Exercise prescription for patients with a Fontan circulation: current evidence and future directions

Abstract

It is well documented that children with a Fontan circulation have a reduced exercise capacity. One of the modalities to improve exercise capacity might be exercise training. We performed a systematic literature review on the effects of exercise training in patients with a Fontan circulation. Six published studies were included that reported on the effects of exercise training in 40 patients. All studies had a small sample size and/or did not include a control group.Based on the six published studies we can conclude that children who have undergone a Fontan operation and who are in a stable haemodynamic condition can safely participate in an exercise training programme and that exercise training results in an improved exercise capacity. However, more research is needed to establish the optimal exercise mode, dose-response relation, and the effects of exercise training on cardiac function, peripheral muscle function, physical activity, and health-related quality of life. (Neth Heart J 2007;15:142-7.).

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease

“…There is an increasing body of literature showing that children with a chronic disease or condition are able to improve their physical fitness levels through an exercise training program (Klijn et al, 2004;Edouard et al, 2007;Takken et al, 2007;Verschuren et al, 2007;Van Brussel et al, 2008;Johnson, 2009). However, a frequently encountered problem is the deconditioning after the cessation of the structured exercise training program (Verschuren et al, 2007;Van Brussel et al, 2008).…”

A functional understanding of moderate to complex congenital heart disease and the impact of pregnancy. Part II: Tetralogy of Fallot, Eisenmenger’s syndrome and the Fontan operation

“…Low to moderate exercise training may improve cardiopulmonary fitness and should be preceded by exercise testing with electrocardiography. 45 Unfortunately, atrial arrhythmias occur in up to 45% of patients and are due to incorporation of the atrial wall in the repair, causing atrial dilatation and hypertrophy. The sino-atrial node, its arterial supply or its innervations may also be injured.…”

Children After Fontan have Strength and Body Composition Similar to Healthy Peers and Can Successfully Participate in Daily Moderate-to-Vigorous Physical Activity

“…Based on these findings, guidelines for the physical activity and sport participation of children after Fontan typically recommend only light-or moderate-intensity activity [12,14,33]. Children and parents are therefore advised to limit the child's exertion or to allow participation only in activities that enable the child to rest as required.…”

“…Children after Fontan have approximately 70 % of the maximum exercise capacity expected for healthy children of similar age and gender [33]. Based on these findings, guidelines for the physical activity and sport participation of children after Fontan typically recommend only light-or moderate-intensity activity [12,14,33].…”