Home-Based Physical Activity Program in Fontan Preteens
Is a home-based activity program safe and helpful in improving the quality of life (QOL) and physical functioning in children with Fontan circulation?
In this prospective single-center study, 14 children ages 8-12 years, palliated with the Fontan circulation (eight with a dominant right ventricle, two with lateral tunnel, seven with a patent fenestration), volunteered to participate in a 12-week home-based activity program. All recruits had normal or at most mildly depressed ventricular systolic contractility and aortic dimensions <4 cm on a recent imaging study. All were without exertional syncope, tachyarrhythmia, pacemaker or implantable defibrillator, or a noncardiac medical or psychiatric disorder precluding participation. Participants performed a 45-minute exercise regimen 3-4 times/week, self-reported and logged their activities, and attended three in-person sessions. Compliance was verified by reports from a personal activity monitor (FitBit FlexTM). QOL questionnaires were completed by participants and their guardians at the beginning and end of the 12-week program. Exercise capacity and V02max estimates were made based on performance on 20-meter shuttle run tests at increasing speeds using pre-recorded audio as a guide.
Thirteen subjects, whose activity logs were similar to FitBitTM data, completed the program without adverse effects. Parents (but not participants) reported improvements in QOL, with no change in resting and post-exercise vital signs, including oxygen saturations. Exercise capacity and V02max improved significantly from baseline, with a mean 22% improvement by 6 weeks for the former.
A home-based physical activity program is safe for preteen Fontan patients, with improvement in parent-reported QOL and objective measurements of exercise capacity and V02max.
Fontan survivors are at risk for QOL impairment, which worsens with age. (See related Journal Scan at: http://www.acc.org/latest-in-cardiology/journal-scans/2016/03/03/15/32/assessment-of-quality-of-life-in-young-patients-with-single-ventricle). Parental anxiety regarding child safety, contributing to the development of the ‘Vulnerable Child syndrome,’ may be an impediment to exercise participation and result in poor physical conditioning in children with chronic diseases, including those palliated for complex single ventricles. This is an important, innovative pilot study that demonstrates the safety and efficacy of a thoughtful exercise regimen that improves physical conditioning and parental perception of their child’s abilities and QOL. A home-based physician- and parent-approved program for preteens may improve compliance and foster habits that may continue onto adulthood, with the potential to impact modifiable factors, and possibly, long-term outcomes. Exercise ‘prescription,’ rather than ‘restriction’ may be just what some select patients need.
Keywords: Anxiety, Cardiac Surgical Procedures, Defibrillators, Implantable, Exercise, Fontan Procedure, Heart Defects, Congenital, Patient Compliance, Quality of Life, Secondary Prevention, Survivors, Syncope, Tachycardia
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