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Published on: February 22, 2022
Safety and feasibility of inpatient exercise training in pediatric heart failure: a preliminary report
Michael G McBride1, Tracy Jo Binder, Stephen M Paridon
1Divisions of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. mcbride@email.chop.edu
Insights
Pediatric heart transplant candidates on inotropic support can safely undergo inpatient exercise training. This program demonstrated moderate to high compliance with minimal adverse events, improving patient conditioning.
Area of Science:
- Cardiology
- Pediatric Medicine
- Exercise Physiology
Background:
- Children with end-stage heart disease often require heart transplantation.
- Limited data exist on inpatient exercise programs for pediatric heart transplant candidates on inotropic support.
Purpose of the Study:
- To assess the safety and feasibility of an inpatient exercise training program.
- To evaluate participation in exercise for pediatric heart transplant candidates receiving inotropic support.
Main Methods:
- Twenty pediatric patients awaiting heart transplantation were enrolled.
- Patients received a combination of dobutamine, dopamine, or milrinone.
- Exercise sessions included aerobic and musculoskeletal conditioning three times weekly.
Main Results:
- Over 6 months, 1,251 exercise sessions were completed (83% compliance).
- Two seizures occurred, but neither led to program termination.
- No significant hypotension, arrhythmias, or IV access complications were observed.
Conclusions:
- Inpatient exercise training is safe for pediatric heart transplant candidates on inotropic support.
- Moderate to high compliance is achievable in this patient population.
- Exercise programs can be beneficial for conditioning these critically ill children.
Purpose:
To determine the safety and feasibility of an inpatient exercise training program for a group of pediatric heart transplantation candidates on multiple inotropic support.
Background:
Children with end-stage heart disease often require heart transplantation. Currently, no data exist on the safety and feasibility of an inpatient exercise training program in pediatric patients awaiting heart transplantation while on inotropic support.
Methods:
Twenty ambulatory patients (11 male; age, 13.6 +/- 3.2 years) were admitted, listed, and subsequently enrolled into an exercise training program while awaiting heart transplantation. Patient diagnoses consisted of dilated cardiomyopathy (n = 15), restrictive cardiomyopathy (n = 1), and failing single-ventricle physiology (n = 4). Inotropic support consisted of a combination of dobutamine, dopamine, or milrinone. Exercise sessions were scheduled three times a week lasting from 30 to 60 minutes and consisted of aerobic and musculoskeletal conditioning.
Results:
Over 6.2 +/- 4.2 months, 1,251 of a possible 1,508 exercise training sessions were conducted, with a total of 615 hours (26.3 +/- 2.7 min/session) dedicated to low-intensity aerobic exercise. Reasons for noncompliance included a change in medical status, staffing, or patient cooperation. Two adverse episodes (seizures) occurred, neither of which resulted in termination from the program. No adverse episodes of hypotension or significant complex arrhythmias occurred. No complication of medication administration or loss of intravenous access occurred.
Conclusion:
Data from this study indicate that pediatric patients on inotropic support as a result of systemic ventricular or biventricular heart failure can safely participate in exercise training programs with relatively moderate to high compliance.
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