Impact of Cardiac Rehabilitation on the Exercise Function of Children With Serious Congenital Heart Disease

Abstract

Objectives. The exercise capacity of children with congenital heart disease (CHD) is often depressed. This depression is thought to be attributable to (1) residual hemodynamic defects and (2) deconditioning secondary to physical inactivity. We hypothesized that this latter component would be ameliorated by a formal cardiac rehabilitation program designed specifically for children. The objective of this study was to characterize the effect of a cardiac rehabilitation program on the exercise performance of children with CHD and to define the physiologic mechanisms that might account for any improvements that are observed.Methods. Nineteen patients with CHD who were referred for exercise testing and found to have a peak oxygen consumption (VO 2 ) and/or peak work rate <80% of predicted were enrolled in the study. Sixteen patients (11 Fontan patients, 5 with other CHD) completed the program and had postrehabilitation exercise tests, results of which were compared with the prerehabilitation studies.Results. Improvements were found in 15 of 16 patients. Peak VO 2 rose from 26.4 ؎ 9.1 to 30.7 ؎ 9.2 mL/kg per min; peak work rate from 93 ؎ 32 to 106 ؎ 34 W, and the ventilatory anaerobic threshold from 14.2 ؎ 4.8 to 17.4 ؎ 4.5 mL/kg per min. The peak heart rate and peak respiratory exchange ratio did not change, suggesting that the improvements were not attributable merely to an increased effort. In contrast, the peak oxygen pulse rose significantly, from 7.6 ؎ 2.8 to 9.7 ؎ 4.1 mL/beat, an improvement that can be attributed only to an increase in stroke volume and/or oxygen extraction at peak exercise. No patient experienced rehabilitation-related complications.Conclusion. Cardiac rehabilitation can improve the exercise performance of children with CHD. This improvement is mediated by an increase in stroke volume and/or oxygen extraction during exercise. Routine use of formal cardiac rehabilitation may greatly reduce the morbidity of complex CHD. Pediatrics 2005;116:1339-1345; congenital heart defects, exercise, cardiac rehabilitation.

Exercise Standards for Testing and Training

“…On completion of a variety of training programs, peak Vȯ 2 has been reported to increase 7% to 21% over baseline values. [586][587][588][589] Most of the improvement appears to be attributable to an increase in the oxygen pulse at peak exercise. 589 In one study, the short-term improvements were sustained 6 to 9 months after the termination of the rehabilitation program (1 year after the prerehabilitation study) and were associated with improvements in lifestyle, perceived exercise function, self-esteem, and emotional state.…”

“…[586][587][588][589] Most of the improvement appears to be attributable to an increase in the oxygen pulse at peak exercise. 589 In one study, the short-term improvements were sustained 6 to 9 months after the termination of the rehabilitation program (1 year after the prerehabilitation study) and were associated with improvements in lifestyle, perceived exercise function, self-esteem, and emotional state. 590 Improvements in exercise function and other areas were not observed in a control group, composed of 18 children with similar diagnoses, observed over the same time period.…”

Exercise Testing and Training in Children With Congenital Heart Disease

“…More recently, Rhodes et al 80 reported that, in a study of 16 children with serious CHD, a 12-week rehabilitation program was associated with a 17% increase in peak V O 2 . Improvements in the V O 2 at the VAT were even more substantial.…”

“…80 However, data on the optimal design of pediatric cardiac rehabilitation programs do not exist, and further investigations are needed to elucidate the most effective rehabilitation strategies for children with CHD. Furthermore, reliance on a facility-based rehabilitation program is, for many patients, impractical, and the costs of these programs are not covered reliably by most third-party payers.…”

Dynamic of bio-geometric profile indicators of children’s with functionally one ventricle posture at stage of physical rehabilitation

“…The most wide-scale studies of physical loads' influence in cardio-rehabilitation programs for persons with CHD were made by J. Rhodes [26][27][28] -increase of peak VO 2 and maximal load for long period; P. E. Longmuir [20,21] -long term improvement of physical fitness indicators; L. M. Bradley [10] -improvement of peak VO 2 and endurance; I. C. Balfour [8] -improvement of peak VO 2 ; B. Goldberg [16] -improvement of maximal power and workability, influence on peak VO 2 was absent; H. D. Ruttenberg [29], P. M. Fredriksen [13] -improvement of endurance, influence on peak VO 2 was absent.…”