Exercise Training Improves Exercise Capacity in Adult Patients With a Systemic Right Ventricle: A Randomized Clinical Trial

Study Questions:

Does exercise training in adults with a systemic right ventricle (RV) improve exercise capacity and quality of life, and lower serum N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels?

Methods:

A randomized controlled trial was performed at three centers. The patient population included adults with congenitally corrected as well as surgically palliated transposition of the great arteries (TGA). Patients with New York Heart Association (NYHA) functional class III or IV were excluded. The exercise protocol consisted of 32 minutes of step aerobics interval training three times per week for 10 consecutive weeks. Patients exercised to 90% of maximum heart rate based on prerandomization exercise testing. Perceived health status was measured with the short form-36 (SF-36) instrument, while quality of life was measured with the TAAQOL instrument, which was specifically designed to study quality of life in adults with congenital heart disease. Patients underwent exercise testing, measurement of NT-proBNP, and assessment of quality of life at enrollment and after the study period.

Results:

A total of 46 patients participated, including 24 in the intervention group and 22 in the control group. Patients in the intervention group showed improvement in peak VO2 (27 ± 7 ml/kg/min to 29 ± 7 ml/kg/min) and reduction in resting systolic blood pressure (115 ± 12 mm Hg to 109 ± 12 mm Hg). There was no difference in perceived health status, quality of life, or NT-proBNP levels. None of the patients in the intervention group discontinued the training protocol because of adverse events.

Conclusions:

The authors concluded that in adult patients with a systemic RV, exercise training improves exercise capacity.

Perspective:

This study demonstrates a positive impact of exercise training on adults with systemic RVs. Both patients with congenitally corrected transposition and D-TGA following atrial switch procedures were included in this study. While these patient populations are similar in that the RV functions as the systemic ventricle, the natural histories of these groups are not likely the same. However, this limitation is mitigated by the equal distribution of congenitally corrected TGA and atrial switch patients in the control and treatment groups. An additional limitation of the study is the exclusion of NYHA class III and IV patients, which precludes its generalizability to more symptomatic patients. Importantly, this study showed safety of activity in this patient population.

Clinical Topics: Anticoagulation Management, Congenital Heart Disease and Pediatric Cardiology, Congenital Heart Disease, CHD & Pediatrics and Prevention

Keywords: Heart Diseases, Heart Atria, Heart Defects, Congenital, Quality of Life, Transposition of Great Vessels, Peptide Fragments, Blood Pressure, Heart Rate, Heart Ventricles, Exercise Test, Natriuretic Peptide, Brain


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