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Can endurance training improve physical capacity and quality of life in young Fontan patients?

Published online by Cambridge University Press:  14 December 2017

Eva R. Hedlund ,
Bo Lundell ,
Liselott Söderström  and
Gunnar Sjöberg
Eva R. Hedlund*
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Bo Lundell
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Liselott Söderström
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
Gunnar Sjöberg
Affiliation:
Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
*
Correspondence to: E. R. Hedlund, MD, Karolinska University Hospital, Astrid Lindgren Children’s Hospital Solna, Barnhjärtcentrum, Eugeniavägen 23, C8:34, S-171 76 Stockholm, Sweden. Tel: +46 707421285; Fax: +46 8 51777778; E-mail: [email protected]
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Abstract

Objective

Children after Fontan palliation have reduced exercise capacity and quality of life. Our aim was to study whether endurance training could improve physical capacity and quality of life in Fontan patients.

Methods

Fontan patients (n=30) and healthy age- and gender-matched control subjects (n=25) performed a 6-minute walk test at submaximal capacity and a maximal cycle ergometer test. Quality of life was assessed with Pediatric Quality of Life Inventory Version 4.0 questionnaires for children and parents. All tests were repeated after a 12-week endurance training programme and after 1 year.

Results

Patients had decreased submaximal and maximal exercise capacity (maximal oxygen uptake 35.0±5.1 ml/minute per·kg versus 43.7±8.4 ml/minute·per·kg, p<0.001) and reported a lower quality of life score (70.9±9.9 versus 85.7±8.0, p<0.001) than controls. After training, patients improved their submaximal exercise capacity in a 6-minute walk test (from 590.7±65.5 m to 611.8±70.9 m, p<0.05) and reported a higher quality of life (p<0.01), but did not improve maximal exercise capacity. At follow-up, submaximal exercise capacity had increased further and improved quality of life was sustained. The controls improved their maximal exercise capacity (p<0.05), but not submaximal exercise capacity or quality of life after training. At follow-up, improvement of maximal exercise capacity was sustained.

Conclusions

We believe that an individualised endurance training programme for Fontan patients improves submaximal exercise capacity and quality of life in Fontan patients and the effect on quality of life appears to be long-lasting.

Keywords

Endurance trainingFontan palliationphysical capacityquality of life
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 3 , March 2018 , pp. 438 - 446
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Copyright
© Cambridge University Press 2017 

