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Exercise Capacity and Training Programs in Paediatric Fontan Patients: A Systematic Review
Jessica E Herrmann1, Elif Seda Selamet Tierney1,2
1Department of Pediatrics/Cardiology, Stanford University School of Medicine, Stanford, California, USA.
Insights
Exercise training programs safely improve exercise capacity in pediatric Fontan patients. This systematic review found significant improvements in exercise measures with no adverse events in these young individuals with congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Exercise Physiology
- Congenital Heart Disease
Background:
- Adults with congenital heart disease, including Fontan patients, benefit from exercise training.
- Limited research exists on exercise training's impact on pediatric Fontan populations.
- This study reviews exercise capacity and training effects in children with Fontan physiology.
Purpose of the Study:
- To systematically review exercise capacity in pediatric Fontan patients.
- To assess the impact of exercise training programs on cardiovascular health in this cohort.
Main Methods:
- Searched Medline and Embase databases (1990-2021).
- Included studies with pediatric Fontan patients (≤20 years).
- Extracted cardiopulmonary exercise parameters and training protocols.
Main Results:
- Fontan patients showed significantly lower peak exercise capacity than healthy peers.
- Nine training programs exclusively for pediatric Fontan patients were identified.
- All analyzed programs showed significant improvements in exercise capacity without adverse events.
Conclusions:
- Exercise training programs can safely and effectively enhance exercise capacity in pediatric Fontan patients.
- Improvements were observed in maximal and submaximal exercise measures.
- Further research supports incorporating exercise interventions for this population.
Background:
Exercise training programs can effectively enhance exercise capacity in adults with congenital heart disease, including Fontan patients. However, few studies have explored the impact of exercise training exclusively on paediatric Fontan cohorts. This study systematically reviews exercise capacity in paediatric Fontan patients and the impact of training programs on their cardiovascular health.
Methods:
Medline and Embase were searched for articles published between January 1990 and November 2021. Studies were included in which data could be analyzed discretely for patients who had undergone the Fontan procedure and were ≤20 years old at the time of study. Cardiopulmonary exercise parameters were extracted from all studies, and training protocols were collected from training programs.
Results:
The studies demonstrated that Fontan patients exhibit significantly diminished peak exercise capacity relative to healthy peers. We identified 9 training programs that exclusively studied Fontan patients ≤20 years. The programs ranged from 6 weeks to 12 months in duration, with 8 programs incorporating aerobic activity and 1 focused only on inspiratory muscle training. At least 1 measure of maximal or submaximal exercise capacity improved significantly within each program in which statistical analysis was performed, with no reported adverse events. There were 2 additional training programs in which the patients were predominantly (>65%), but not exclusively, Fontan patients.
Conclusions:
Overall, the results indicate that exercise training programs can safely and effectively improve at least 1 measure of exercise capacity in paediatric Fontan patients.
