Rehabilitation of children after total correction of tetralogy of Fallot

Calzolari, A.; Turchetta, Attilio; Biondi, Giuseppina; Drago, Fabrizio; Ranieri, Christine; Gagliardi, Maria Giulia; Giambini, Ilio; Giannico, Salvatore; Kofler, A.; Perrotta, Fabio Massimo; Santilli, Antonella; Vezzoli, P.; Ragonese, P; Marcelletti, Carlo

doi:10.1016/0167-5273(90)90055-a

Cited by 27 publications

(15 citation statements)

References 7 publications

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“…However, only seven of the clinical trials studied a homogenous population. 12,26,29,31,33,38,39 The structure of the rehabilitation programmes also varied considerably with regard to the intensity, frequency, and duration of exercise. Most early studies also limited their training programmes to aerobic exercises.…”

Section: Discussionmentioning

confidence: 99%

Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

et al. 2012

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Cardiac Rehabilitation Programmes in the paediatric population are greatly underutilised, and clinical research on this promising form of therapy has been limited. Questions remain regarding the optimal structure and efficacy of the programmes. The complex needs of this unique population also mandate that additional outcome measures, beyond serial cardiopulmonary exercise testing, be identified and studied.

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Section: Discussionmentioning

confidence: 99%

Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

et al. 2012

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“…As was pointed out by Cumming [12], these findings probably resulted in part from a greater maximal effort during the exercise but also from a better physical fitness of the Canadian children due to a greater level of physical activity in general compared to U.S. children. The importance of physical activity is also supported by subsequent training studies after ICR, which all showed improved physical performance after training [5,7,25,74], and by observations that patients who participate in varsity sports after ICR perform better than nonathletes [36,93].…”

Section: Work Performancementioning

confidence: 90%

“…If training is carried out at home, true verification of the training activity is a most difficult task. Nevertheless, four such studies were reported [5,7,25,74] involving a total of 30 patients (range 1-16). Duration of training varied from 6 to 12 weeks with two or three sessions per week of variable intensity.…”

Section: Exercise Training and Serial Studiesmentioning

confidence: 94%

Exercise Studies in Tetralogy of Fallot: A Review

Wessel

Paul

1999

Pediatr Cardiol

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Exercise evaluation of patients with congenital heart disease in general and tetralogy of Fallot in particular has had much less impact on clinical care than that of adults with coronary heart disease. Of over 4000 references on tetralogy of Fallot in the literature since 1965, only 87 involve exercise. These studies were reported from 56 institutions, with 39 originating from the United States and Canada, 40 from Europe, and 8 from Japan. They involved 3157 patients, studied mostly after intracardiac repair (ICR). In reviewing these data one is struck by the wide range of different approaches to exercise testing. This is in part related to the different purposes of each exercise study, but it also relates to the lack of uniform standards for exercise testing in patients with congenital heart disease. The studies involved maximal treadmill exercise and maximal or submaximal cycle ergometer work, in the upright or supine position, utilizing 52 different work protocols, the most common being the Bruce treadmill protocol (employed 27 times). Despite this lack of standardization exercise evaluation has significantly contributed understanding of the natural history and pathophysiology of surgically corrected tetralogy of Fallot. Work PerformanceThe majority of patients were asymptomatic when exercise tested, despite impaired exercise responses and significant residual cardiac pathology. This suggests that patient or parent assessment of physical work capacity does not correlate well with objective criteria of work performance, an impression confirmed in a study which specifically addressed this point [70]. Work capacity is best evaluated by maximal exercise. The data should be expressed as percentage of predicted known standards or simultaneously studied normal controls and/or in terms of the maximal oxygen uptake (VO 2max ), conventionally expressed in ml/min/kg body weight. For submaximal exercise tests only the determination of VO 2 at the ventricular anaerobic threshold (VAT) seems promising since VO 2 at VAT defines the limits of endurance performance and correlates well with VO 2max . Moreover, normal standards in children and adolescents have been reported [65].By objective criteria, work capacity remains markedly impaired after shunt palliation, with an average VO 2max of only 18 ml/min/kg [3,10]. In shunted patients work capacity is directly proportional to the magnitude of the systemic to pulmonary artery shunt and most limited in patients with the smallest pulmonary blood flow and the largest right-to-left shunt during exercise [24]. Following ICR there is marked improvement of the work capacity, which averaged 84.7 ± 8.8% in 20 studies (Tables 1 and 2). VO 2max averaged 36.4 ± 5.8 ml/min/kg in 45 studies, corresponding to 81% of 45 ml/min/kg, a reasonable estimate of VO 2max in untrained normal children and adolescents, as was also shown in 18 studies with normal controls (Table 2). Exercise performance varied considerably between studies. The poorest results after ICR were found in patients corrected as a...

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“…The slope of the treadmill is kept at 0%. The test lasts 6 minutes and measures the distance run in meters [9]. These specifications have an extremely important bearing on the later interpretation of the exercise test results in the new functional assessment after the rehabilitation protocol.…”

mentioning

confidence: 99%

“…The procedures used for maximal and submaximal functional assessment before and after the rehabilitation program must be identical [9,10,17,18]. In addition to repeating each examination in the protocol twice, the successful outcome of the pre-and postrehabilitation exercise test depends on two other factors.…”

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confidence: 99%

Exercise Testing as a Rehabilitative/Training Tool

Calzolari

Pastore

1999

Pediatr Cardiol

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Exercise testing is an exceedingly useful noninvasive method for assessing cardiovascular function not only at rest but also during programmed, supervised physical exercise. Exercise testing has been intensively studied to delineate the cardiovascular response in various disorders [3-5, 15, 19, 22, 23, 26, 32]. Exercise testing as a tool for rehabilitation and for training to perform physical activity is discussed here.

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Rehabilitation of children after total correction of tetralogy of Fallot

Cited by 27 publications

References 7 publications

Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

Exercise Studies in Tetralogy of Fallot: A Review

Exercise Testing as a Rehabilitative/Training Tool

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