Exercise prescription improves exercise tolerance in young children with CHD: a randomised clinical trial

Abstract

ObjectiveThe main objective of this study was to ascertain if a structured intervention programme can improve the biophysical health of young children with congenital heart disease (CHD). The primary end point was an increase in measureable physical activity levels following the intervention.MethodsPatients aged 5–10 years with CHD were identified and invited to participate. Participants completed a baseline biophysical assessment, including a formal exercise stress test and daily activity monitoring using an accelerometer. Following randomisation, the intervention group attended a 1 day education session and received an individual written exercise plan to be continued over the 4-month intervention period. The control group continued with their usual level of care. After 4 months, all participants were reassessed in the same manner as at baseline.ResultsOne hundred and sixty-three participants (mean age 8.4 years) were recruited, 100 of whom were male (61.3%). At baseline, the majority of the children were active with good exercise tolerance. The cyanotic palliated subgroup participants, however, were found to have lower levels of daily activity and significantly limited peak exercise performance compared with the other subgroups. One hundred and fifty-two participants (93.2%) attended for reassessment. Following the intervention, there was a significant improvement in peak exercise capacity in the intervention group. There was also a trend towards increased daily activity levels.ConclusionOverall physical activity levels are well preserved in the majority of young children with CHD. A structured intervention programme significantly increased peak exercise capacity and improved attitudes towards positive lifestyle changes.

Cardiac Rehabilitation and Cardiopulmonary Fitness in Children and Young Adults With Congenital Heart Diseases: A Critically Appraised Topic

“…The four relevant studies identified by this review involved the use of aerobic exercise activity in patients who had ConHD and no adverse medical events occurred during the studies. The Callaghan et al study, the largest randomized control trial, investigated exercise might impact children afflicted with ConHD [ 13 ]. Overall, after a baseline biophysical assessment, participants in the intervention group showed an 11% increase in exercise duration, coupled with an increase in maximum power output and daily activity.…”

“…There is also an increased risk for poor long-term outcomes that could adversely affect their physical, motor, and psychosocial development [ 19 ]. Another distinctive approach of the Callaghan et al's study was the deployment of motivational interviewing techniques when delivering an individualized exercise advice plan to the patients in the intervention group [ 13 ]. Such initiatives are encouraged by the American Heart Association because it is thought to promote behavioral changes and adherence to structured exercise programs which can encourage better future habits, especially within this patient population who are known to have a low motivation for exercising [ 20 ].…”

“…Table 1 summarizes the findings of four articles found to be highly relevant to this appraisal based on the inclusion criteria [ 13 - 16 ].…”

Exercise prescription in young children with congenital heart disease: time for a change in culture

“…In the paper by Callaghan, the authors conducted a randomised clinical trial of exercise training in a cohort of 163 young children (5–10 years old) with CHD. 12 This is the first large study to look at exercise prescription in the primary school age child with CHD and is the largest randomised controlled trial of an exercise intervention in children of any age. Using procedures that can easily be performed in the outpatient clinic, the authors build on their previous exercise intervention study in adolescents with CHD.…”

“…Using procedures that can easily be performed in the outpatient clinic, the authors build on their previous exercise intervention study in adolescents with CHD. 12 They used a waist-worn accelerometer to monitor baseline activity, an exercise ECG stress test to assess exercise capacity and a questionnaire to assess daily activities. The intervention group attended an educational day in which they participated in a psychologist-led motivational group discussion.…”