Cardiopulmonary cardiac fitness programmes: a new reality in paediatric heart disease

Exercise interventions through cardiac fitness programmes improve aerobic capacity and quality of life in paediatric patients with heart disease. The aim of this study was to characterise the landscape of paediatric cardiac fitness programmes via the Global Coalition for Fitness and Congenital Heart Disease (GloCo), an international network of experts providing exercise-based interventions for children and young adults with congenital and acquired heart disease. A survey was developed and distributed electronically to GloCo members and was completed by 40/53 individuals (response rate 75%), including 23 centres in 6 countries, predominantly US based. Programmes were similar with regard to duration, session frequency, and eligible patient populations but varied with regard to mode of delivery, equipment, incentives, funding sources, and cost. At the time of completion, 14 (61%) centres had enrolled at least 1 patient, and 4 (17%) centres were developing programmes. Respondents felt that cardiac fitness programmes are effective at improving quality of life/wellness (87%), cardiovascular fitness parameters (67%), and neuromuscular strength (47%) and that the most important outcomes were quality of life/wellness, exercise testing parameters, and strength/flexibility assessments. Paediatric cardiac fitness programmes focusing on exercise interventions represent a growing international field with diverse applications. Significant variability in their structure and implementation creates barriers to developing consensus guidelines and achieving standardised care. This study underscores this variability and the need for increased collaboration across centres. Multicentre research is essential to determining the optimal design of these programmes, which in turn will allow for the development of comprehensive, evidence-based guidelines.