Effects of Exercise Training in Patients With Fontan Circulation: A Systematic Review and Meta-Analysis.

Area of Science:

• Cardiology
• Pediatric Cardiology
• Exercise Physiology

Background:

• Improved long-term survival post-Fontan operation highlights the importance of exercise capacity.
• Exercise capacity is a critical prognostic factor in Fontan circulation patients.
• Various rehabilitation programs exist, necessitating a comparative analysis.

Purpose of the Study:

• To systematically review and meta-analyze the effects of exercise rehabilitation in Fontan circulation patients.
• To compare outcomes based on patient age group and exercise modality.
• To assess the impact on peak oxygen consumption (VO₂) and VE/VCO₂ slope.

Main Methods:

• Searched PubMed, Embase, and Cochrane Library databases up to November 2023.
• Included 20 studies (5 RCTs, 2 randomized trials, 13 cohort studies).
• Performed meta-analysis on peak oxygen consumption (VO₂) and VE/VCO₂ slope.

Main Results:

• Exercise training significantly improved peak VO₂ compared to controls (SMD, 0.48; p=0.0017) and pre-post training (SMD, 0.44; p=0.001).
• No significant changes were observed in VE/VCO₂ slope.
• Subgroup analyses showed significant peak VO₂ improvements with aerobic exercise (SMD, 0.32; p=0.0136) and in pediatric groups (SMD, 0.49; p<0.05).

Conclusions:

• Exercise training effectively enhances exercise capacity in post-Fontan patients.
• Aerobic exercise interventions are particularly beneficial.
• Initiating exercise rehabilitation at a younger age yields superior outcomes.