Healthy hearts in pediatric heart transplant patients with an exercise and diet intervention via live video conferencing—Design and rationale

Abstract

Background: Pediatric heart transplant (PedHtx) patients have increased cardiovascular risk profiles that affect their long-term outcomes and quality of life. We designed a 12-to 16-week diet and exercise intervention delivered via live video conferencing to improve cardiovascular health. Our methodology and baseline assessment of the first 13 enrolled patients are reported. Methods: Inclusion criteria are as follows: (a) 8-19 years old; (b) heart transplant >12 months; (c) ability to fast overnight; (d) cardiac clearance by cardiologist; and (e) presence of an adult at home during exercise sessions for patients <14 years old. Exclusion criteria are as follows: (a) acute illness; (b) latex allergy; (c) transplant rejection <3 months ago; and (d) multi-organ transplantation. The intervention consists of one diet and three exercise sessions weekly via live video conferencing. Study visits are conducted at baseline, intervention completion, and end of maintenance period. Results: A total of 13 participants (15.2 [2.3] years) have been enrolled. Median percent-predicted VO 2 max was 56.8 [20.7]% (10 patients <70%). Ten patients had abnormal endothelial function (reactive hyperemia index <1.9; 1.4 [0.325]) and 11 patients had stiff arteries (pulse wave velocity ≧5.5 m/s for 15-19 years, ≧4.5 m/s for 8-14 years; 5.6 [0.7] m/s). Patients had suboptimal diets (saturated fat: 22.7 [23.8] g/d, sodium: 2771 [1557] mg/d) and were sedentary at a median of 67.5 [13.8]% of their time. Conclusions: Baseline assessment confirms that PedHtx patients have abnormal cardiac, vascular, and functional health indices, poor dietary habits, and are sedentary.These results support the rationale to test the feasibility and impact of a non-pharmacologic lifestyle intervention in this patient population.

Cardiovascular Health in Pediatric Heart Transplant Patients

“…Previous studies examining individual CVH metrics among pediatric HT recipients have been somewhat inconsistent, with some but not all suggesting worse levels of CVH metrics among HT recipients compared with the general population. Suboptimal nutrition and a sedentary lifestyle in combination with immunosuppressants and steroid medication are thought to be contributory to worse CVH metrics after HT (3,8,29,31). Several studies suggested increased risks of obesity, dyslipidemia and a higher incidence of type 2 diabetes post-HT (8,13,(32)(33)(34).…”

Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review

“…Of these, 7894 records were excluded at the title and abstract screening stage, and 97 full text records were assessed for eligibility ( Figure 1 ). A total of 84 of the 97 full text records were excluded for the following reasons: 26 did not measure smoking, nutrition, alcohol consumption, physical activity, and obesity outcomes; 23 did not use any form of video counseling intervention; 19 involved group video counseling and not individual video counseling [ 37 - 54 ]; 3 were protocol papers [ 55 - 57 ]; 8 were not randomized studies [ 58 - 65 ]; 2 studies were ongoing [ 32 , 66 ]; 1 was a conference abstract [ 67 ]; and 2 studies described a multicomponent intervention, and it was not possible to isolate the effect of real-time video counseling [ 68 , 69 ]. The remaining 13 eligible studies were included in the review.…”

Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review (Preprint)

“…Of these, 7894 records were excluded at the title and abstract screening stage, and 97 full text records were assessed for eligibility (Figure 1). A total of 84 of the 97 full text records were excluded for the following reasons: 26 did not measure smoking, nutrition, alcohol consumption, physical activity, and obesity outcomes; 23 did not use any form of video counseling intervention; 19 involved group video counseling and not individual video counseling [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]; 3 were protocol papers [55][56][57]; 8 were not randomized studies [58][59][60][61][62][63][64][65]; 2 studies were ongoing [32,66]; 1 was a conference abstract [67]; and 2 studies described a multicomponent intervention, and it was not possible to isolate the effect of real-time video counseling [68,69]. The remaining 13 eligible studies were included in the review.…”