Home-Based Long-Term Physical Endurance and Inspiratory Muscle Training for Children and Adults With Fontan Circulation—Initial Results From a Prospective Study

Abstract

BackgroundPatients with congenital heart disease (CHD)—including those after Fontan operation—are encouraged to be physically active.AimTo prospectively determine the effects of an individually adapted, home-based cycle ergometer endurance training in combination with inspiratory muscle training (IMT) in pediatric and adult Fontan patients. We, herein, report the results of the initial 10-months follow-up (phase 1).Methods18 patients (median age 16.5 years; range 10-43 years) completed baseline check-ups, and 4 and 10 months follow-up visits, which each included cardiopulmonary exercise testing (CPET), bodyplethysmography (including measurement of respiratory muscle strength), and a quality of life questionnaire (PedsQL™). The training program consisted of a home-based cycle ergometer endurance training on a “Magbike® AM-5i/3i” (DKN Technology®, Clermont-Ferrand, France) and IMT with a handheld “POWERbreathe® Medic plus” device. Patients performed 90 min of endurance training per week in addition to IMT (30 breaths per day, 6-7 times per week). After the first 4 months, patients underwent additional interval training.ResultsAfter 10 months of training, we observed significant increases in maximum relative workload (W/kg, p = 0.003) and in maximum inspiratory (MIP, p = 0.002) and expiratory (MEP, p = 0.008) pressures. Peak VO2 values did not increase significantly as compared to baseline (p = 0.12) in the entire cohort (n = 18), but reached statistical significance in a subgroup analysis of teenage/adult patients (n = 14; p = 0.03). Patients' subjective quality of life did not show any significant changes after 10 months of training.DiscussionIn Fontan patients, an individually adapted home-based training is safe and associated with improvements in some CPET variables. However, these improvements did not translate into an improved QoL after 10 months. With an unclear, but most likely negative, impact of the COVID-19 pandemic, improvements in QoL may become evident during further follow-up (phase 2 of the study).

Peak Work Rate Increases With Lower Extremity‐Focused Exercise Training in Adolescents With Fontan Circulation

“…45 , 46 , 47 Neither quality of life nor PAQ scores increased with our intervention. However, like other studies during the pandemic, 48 we cannot separate the potential benefits of exercise from the negative effects of the COVID‐19 pandemic. Perhaps participants were able to maintain their quality of life and activity levels during a global pandemic through engagement in an exercise program.…”

Narrative review of single ventricle: where are we after 40 years?

“…More recently, several programs of cardiopulmonary training, including exercise training, fitness intervention trials, home-based long-term physical endurance and inspiratory muscle trainings, have been instituted in Fontan patients. These programs have been shown to be safe and beneficial, improving exercise capacity, cardiorespiratory performance and cardiac biomarker values, and self-reported quality of life (273)(274)(275)(276)(277).…”

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

“…Exercise training has been shown to positively affect stroke volume, cardiac output, lung function, and skeletal muscle mass, subsequently optimising overall physical function and exercise capacity (30)(31)(32)(33)(34). Exercise participation is now strongly encouraged as a safe therapy for most children and adults with Fontan physiology (35, 36), although guidance regarding the nature and intensity of exercise should continue to be provided to patients on an individualised basis (37).…”