Home-Based Rehabilitation Enhances Daily Physical Activity and Motor Skill in Children Who Have Undergone the Fontan Procedure

Abstract

This randomized trial compared physical activity enhancing exercise prescription and education programs in 61 children (36 male) with single-ventricle physiology after Fontan. After Fontan, children are less active than recommended for optimal health. They are often geographically dispersed and unable to attend weekday programs. Participants, 5.9-11.7 years of age who were status 5.3 years post-Fontan, received 12-month, parent-delivered home programs to enhance physical activity, motor skill, fitness, and activity attitudes. Daily moderate-to-vigorous physical activity (MVPA) was measured at baseline and again at 6, 12, and 24 months. Secondary outcomes were gross motor skill, fitness, and activity attitudes. Gross motor skill (p = .01) was significantly greater at the end of the 2-year study period for both intervention groups combined. MVPA at 2 years was significantly greater (p = .03) than the predicted decrease with age. Spring season (85 ± 25 min), male sex (69 ± 21 min), greater baseline activity (0.3 ± 0.1 min/baseline minute), and better gross motor skill (1.1 ± 0.4 min/percentile) increased weekly MVPA in a multivariable repeated-measures regression model adjusted for intervention, maturation during the 2-year study, sex, season, and baseline activity. Benefits were not influenced by type of rehabilitation, compliance, or rural/urban location. Home-based, pediatric physical activity rehabilitation enhances physical activity, gross motor skill, exercise capacity, and physical fitness among preadolescent children after Fontan regardless of rural/urban location. Prescribed education and exercise programs are similarly effective for providing the important health benefits of daily physical activity. Enhanced gross motor skill is associated with increased MVPA despite exercise capacity limitations after Fontan. Rehabilitation attenuates the expected decrease in MVPA with age.

Physical Activity and Sedentary Behavior in Children With Congenital Heart Disease

“…These high levels of activity are likely explained by a combination of the very young age range (because PA decreases with age) and the researchers' use of a much lower accelerometry sampling interval (3 seconds), to capture the sporadic high‐intensity activity typical of young children, and a lower MVPA threshold; combined, these measures will lead to higher estimates of MVPA compared with our analytical approach. A study of Fontan patients (in Ontario, Canada; n≈60) reported mean estimates of MVPA that were similar to our sample (≈50 versus 49 min/day); these data are also based on 15‐second epoch, but the investigators used a different device and MVPA threshold, and it is of note that their sample was much younger than ours (6–12 years) . Another small study (in Milwaukee, Wisconsin) assessed MVPA across a range of CHD severities and found high levels of MVPA overall (≈70 min/day), despite using a lower sampling interval (30‐second epoch) and higher, metabolic equivalent–based MVPA (≥4 metabolic equivalents) thresholds that would yield lower estimates of MVPA compared with our approach.…”

Can a Home-based Cardiac Physical Activity Program Improve the Physical Function Quality of Life in Children with Fontan Circulation?

“…Interestingly, there was no change in activity attitudes, as assessed through verbal administration of Children's Self-Perception of Adequacy & Predilection for Physical Activity Scale. 28 Collectively, the results from our study and the previously discussed studies suggest that physical function HRQOL and exercise capacity is modifiable in patients with Fontan circulation and may improve with programs that encourage an increase in physical activity and exercise. Our study is unique in that the majority of participation was home-based, and thus the program could be completed by patients that reside long distances from our hospital center.…”

Impaired lung function in children and adolescents with Fontan circulation may improve after endurance training

“…Exercise training may, also, have a positive effect on peripheral muscles in children with congenital heart disease (49). Rehabilitation programmes can also enhance physical activity levels in children with Fontan circulation (50). Performing exercise tests, taking part of exercise interventions, and seeing that physical activity is safe, is of importance for patients and their parents (51).…”