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Home- and hospital-based exercise training programme after Fontan surgery

Published online by Cambridge University Press:  28 August 2018

Nigel Sutherland
Affiliation:
Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Vic, Australia Murdoch Childrens Research Institute, Melbourne, Vic, Australia
Bryn Jones
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia Department of Cardiology, The Royal Children’s Hospital, Melbourne, Vic, Australia
Sofia Westcamp Aguero
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Cardiology, The Royal Children’s Hospital, Melbourne, Vic, Australia
Tristan Melchiori
Affiliation:
Department of Physiotherapy, The Royal Children’s Hospital, Melbourne, Vic, Australia
Karin du Plessis
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia
Igor E. Konstantinov
Affiliation:
Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Vic, Australia Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
Michael M. H. Cheung
Affiliation:
Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia Department of Cardiology, The Royal Children’s Hospital, Melbourne, Vic, Australia
Yves d’Udekem*
Affiliation:
Cardiac Surgery Department, Royal Children’s Hospital, Melbourne, Vic, Australia Murdoch Childrens Research Institute, Melbourne, Vic, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Vic, Australia
*
Author for correspondence: Professor Y. d’Udekem, MD, PhD, Department of Cardiac Surgery, Royal Children’s Hospital, 50 Flemington Road, Parkville, Melbourne, Vic 3052, Australia. Tel: +61 3 9345 6410; Fax: +61 3 9345 6001; E-mail: yves.dudekem@rch.org.au

Abstract

Background

Exercise training has been shown to increase exercise capacity in survivors of Fontan surgery. The geographic distribution of the Fontan population has been a barrier to hospital-based exercise training programmes. The objective of this study was to establish whether a home exercise training programme could achieve similar improvements to a hospital programme.

Methods

Adolescents with a Fontan circulation aged 12–19 years were prospectively recruited in a hospital or home exercise training programme. Patients underwent cardiopulmonary exercise testing and completed the Paediatric Quality of Life Inventory at initial assessment and after completion of an 8-week programme. Both groups performed two 1-hour training sessions per week. Patients in the home training programme had their first session in the hospital, and then progressed independently with one phone consult per week and one home visit by a physiotherapist.

Results

In total, 17 patients, with a mean age of 15±3 years, completed the training programme (six hospital). Characteristics and baseline performance of patients were similar in both groups. Oxygen consumption at anaerobic threshold increased from 19.3±3.8 to 21.6±6.0 ml/kg/minute (p=0.02) and peak oxygen pulse increased from 8.8±2.5 to 9.5±2.7 ml/beat (p=0.049). Total quality of life scale improved from 68 to 74% (p=0.01) and psychosocial health improved from 67 to 74% (p=0.02). No patient experienced training-related complications.

Conclusions

Exercise training is beneficial and most likely safe after Fontan, resulting in improved exercise capacity and self-reported quality of life. Home exercise training programmes are probably as effective as hospital programmes. Home exercise training programmes should be integrated in the follow-up care of patients undergoing Fontan surgery.

Type
Original Article
Copyright
© Cambridge University Press 2018 

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