Physical activity and heart rate monitoring in Fontan patients – Should we recommend activities in higher intensities?

Abstract

ObjectiveExercise capacity is impaired in Fontan palliated patients. The change in daily activity behaviour with an increase in sedentary lifestyle results in low physical activity levels. This might have a greater impact on patients with chronic heart disease in contrast to healthy controls. For a better understanding, we compared data from cardiopulmonary exercise testing (CPET) with heart rates and physical activity in daily life. Methods21 Fontan patients and 20 age, sex and BMI matched controls underwent CPET and 5 days of daily life activity tracking with a triaxial accelerometer (wGT3x-BT, Actigraph) including heart rate monitoring with an optical heart rate sensor. Results27% of our Fontan teenagers and 71% of the Fontan adults reached the specific WHO recommendations for moderate to vigorous physical activity (MVPA) during everyday life (EDL), without differences to controls. There was a strong correlation between MVPA and _ VO 2peak for all Fontan patients (p = 0.0035, Pearson r = 0.788). Daily MVPA correlated to peak oxygen uptake and lactate production. Up to workloads of 2 W/kg and in daily life heart rates in Fontan patients were similar to controls. ConclusionsDaily MVPA is alarmingly low without any differences between Fontan patients and controls. Heart rate behaviour was similar and does not seem to be a limiting factor for physical activity in daily life. Higher intensity activities should be implemented regularly in EDL for Fontan patients. Proof is needed as to whether sports in moderate or possibly even in vigorous activity (e.g. high-intensity interval training) improve exercise capacity the most. PLOS ONE | https://doi.org/10.1371/journal.pone.

Physical activity modification in youth with congenital heart disease: a comprehensive narrative review

“…(26,29,31,33,34,37) In nine of the 18 (50%) studies, there were no statistically significant differences in PA level between children with CHD and age-matched healthy peers. (23,(26)(27)(28)(29)(30)(31)34) Of the remaining nine studies, four reported that children with CHD were generally more inactive than the control group(22, 24, 38) or than normative data. (35) The other studies were ambiguous or found diminished PA only in subgroups.…”

“…All studies reported PA level, either expressed as time in PA, exercise frequency, score on a PA scale or expended energy. In addition, eight studies described the proportion of individuals meeting national or international PA recommendations, (24,26,28,29,31,34,36,37) while six studies also reported on the time spent sedentary. (26,29,31,33,34,37) In nine of the 18 (50%) studies, there were no statistically significant differences in PA level between children with CHD and age-matched healthy peers.…”

“…In addition, eight studies described the proportion of individuals meeting national or international PA recommendations, (24,26,28,29,31,34,36,37) while six studies also reported on the time spent sedentary. (26,29,31,33,34,37) In nine of the 18 (50%) studies, there were no statistically significant differences in PA level between children with CHD and age-matched healthy peers. (23,(26)(27)(28)(29)(30)(31)34) Of the remaining nine studies, four reported that children with CHD were generally more inactive than the control group(22, 24, 38) or than normative data.…”

“…(33) The proportion of children with CHD reaching the prevailing national or international recommendations of minimum PA (at least 60 minutes a day for most countries) varied between studies, ranging from 7%(31) to 76%. (28) Six out of eight studies found that the proportion of children reaching these recommendations did not differ between children with CHD and either a control group (26,28,34,36) or regional estimates. (31,37) One study reported that 19% and 31% of the children after transposition of the great arteries and atrial septal defect/ventricular septal defect repair, respectively, reached national PA recommendations; significantly lower than 57% of controls.…”

“…(29) The six studies that report on the sedentary time of children with CHD are in agreement that these children spent the majority of time sedentary; up to 74% of monitored time. (34) However, four studies found no differences between children with CHD and controls, (29,33,34) two studies had no control group or normative data for comparison, (31,37) and one study actually reported less sedentary time in children with Fontan than healthy controls. 33Taken together, most of the studies on PA level in children with CHDespecially those…”