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

Hedlund, Eva Rylander; Lundell, Bo; Söderström, Liselott; Sjöberg, Gunnar

doi:10.1017/s1047951117002360

Cited by 42 publications

(86 citation statements)

References 31 publications

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“…Excluding children with Fontan circulation from school or team sports is not acceptable. This is in accordance to data from Hedlund et al and a review by Cordina et al, who recently assumed that endurance training, amongst others, improves physical capacity of these patients and is beneficial [29,30].…”

Section: Discussionsupporting

confidence: 92%

Physical activity and heart rate monitoring in Fontan patients – Should we recommend activities in higher intensities?

et al. 2020

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ObjectiveExercise capacity is impaired in Fontan palliated patients. The change in daily activity behaviour with an increase in sedentary lifestyle results in low physical activity levels. This might have a greater impact on patients with chronic heart disease in contrast to healthy controls. For a better understanding, we compared data from cardiopulmonary exercise testing (CPET) with heart rates and physical activity in daily life. Methods21 Fontan patients and 20 age, sex and BMI matched controls underwent CPET and 5 days of daily life activity tracking with a triaxial accelerometer (wGT3x-BT, Actigraph) including heart rate monitoring with an optical heart rate sensor. Results27% of our Fontan teenagers and 71% of the Fontan adults reached the specific WHO recommendations for moderate to vigorous physical activity (MVPA) during everyday life (EDL), without differences to controls. There was a strong correlation between MVPA and _ VO 2peak for all Fontan patients (p = 0.0035, Pearson r = 0.788). Daily MVPA correlated to peak oxygen uptake and lactate production. Up to workloads of 2 W/kg and in daily life heart rates in Fontan patients were similar to controls. ConclusionsDaily MVPA is alarmingly low without any differences between Fontan patients and controls. Heart rate behaviour was similar and does not seem to be a limiting factor for physical activity in daily life. Higher intensity activities should be implemented regularly in EDL for Fontan patients. Proof is needed as to whether sports in moderate or possibly even in vigorous activity (e.g. high-intensity interval training) improve exercise capacity the most. PLOS ONE | https://doi.org/10.1371/journal.pone.

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Section: Discussionsupporting

confidence: 92%

Physical activity and heart rate monitoring in Fontan patients – Should we recommend activities in higher intensities?

et al. 2020

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“…At follow-up after 1 year, patients (14.3 (0-17.0)) and controls (15.0 (0-19.0)) reported an average intensity on the Borg scale for all activities similar to after the training program, as described previously. 19 Total vector magnitude and time in moderate-to-vigorous activity did not change for patients or controls after training or at follow-up after 1 year.…”

Section: Sleep Scoringmentioning

confidence: 84%

“…Accelerometer recordings were repeated after the 12-week endurance training program and once again after 1 year, without further encouragement by the study leaders, as described previously. 19 The purpose of the training program was to increase endurance training at a sub-maximal level with the aim to increase load gradually during the training program. The patients were instructed not to perform exercise training at maximal effort.…”

Section: Methodsmentioning

confidence: 99%

Physical exercise may improve sleep quality in children and adolescents with Fontan circulation

et al. 2019

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Objective:To study physical activity and sleep in Fontan patients and healthy controls before and after an endurance training program, and after 1 year.Method:Fontan patients (n = 30) and healthy controls (n = 25) wore accelerometers for seven consecutive days and nights during a school week before and after a 12-week endurance training program and after 1 year.Results:Patients had similar sleep duration and sleep efficiency as healthy controls. Latency to sleep onset in minutes was longer for patients than controls (22.4 (4.3–55.3) minutes versus 14.8 (8.6–29.4) minutes, p < 0.01). More time in moderate-to-vigorous activity daytime was correlated with increased sleep time (p < 0.05; r2 = 0.20), improved sleep efficiency (p < 0.01; r2 = 0.24) and less time as wake after sleep onset (p < 0.05; r2 = 0.21) for patients but not controls. Sleep variables did not change after the exercise intervention for patients or controls. After 1 year, patients had decreased total sleep time, decreased sleep efficiency, increased accelerometer counts during sleep and more time as wake after sleep onset during sleep time, but not controls.Conclusions:Fontan patients have prolonged latency to sleep onset compared with controls. More time in physical activities was correlated with better sleep quality for the patients. Also, subjects with low sleep efficiency and long latency to sleep onset may benefit most from physical exercise. These patients should be encouraged to engage in individually designed physical exercise as this could improve sleep quality.

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“…Nine patients could not suggest a healthy peer, so eight healthy unrelated matched control patients were also recruited from families and friends of hospital staff. 24,25 A matched control group for comparisons was considered important, in order to avoid comparisons with old reference material, since studies have shown a decline in physical activity and exercise performance in the general population over time. 27,28 Thus, the study groups comprised 27 patients with Fontan circulation and 25 healthy control patients.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously published studies of quality of life, 24 physical capacity and effects of endurance training, 25 and lung function 26 in a cohort of young Fontan patients compared with a matched group of healthy children and adolescents. For detailed information about our Fontan cohort, control group, and methods used, we refer to those publications.…”

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confidence: 99%

Appropriate heart rate during exercise in Fontan patients

2020

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Objective:To evaluate heart rate against workload and oxygen consumption during exercise in Fontan patients.Method:Fontan patients (n = 27) and healthy controls (n = 25) underwent cardiopulmonary exercise testing with linear increase of load. Heart rate and oxygen uptake were measured during tests. Heart rate recovery was recorded for 10 minutes.Results:Heart rate at midpoint (140 ± 14 versus 153 ± 11, p < 0.001) and at maximal effort (171 ± 14 versus 191 ± 10 beats per minute, p < 0.001) of test was lower for patients than controls. Heart rate recovery was similar between groups. Heart rate in relation to workload was higher for patients than controls both at midpoint and maximal effort. Heart rate in relation to oxygen uptake was similar between groups throughout test. Oxygen pulse, an indirect surrogate measure of stroke volume, was reduced at maximal effort in patients compared to controls (6.6 ± 1.1 versus 7.5 ± 1.4 ml·beat−1·m−2, p < 0.05) and increased significantly less from midpoint to maximal effort for patients than controls (p < 0.05).Conclusions:Heart rate is increased in relation to workload in Fontan patients compared with controls. At higher loads, Fontan patients seem to have reduced heart rate and smaller increase in oxygen pulse, which may be explained by inability to further increase stroke volume and cardiac output. Reduced ability to increase or maintain stroke volume at higher heart rates may be an important limiting factor for maximal cardiac output, oxygen uptake, and physical performance.

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

Abstract: 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.

Cited by 42 publications

References 31 publications

Physical activity and heart rate monitoring in Fontan patients – Should we recommend activities in higher intensities?

Physical activity and heart rate monitoring in Fontan patients – Should we recommend activities in higher intensities?

Physical exercise may improve sleep quality in children and adolescents with Fontan circulation

Appropriate heart rate during exercise in Fontan patients

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