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Updated: Jun 6, 2025

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Cardiac Rehabilitation for Fontan Circulation Patients: A Systematic Review, and Meta-Analysis.

Luna van de Ven¹, Ana Clara Félix², Joana Suarez²

¹Department of Paediatric Cardiology, Children's Hospital, University Medical Center Utrecht, P.O. Box 85090, AB 3508 Utrecht, The Netherlands.

Medicina (Kaunas, Lithuania)

|November 27, 2024

Summary

Cardiac rehabilitation (CR) improves exercise capacity in Fontan patients, especially with combined aerobic exercise training (AET) and resistance training. Home-based programs show promise but require cautious interpretation due to potential publication bias.

Keywords:

Fontan circulation aerobic exercise cardiac rehabilitation exercise training meta-analysis systematic review univentricular heart

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Published on: August 16, 2021

Area of Science:

Cardiology
Exercise Physiology
Rehabilitation Medicine

Background:

Patients with Fontan circulation experience impaired exercise capacity and quality of life despite surgical advances.
Exercise-based cardiac rehabilitation (CR) is a potential intervention, but its implementation and adherence are inconsistent.
This study systematically reviews and meta-analyzes the safety and efficacy of CR for Fontan patients.

Approach:

A systematic literature search was conducted across major databases (PubMed, Scopus, Web of Science, Cochrane Library).
Study quality was assessed using Cochrane RoB Tool 2 and STROBE checklist.
Meta-analysis employed a continuous random-effects model to evaluate aerobic exercise training (AET), resistance training, and inspiratory muscle training (IMT).

Key Points:

CR significantly improved exercise capacity (peak VO2) in Fontan patients (pooled mean difference: 1.947).
Combined AET and resistance training demonstrated the most significant benefits (mean difference: 2.11).
Home-based interventions showed significant benefits, though publication bias was noted; supervised and hybrid interventions did not show statistically significant differences.

Conclusions:

Cardiac rehabilitation, particularly combining AET with resistance training, is effective for enhancing exercise capacity in Fontan patients.
Home-based CR programs yield promising results, but findings require cautious interpretation due to potential publication bias in smaller studies.
Further research is needed to optimize protocols, assess long-term outcomes, and understand mechanisms, especially in severe cases, reinforcing the safety of CR.