Exercise testing and prescription in patients with congenital heart disease (original) (raw)
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Exercise and training in adults with congenital heart disease
International Journal of Cardiology, 2004
Patients with congenital heart disease run the risk of overweight and low physical activity. Lifestyle measures are as important in these patients as in the general population. Exercise testing is an effective tool to identify patients in whom exercise may induce arrhythmias or hemodynamic instability but more often to reveal the safety of exercise, which is the conclusion in the majority of these patients. Systematic training programs have only been introduced to small groups of patients with congenital heart disease, and there are only few data on the effects obtained. The studies concluded that the exercise training programs used were safe. D
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2018
The aim of the study was to compare functional capacity in different types of congenital heart disease (CHD), as assessed by cardiopulmonary exercise testing (CPET). A retrospective analysis was performed of adult patients with CHD who had undergone CPET in a single tertiary center. Diagnoses were divided into repaired tetralogy of Fallot, transposition of the great arteries (TGA) after Senning or Mustard procedures or congenitally corrected TGA, complex defects, shunts, left heart valve disease and right ventricular outflow tract obstruction. We analyzed 154 CPET cases. There were significant differences between groups, with the lowest peak oxygen consumption (VO) values seen in patients with cardiac shunts (39% with Eisenmenger physiology) (17.2±7.1ml/kg/min, compared to 26.2±7.0ml/kg/min in tetralogy of Fallot patients; p<0.001), the lowest percentage of predicted peak VO in complex heart defects (50.1±13.0%) and the highest minute ventilation/carbon dioxide production slope i...
Exercise training in paediatric congenital heart disease: fit for purpose?
Archives of Disease in Childhood, 2021
Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.
Measures of exercise capacity in adults with congenital heart disease
International Journal of Cardiology, 2011
Background: Exercise capacity in grown-ups with congenital heart disease (GUCH) is mostly reported by peak oxygen consumption (peak VO 2 ). Our aim was to evaluate the maximal character of exercise tests, and to investigate submaximal measures of exercise capacity. Methods: Adults with Coarctation of the Aorta (COA, n = 155), Tetralogy of Fallot (TOF, n = 98), dextro-Transposition of the Great Arteries (dTGA, n = 68) and Univentricular Heart (UVH, n = 10), and 122 healthy adults performed cardiopulmonary exercise testing until exhaustion. Gas exchange was measured breath by breath. The maximal performance of the test was evaluated by respiratory exchange ratio (RER), ventilatory equivalent for oxygen and Borg scale. Oxygen uptake efficiency slope (OUES), VE/VCO 2 slope and VO 2 /WR slope were calculated and ventilatory anaerobic threshold (VAT) was defined. Correlations of these measures with peak VO 2 were calculated. Results: GUCH showed significantly lower peak VO 2 than controls (p b 0.001), declining from 80% in COA, 74% in TOF, 64% in dTGA, to 55% in UVH. Compared to suggested criteria, mean peak RER and median Borg scale indicated a maximal effort in GUCH, however these results were significantly lower than controls (p b 0.05). OUES, VO 2 /WR slope and VAT were significantly lower in patients compared to controls. OUES (r =0.853) and VAT (r = 0.840) correlated best with peak VO 2 ; VO 2 /WR slope (r =0.551) and VE/VCO 2 slope (r = −0.421) correlated to a lesser degree (p b 0.001). Conclusion: The investigated GUCH show reduced exercise tolerance compared to controls, related to the underlying heart defect. Different expressions of exercise tolerance clearly reveal the same differences in exercise capacity across groups of GUCH.
