Exercise Training for People Living With Fontan Circulation: An Underutilized Intervention

Khoury, Michael; Cordina, Rachael

doi:10.1016/j.cjca.2022.01.008

Cited by 17 publications

(8 citation statements)

References 93 publications

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“…Peripheral impairment to exercise secondary to skeletal muscle dysfunction is a recognized source of dyspnoea, even among heart failure patients 25,26 . We hypothesize that peripheral impairment to exercise constitutes a major aetiology of exertional intolerance in post‐Fontan patients with optimal haemodynamics, and the current findings underscore the importance and potential benefits of exercise training in this population 27 …”

Section: Discussionmentioning

confidence: 55%

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Exercise catheterization in adults post‐Fontan with normal and abnormal haemodynamic criteria: Insights into normal Fontan physiology

Miranda,

Jain,

Borlaug

et al. 2024

European J of Heart Fail

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BackgroundThe normal (i.e., expected) hemodynamics in adults post‐Fontan remain poorly delineated. Moreover, the definitions of elevated exercise pulmonary artery (PA) and PA wedge pressure (PAWP) for this population have not been described.Methods and ResultsSeventy‐two adults post‐Fontan undergoing exercise catheterization were categorized into abnormal (Group I, n = 59; defined as resting mean PA ≥14 mmHg and/or PAWP ≥12 mmHg, ΔPAWP/Δsystemic flow >2 mmHg/L/min, and/or ΔPA/Δpulmonary flow >3 mmHg/L/min) and normal (Group II, n = 13) hemodynamics. Thirty‐nine patients with non‐cardiac dyspnea (NCD) were included as controls. There was no difference in exercise arterial O2 saturation (87% [81;92] vs 89% [85;93], p = 0.29), while exercise PA pressure (27 [23;31] vs 16 [14.5;19.5] mmHg, p < 0.001) and PAWP were higher (21 [18;28] vs 12 [8;14] mmHg, p < 0.001) in Group I. At peak exercise, Group I had lower heart rate (97 [81;120] vs 133 [112.5; 147.5] bpm, p < 0.001) and Qs response (67.3 [43.8;93.1] vs 105.9 (82;118.5) % predicted, p < 0.001) than Group II. Exercise SVC pressures were higher (16 [14;22.5] vs 5.5 [3;7.3] mmHg, p < 0.001) and arterial O2 saturation lower (89% [85;93] vs 97% [96;98], p < 0.001) in Group II compared to NCD, while no differences in PAWP, stroke volume index, heart rate, or Qs response were seen. If defined as 2 standard deviations above mean values for Group II, elevated PAWP and mean PA pressure post‐Fontan would correspond to 20.6 and 25.8 mmHg, respectively.ConclusionPAWP >20 mmHg and mean PA pressure > 25 mmHg could be used to define elevated values during exercise in adults post‐Fontan. The major discrepancy in exercise hemodynamics among Group II compared to controls appears to be the degree of systemic venous hypertension and arterial desaturation.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 55%

“…25,26 We hypothesize that peripheral impairment to exercise constitutes a major aetiology of exertional intolerance in post-Fontan patients with optimal haemodynamics, and the current findings underscore the importance and potential benefits of exercise training in this population. 27…”

Section: Exercise Haemodynamics In Group II Compared To Non-cardiac D...mentioning

confidence: 99%

Exercise catheterization in adults post‐Fontan with normal and abnormal haemodynamic criteria: Insights into normal Fontan physiology

Miranda,

Jain,

Borlaug

et al. 2024

European J of Heart Fail

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“…Recreational and competitive activities should be encouraged in this population with an eye towards the risk: benefit calculation, balancing the concerns for sudden cardiac arrest during athletics, and the long-term morbidity and mortality that arises from sedentary behaviors. For individuals so severely deconditioned that participation in organized sports would be impractical, exercise prescription and structured cardiac rehabilitation should be encouraged to improve cardiopulmonary fitness ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Stable fitness during COVID-19: Results of serial testing in a cohort of youth with heart disease

et al. 2023

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BackgroundLittle is known about how sport and school restrictions early during the novel coronavirus 2019 (COVID-19) pandemic impacted exercise performance and body composition in youth with heart disease (HD).MethodsA retrospective chart review was performed on all patients with HD who had serial exercise testing and body composition via bioimpedance analysis performed within 12 months before and during the COVID-19 pandemic. Formal activity restriction was noted as present or absent. Analysis was performed with a paired t-test.ResultsThere were 33 patients (mean age 15.3 ± 3.4 years; 46% male) with serial testing completed (18 electrophysiologic diagnosis, 15 congenital HD). There was an increase in skeletal muscle mass (SMM) (24.1 ± 9.2–25.9 ± 9.1 kg, p < 0.0001), weight (58.7 ± 21.5–63.9 ± 22 kg, p < 0.0001), and body fat percentage (22.7 ± 9.4–24.7 ± 10.4%, p = 0.04). The results were similar when stratified by age <18 years old (n = 27) or by sex (male 16, female 17), consistent with typical pubertal changes in this predominantly adolescent population. Absolute peak VO2 increased, but this was due to somatic growth and aging as evidenced by no change in % of predicted peak VO2. There remained no difference in predicted peak VO2 when excluding patients with pre-existing activity restrictions (n = 12). Review of similar serial testing in 65 patients in the 3 years before the pandemic demonstrated equivalent findings.ConclusionsThe COVID-19 pandemic and related lifestyle changes do not appear to have had substantial negative impacts on aerobic fitness or body composition in children and young adults with HD.

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“…While current recommendations highlight the importance of exercise for people living with a Fontan circulation ( 26 , 34 , 37 , 147 ), the optimal methods and guidelines surrounding exercise prescription remain poorly characterised. The primary target of exercise intervention in this cohort is to optimise cardiac and physical functioning, however investigations should consider the intensity, duration and type of exercise that is required to also maximise cognitive outcomes.…”

Section: Uncertainties and Future Directionsmentioning

confidence: 99%

Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review

Verrall

Tran²,

Yang³

et al. 2023

Front. Pediatr.

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People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.

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Exercise Training for People Living With Fontan Circulation: An Underutilized Intervention

Cited by 17 publications

References 93 publications

Exercise catheterization in adults post‐Fontan with normal and abnormal haemodynamic criteria: Insights into normal Fontan physiology

Exercise catheterization in adults post‐Fontan with normal and abnormal haemodynamic criteria: Insights into normal Fontan physiology

Stable fitness during COVID-19: Results of serial testing in a cohort of youth with heart disease

Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review

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