Objectives. The exercise capacity of children with congenital heart disease (CHD) is often depressed. This depression is thought to be attributable to (1) residual hemodynamic defects and (2) deconditioning secondary to physical inactivity. We hypothesized that this latter component would be ameliorated by a formal cardiac rehabilitation program designed specifically for children. The objective of this study was to characterize the effect of a cardiac rehabilitation program on the exercise performance of children with CHD and to define the physiologic mechanisms that might account for any improvements that are observed.Methods. Nineteen patients with CHD who were referred for exercise testing and found to have a peak oxygen consumption (VO 2 ) and/or peak work rate <80% of predicted were enrolled in the study. Sixteen patients (11 Fontan patients, 5 with other CHD) completed the program and had postrehabilitation exercise tests, results of which were compared with the prerehabilitation studies.Results. Improvements were found in 15 of 16 patients. Peak VO 2 rose from 26.4 ؎ 9.1 to 30.7 ؎ 9.2 mL/kg per min; peak work rate from 93 ؎ 32 to 106 ؎ 34 W, and the ventilatory anaerobic threshold from 14.2 ؎ 4.8 to 17.4 ؎ 4.5 mL/kg per min. The peak heart rate and peak respiratory exchange ratio did not change, suggesting that the improvements were not attributable merely to an increased effort. In contrast, the peak oxygen pulse rose significantly, from 7.6 ؎ 2.8 to 9.7 ؎ 4.1 mL/beat, an improvement that can be attributed only to an increase in stroke volume and/or oxygen extraction at peak exercise. No patient experienced rehabilitation-related complications.Conclusion. Cardiac rehabilitation can improve the exercise performance of children with CHD. This improvement is mediated by an increase in stroke volume and/or oxygen extraction during exercise. Routine use of formal cardiac rehabilitation may greatly reduce the morbidity of complex CHD. Pediatrics 2005;116:1339-1345; congenital heart defects, exercise, cardiac rehabilitation.

In patients with congenital heart disease, cardiac rehabilitation produces significant, sustained improvements in exercise function, behavior, self-esteem, and emotional state.

We assessed heart rate (HR) recovery following peak exercise before and after a 12-week cardiac rehabilitation program in 14 children, 12.1+/-1.8 years of age, with repaired complex congenital heart disease (CHD; 11 with Fontan surgery) and impaired exercise performance. Exercise testing using bicycle ergometry was performed at baseline, after completion of the rehab program and 1.0+/-0.2 years after the baseline test. These data were compared to HR recovery in 15 controls (age, 12.7+/-2.4 years) with CHD (13 with Fontan surgery) with two serial exercise tests at an interval of 1.1+/- 0.3 years. There was no change in peak HR between the two serial tests in either group. Peak VO2 improved in the rehab group (26.3+/-9.6 ml/kg/min at baseline vs 30.9+/-9.6 ml/kg/min after rehab, p=0.01) but remained unchanged in controls on serial testing. One-minute HR recovery (in beats per minute) improved significantly following completion of the rehab program (27+/-15 at baseline vs 40+/-23 after rehab, p=0.01). Partial improvement in 1-minute HR recovery in the rehab group persisted 1 year later (1-minute HR recovery, 35+/-19; p=0.1 compared to baseline). There was no change in 1-minute HR recovery over time in the control group (37+/-16 vs 40+/-13, p = not significant). In conclusion, HR recovery following peak exercise improves in children with CHD after participation in a cardiac rehab program.

No abstract

VO(2) decline during the first minute of recovery after maximum exercise is faster in children with higher peak VO(2). VO(2) recovery may be a useful tool in assessing cardiopulmonary health in children.

No abstract

Introduction: The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach. Methods: A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2. Results: Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence. Conclusion: This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.

No abstract