Is Neurodevelopment Related to Exercise Capacity in Single Ventricle Patients Who Have Undergone Fontan Palliation?

Cooney, Sean J.; Campbell, Kristen; Wolfe, Kelly R.; Maria, Michael V. Di; Rausch, Christopher M.

doi:10.1007/s00246-020-02497-7

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…In addition, these researchers found that those achieving higher HR during CPET demonstrated fewer attention problems on a performance measure of sustained visual attention. 17 Inattention and executive dysfunction in those with FC clearly have the potential to impact exercise capacity metrics, however, specificity in terms what aspects of physical fitness these symptoms influence requires further study.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Exercise Capacity and Psychological Functioning in Children and Adolescents with Fontan Circulation

Seivert,

Dodds,

O’Malley

et al. 2024

Preprint

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Background: Pediatric patients with Fontan circulation (FC) often have diminished exercise capacity. They are also at risk for psychological problems, including anxiety, depression, and inattention. The current study examines associations between exercise capacity and psychological functioning in a clinical sample of pediatric patients with FC. Methods: A multidisciplinary team evaluated participants in a dedicated clinic for pediatric patients with FC. Patients completed cardiopulmonary exercise testing (CPET); metrics selected for analyses included peak oxygen consumption (VO2), maximum achieved heart rate (HR), oxygen saturation at peak exercise, ventilatory anaerobic threshold, work rate, respiratory exchange ratio, and HR recovery at 1-, 3-, and 8-minutes after exercise. Parent and child were administered a standardized questionnaire to measure depression, anxiety, and inattention symptoms. Patients who completed CPET with adequate effort and a psychological measure were eligible for inclusion. Clinical data were extracted from medical records and analyzed using Pearson correlations. Results: Clinical sample (n = 51) was 55% male with a mean age of 13.6 years (SD=2.5). A majority had hypoplastic left heart syndrome (51%). There was a significant negative correlation between parent-report of inattention and peak VO2 (R= -.307, 95% CI -.549/-.018, P= 0.038). Self-report of anxiety was positively correlated with HR recovery at 3 (R= .438, 95% CI .155/.655, P= 0.004) and 8 (R= .432, 95% CI .147/.651, P= 0.004) minutes post exercise. Depression was positively correlated with HR recovery at 3 minutes for parent report (R= .294, 95% CI .004/.538, P= 0.047) and 8 minutes for self-report (R= .410, 95% CI .122/.635, P= 0.007). Conclusions: Inattention, depression, and anxiety symptoms were correlated with some CPET metrics in our clinical sample of pediatric patients with FC. Greater inattention symptoms were associated with lower peak VO2. Those with greater depression and anxiety symptoms showed a more rapid decline from max HR to recovery period.

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Section: Discussionmentioning

confidence: 99%

Associations Between Exercise Capacity and Psychological Functioning in Children and Adolescents with Fontan Circulation

Seivert,

Dodds,

O’Malley

et al. 2024

Preprint

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“…Sequential CPET studies in young adult subjects with Fontan physiology have emphasized the prognostic value of this test regarding survival, mortality and the need for transplantation. There is often a decrease in VO 2 peak that precedes these events ( 44 ). Cooney et al postulate that a change in VO 2 peak is an independent prognostic factor, which may allow early identification of subjects who could benefit from more intensive and preventive management ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

“…There is often a decrease in VO 2 peak that precedes these events ( 44 ). Cooney et al postulate that a change in VO 2 peak is an independent prognostic factor, which may allow early identification of subjects who could benefit from more intensive and preventive management ( 44 ). The change in VO 2 peak between sequential CPETs predicts transplant-free survival during and above any risk predicted by a single VO 2 peak measurement.…”

Section: Discussionmentioning

confidence: 99%

Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis

Villaseca-Rojas

Varela-Melo

Torres‐Castro

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCongenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality.ObjectiveTo describe exercise capacity in children and adolescents with CHD compared with healthy controls.MethodsA systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence.Results5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of −7.9 ml/Kg/min (95% CI: −9.9, −5.9, p = 0.00001), maximum workload (Wmax) −41.5 (95% CI: −57.9, −25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)−2.4 ml/beat (95% CI: −3.7, −1.1, p = 0.0003), and maximum heart rate (HRmax) −15 bpm (95% CI: −18, −12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (−10.0 ml/Kg/min (95% CI: −12.0, −5.3), p < 0.00001), Wmax (−45.5 watts (95% CI: −54.4, −36.7), p < 0.00001) and HRmax (−21 bpm (95% CI: −28, −14), p<0.00001).ConclusionSuffering CHD in childhood and adolescence is associated with lower exercise capacity as shown by worse VO2peak, Wmax, VE/VCO2 slope, O2 pulse, and HRmax compared with matched healthy controls. The reduction in exercise capacity was greater in adolescents.Systematic Review Registrationwww.crd.york.ac.uk/prospero/display_record.php?RecordID=208963, identifier: CRD42020208963.

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“…This is an important consideration for individuals with a Fontan circulation, who are predicted to be at increased risk of reduced cognitive reserve and early-onset dementia ( 6 ). Emerging research has shown significant associations between exercise capacity and sustained attention and adaptive functioning in people with a Fontan circulation ( 48 ). The extent to which exercise capacity may improve other cognitive functions (e.g., working memory, processing speed, executive function and/or internalising symptoms) were undetermined in this cohort, that was limited by modest sample sizes.…”

Section: Exercise Cognition and Fontan Physiologymentioning

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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Is Neurodevelopment Related to Exercise Capacity in Single Ventricle Patients Who Have Undergone Fontan Palliation?

Cited by 8 publications

References 37 publications

Associations Between Exercise Capacity and Psychological Functioning in Children and Adolescents with Fontan Circulation

Associations Between Exercise Capacity and Psychological Functioning in Children and Adolescents with Fontan Circulation

Exercise Capacity in Children and Adolescents With Congenital Heart Disease: A Systematic Review and Meta-Analysis

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

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