014; 130: 2021–2030.Google Scholar
6. Schuuring, MJ, Vis, JC, Van Dijk, APJ, et al. Impact of Bosentan on exercise capacity in adults after the Fontan procedure: a randomized controlled trial. Eur J Heart Fail 2013; 15: 690–698.Google Scholar
7. Goldberg, DJ, French, B, McBride, MG, et al. Impact of oral sildenafil on exercise performance in children and young adults after the Fontan operation: a randomized, double-blind, placebo-controlled, crossover trial. Circulation 2011; 123: 1185–1193.Google Scholar
8. Cordina, RL, O’Meagher, S, Karmali, A, et al. Resistance training improves cardiac output, exercise capacity and tolerance to positive airway pressure in Fontan physiology. Int J Cardiol 2013; 168: 780–788.Google Scholar
9. Sutherland, N, Jones, B, d’Udekem, Y. Should we recommend exercise after the Fontan procedure? Heart Lung Circ 2015; 24: 753–768.Google Scholar
10. Balfour, IC, Drimmer, AM, Nouri, S, et al. Pediatric cardiac rehabilitation. Am J Dis Child 1991; 145: 627–630.Google Scholar
11. Rhodes, J, Curran, TJ, Camil, L, et al. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 2005; 116: 1339–1345.Google Scholar
12. Singh, TP, Curran, TJ, Rhodes, J. Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol 2007; 28: 276–279.Google Scholar
13. Minamisawa, S, Nakazawa, M, Momma, K, et al. Effect of aerobic training on exercise performance in patients after the Fontan operation. Am J Cardiol 2001; 88: 695–698.Google Scholar
14. Moalla, W, Maingourd, Y, Gauthier, R, et al. Effect of exercise training on respiratory muscle oxygenation in children with congenital heart disease. Eur J Cardiovasc Prev Rehabil 2006; 13: 604–611.Google Scholar
15. Hjortdal, VE, Emmertsen, K, Stenbog, E, et al. Effects of exercise and respiration on blood flow in total cavopulmonary connection: a real-time magnetic resonance flow study. Circulation 2003; 108: 1227–1231.Google Scholar
16. Sanders, S, Wright, G, Keane, J, et al. Clinical and hemodynamic results of the Fontan operation for tricuspid atresia. Am J Cardiol 1982; 49: 1733–1740.Google Scholar
17. Gewillig, M, Goldberg, DJ. Failure of the Fontan circulation. Heart Fail Clin 2014; 10: 105–116.Google Scholar
18. Cordina, RL, O’Meagher, S, Gould, H, et al. Skeletal muscle abnormalities and exercise capacity in adults with a Fontan circulation. Heart 2013; 99: 1530–1534.Google Scholar
19. Brassard, P, Poirier, P, Martin, J, et al. Impact of exercise training on muscle function and ergoreflex in Fontan patients: a pilot study. Int J Cardiol 2006; 107: 85–94.Google Scholar
20. Fredriksen, PM, Kahrs, N, Blaasvaer, S, et al. Effect of physical training in children and adolescents with congenital heart disease. Cardiol Young 2000; 10: 107–114.Google Scholar
21. Ruttenberg, HD, Adams, TD, Orsmond, GS, et al. Effects of exercise training on aerobic fitness in children after open heart surgery. Pediatr Cardiol 1983; 4: 19–24.Google Scholar
22. Tomassoni, TL, Galioto, F, Vaccaro, P, et al. Effect of exercise training on exercise tolerance and cardiac output in children after repair of congenital heart disease. Sports Med Train Rehabil 1990; 2: 57–62.Google Scholar
23. Longmuir, PE, Tyrrell, PN, Corey, M, et al. Home-based rehabilitation enhances daily physical activity and motor skill in children who have undergone the Fontan procedure. Pediatr Cardiol 2013; 34: 1130–1151.Google Scholar
24. Sandberg, C, Hedstrom, M, Wadell, K, et al. Home-based interval training increases endurance capacity in adults with complex congenital heart disease. Congenit Heart Dis 2018; 13: 254–262.Google Scholar
25. Jacobsen, R, Gine, S, Mussatto, K, et al. Can a home-based cardiac physical activity program improve the physical function quality of life in children with Fontan circulation? Congenit Heart Dis 2016; 11: 175–182.Google Scholar
26. Iyengar, A, Winlaw, DS, Galati, JC, et al. The Australia and New Zealand Fontan Registry: description and initial results from the first population-based Fontan registry. Intern Med J 2014; 44: 148–155.Google Scholar
27. Wasserman, K, Hansen, JE, Sue, DY, et al. Principles of Exercise Testing and Interpretation. Lippincott Williams and Wilkins, Philadelphia, PA, 2005.Google Scholar
28. Uzark, K, Jones, K, Slusher, J, et al. Quality of life in children with heart disease as perceived by children and parents. Pediatrics 2008; 121: 1060–1067.Google Scholar
29. Uzark, K, Jones, K, Burwinkle, TM, et al. The Pediatric Quality of Life Inventory(TM) in children with heart disease. Prog Pediatr Cardiol 2003; 18: 141–149.Google Scholar
30. StataCorp. Stata Statistical Software: Release 12. StataCorp LP, College Station, TX, 2011.Google Scholar
31. Cordina, RL, Celermajer, DS, D’Udekem, Y. Lower limb exercise generates pulsatile flow into pulmonary vascular bed in the setting of the Fontan circulation. Cardiol Young 2018; 28: 732–733.Google Scholar
32. Duppen, N, Takken, T, Hopman, MT, et al. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int J Cardiol 2013; 168: 1779–1787.Google Scholar
33. McCrindle, BW, Williams, RV, Mital, S, et al. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509–514.Google Scholar
34. Mazieres, B, Thevenon, A, Coudeyre, E, et al. Adherence to, and results of, physical therapy programs in patients with hip or knee osteoarthritis. Development of French clinical practice guidelines. Joint Bone Spine 2008; 75: 589–596.Google Scholar
35. Allen, K, Morey, MC. Physical activity and adherence. In: Bosworth H, (ed.) Improving Patient Treatment Adherence. Springer, New York, 2010: 9–38.Google Scholar
36. Linde, LM. Psychiatric aspects of congenital heart disease. Psychiatr Clin North Am 1982; 5: 399–406.Google Scholar
37. Rhodes, J, Curran, TJ, Camil, L, et al. Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics 2006; 118: e586–e593.Google Scholar
38. Blumenthal, JA, Babyak, MA, Doraiswamy, PM, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychom Med 2007; 69: 587–596.Google Scholar