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References

1. Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
2. Kanakis, MA, Petropoulos, AC, Mitropoulos, FA. Fontan operation. Hellenic J Cardiol 2009; 50: 133–141.Google Scholar
3. Dulfer, K, Bossers, SS, Utens, EM, et al. Does functional health status predict health-related quality of life in children after Fontan operation? Cardiol Young 2016; 26: 459–468.CrossRefGoogle ScholarPubMed
4. Knowles, RL, Day, T, Wade, A, et al. Patient-reported quality of life outcomes for children with serious congenital heart defects. Arch Dis Child 2014; 99: 413–419.CrossRefGoogle ScholarPubMed
5. McCrindle, BW, Williams, RV, Mitchell, PD, et al. Relationship of patient and medical characteristics to health status in children and adolescents after the Fontan procedure. Circulation 2006; 113: 1123–1129.CrossRefGoogle ScholarPubMed
6. Uzark, K, Jones, K, Slusher, J, Limbers, CA, Burwinkle, TM, Varni, JW. Quality of life in children with heart disease as perceived by children and parents. Pediatrics 2008; 121: e1060–e1067.CrossRefGoogle ScholarPubMed
7. Goldberg, DJ, Avitabile, CM, McBride, MG, Paridon, SM. Exercise capacity in the Fontan circulation. Cardiol Young 2013; 23: 824–830.Google Scholar
8. Jenkins, PC, Chinnock, RE, Jenkins, KJ, et al. Decreased exercise performance with age in children with hypoplastic left heart syndrome. J Pediatr 2008; 152: 507–512.Google Scholar
9. 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
10. Muller, J, Christov, F, Schreiber, C, Hess, J, Hager, A. Exercise capacity, quality of life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection. Eur Heart J 2009; 30: 2915–2920.CrossRefGoogle ScholarPubMed
11. Duppen, N, Etnel, JR, Spaans, L, et al. Does exercise training improve cardiopulmonary fitness and daily physical activity in children and young adults with corrected tetralogy of Fallot or Fontan circulation? A randomized controlled trial. Am Heart J 2015; 170: 606–614.Google Scholar
12. 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.CrossRefGoogle ScholarPubMed
13. Sutherland, N, Jones, B, d’Udekem, Y. Should we recommend exercise after the Fontan procedure? Heart Lung Circ 2015; 24: 753–768.Google Scholar
14. Lammers, AE, Hislop, AA, Flynn, Y, Haworth, SG. The 6-minute walk test: normal values for children of 4-11 years of age. Arch Dis Child 2008; 93: 464–468.CrossRefGoogle ScholarPubMed
15. Varni, JW, Burwinkle, TM, Seid, M. The PedsQL as a pediatric patient-reported outcome: reliability and validity of the PedsQL Measurement Model in 25,000 children. Expert Rev Pharmacoecon Outcomes Res 2005; 5: 705–719.CrossRefGoogle Scholar
16. Petersen, S, Hagglof, B, Stenlund, H, Bergstrom, E. Psychometric properties of the Swedish PedsQL, Pediatric Quality of Life Inventory 4.0 generic core scales. Acta Paediatr 2009; 98: 1504–1512.Google Scholar
17. Eakin, BL, Finta, KM, Serwer, GA, Beekman, RH. Perceived exertion and exercise intensity in children with or without structural heart defects. J Pediatr 1992; 120: 90–93.Google Scholar
18. Hedlund, ER, Lundell, B, Villard, L, Sjoberg, G. Reduced physical exercise and health-related quality of life after Fontan palliation. Acta Paediatr 2016; 105: 1322–1328.Google Scholar
19. 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.CrossRefGoogle ScholarPubMed
20. Takken, T, Hulzebos, HJ, Blank, AC, Tacken, MH, Helders, PJ, Strengers, JL. Exercise prescription for patients with a Fontan circulation: current evidence and future directions. Neth Heart J 2007; 15: 142–147.CrossRefGoogle ScholarPubMed
21. Moalla, W, Elloumi, M, Chamari, K, et al. Training effects on peripheral muscle oxygenation and performance in children with congenital heart diseases. Appl Physiol Nutr Metab 2012; 37: 621–630.CrossRefGoogle ScholarPubMed
22. 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.CrossRefGoogle ScholarPubMed
23. Longmuir, PE, Tyrrell, PN, Corey, M, Faulkner, G, Russell, JL, McCrindle, BW. Home-based rehabilitation enhances daily physical activity and motor skill in children who have undergone the Fontan procedure. Pediatr Cardiol 2013; 34: 1130–1151.CrossRefGoogle ScholarPubMed
24. Dulfer, K, Duppen, N, Kuipers, IM, et al. Aerobic exercise influences quality of life of children and youngsters with congenital heart disease: a randomized controlled trial. J Adolesc Health 2014; 55: 65–72.Google Scholar
25. 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
26. O’Byrne, ML, Desai, S, Lane, M, McBride, M, Paridon, S, Goldmuntz, E. Relationship between habitual exercise and performance on cardiopulmonary exercise testing differs between children with single and biventricular circulations. Pediatr Cardiol 2017; 38: 472–483.CrossRefGoogle ScholarPubMed
27. Moalla, W, Gauthier, R, Maingourd, Y, Ahmaidi, S. Six-minute walking test to assess exercise tolerance and cardiorespiratory responses during training program in children with congenital heart disease. Int J Sports Med 2005; 26: 756–762.CrossRefGoogle ScholarPubMed
28. Banks, L, McCrindle, BW, Russell, JL, Longmuir, PE. Enhanced physiology for submaximal exercise in children after the fontan procedure. Med Sci Sports Exerc 2013; 45: 615–621.CrossRefGoogle ScholarPubMed
29. Opotowsky, AR, Landzberg, MJ, Earing, MG, et al. Abnormal spirometry after the Fontan procedure is common and associated with impaired aerobic capacity. Am J Physiol Heart Circ Physiol 2014; 307: H110–H117.Google Scholar
30. Idorn, L, Hanel, B, Jensen, AS, et al. New insights into the aspects of pulmonary diffusing capacity in Fontan patients. Cardiol Young 2014; 24: 311–320.CrossRefGoogle ScholarPubMed
31. Ortega, FB, Konstabel, K, Pasquali, E, et al. Objectively measured physical activity and sedentary time during childhood, adolescence and young adulthood: a cohort study. PLoS One 2013; 8: e60871.CrossRefGoogle Scholar
32. Raustorp, A, Pagels, P, Froberg, A, Boldemann, C. Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect? Acta Paediatr 2015; 104: 808–814.Google Scholar