Exercise rehabilitation in congenital cardiac disease
Progress in Pediatric Cardiology, 1993
RJ, et al. An exercise program for pediatric patients with congenital heart disease: organizational and physiologic aspects. J Cardiac Rehabil. 1983;3:467-475. Vaccaro P, Galioto FM, Bradley LM, Hansen DA, Vaccaro J. Development of a cardiac rehabilitation program for children. Sports Med. 1984;1:259-262. Longmuir PE, Turner JA, Rowe RD, Olley PM. Postoperative exercise rehabilitation benefits children with congenital heart disease. Clin Invest Med. 1985; 8~232-238. Calzolari A, Turchetta A, Biondi G, et al. Rehabilitation of children after total correction of tetralogy of Fallot. Int 1 Cardiol. 1990;28:151-158. Peja M, Boros A, Toth A. Effect of physical training on children after reconstructive heart surgery. ON Hetil. 1990;131:2089-2090, Galioto FM. Cardiac rehabilitation for children. In: Garson A, Bricker JT, McNamara DG, eds. The Science and Practice of Pediatric Cardiology. Philadelphia, Pa: Lea and Febiger, 1990:2267-2273. Galioto FM. Exercise rehabilitation programs for children with congenital heart disease: a note of enthusiasm. Pediatr Exert Sci. 1990;2:197-200. Ensing G, Heise C, Driscoll D. Cardiovascular response to exercise after the Mustard operation for simple and complex transposition of the great vessels. Am ] Cardiol. 1988;62:617-622. Paridon SM, Humes RA, Pinsky WM. The role of chronotropic impairment during exercise after the
Pulmonary Function and Ventilatory Limitation to Exercise in Congenital Heart Disease
Congenital Heart Disease, 2009
Pulmonary function in older children and adolescents following surgical repair of congenital heart disease is often abnormal for various reasons. Many of these patients report symptoms of exercise intolerance although the reason(s) for this symptom can be complicated and sometimes interrelated. Is it simply deconditioning due to inactive lifestyle, chronotropic or inotropic insufficiency? or could there indeed be ventilatory limitation to exercise? These are the questions facing the clinician with the increasing frequency of patients undergoing repair early in life and growing into adulthood. Understanding pulmonary functional outcomes and means of determining ventilatory limitation to exercise is essential to thoroughly address the problem. This article reviews pulmonary function in patients with congenital heart disease and then describes a newer technique that should be applied to determine ventilatory limitation to exercise. This was not a systematic review of the literature. Articles were gleaned from the scant literature available, and their results were summarized in table form. References in each manuscript were checked to garner additional data. The aim was to review reports of PF in school-aged children and adults, i.e., patients capable of performing conventional spirometry. Thus, data pertaining to PF tests in infants or to gas exchange (e.g., lung diffusing capacity for carbon monoxide) were not 2
Exercise training in adults with congenital heart disease: Feasibility and benefits
International Journal of Cardiology, 2010
Background: Regular physical activity is associated with a range of health benefits; however the influence of regular exercise training on exercise capacity and quality of life in adults with congenital heart disease [ACHD] has not been previously reported. Methods: Prospective study of patients attending the ACHD clinic in a supra-regional centre, assessing feasibility and effects of exercise training. There were 3 phases: Phase I: Initial assessment including quality of life and physical activity questionnaires; treadmill exercise test; physical activity assessment with accelerometers [Caltrac ® and Actigraph ® ]; Phase II: Exercise training (home-based walking 5/7 days) for 10 weeks; Phase III: Re-assessment. Results: Sixty-one adults [36 males; mean age 31.7 +/− 10.9 yrs] were divided into 3 groups according to NYHA class. Fifty patients completed the intervention and all pre-post assessments. Group I (n = 21; 13 males), Group II (n = 16; 10 males), Group III (n = 13, 10 males). Median body mass index was 23.8; 12 were overweight (BMI 25-29.9) and 7 obese (BMI N 30).
Cureus Journal of Medical Sciences, 2022
Public health guidelines and a myriad of studies have proven that exercise is beneficial in the alleviation of various cardio-metabolic diseases. Congenital heart disease (ConHD) is one of the most frequently occurring congenital structural malfunctions in the pediatric population, affecting nine of every 1,000 live births. Only a few studies have established the impact of a structured exercise program on cardiopulmonary fitness in diverse groups of patients with ConHD. It is also alarming to know that a substantial number of these patients and their caregivers often remain very wary of exercise. Anxiety about exercise may increase the risk of developing morbid obesity and other long-term health complications of ConHD. The present review of a critically appraised topic is undertaken to answer the question, "Does structured exercise intervention (cardiac rehabilitation) improve cardiorespiratory fitness in children and young adults with ConHD?" Exercise science and the medical literature were searched for studies that engaged the use of aerobic exercise in patients with different ConHD diagnoses. The search yielded four studies after screening with the inclusion and exclusion criteria, which were further narrowed to three studies after a full-text review. These studies yielded results showing significant increments in peak exercise workload, duration, power output, peak oxygen uptake, or improved tissue oxygenation and muscle strength after an exercise training intervention. It is noteworthy that a group identified as "cyanotic palliated" exhibited the most significant impairment both at baseline and after the exercise intervention. This review provides level 1b medical evidence that a structured exercise program may improve cardiopulmonary fitness in patients with ConHD, which is likely to be beneficial to their overall physical, motor, and psychosocial development. The results of this review may be useful for alleviating the anxiety of patients and their caregivers about participation in structured exercise programs. This review should also motivate future research investigations to develop clinical guidelines for the management of patients with ConHD by adding exercise prescriptions to their daily therapeutic regimens.