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[Cardiac rehabilitation in children. Interdisciplinary approach]
A Calzolari1, E Pastore, G Biondi
1Servizio di Medicina dello Sport, Ospedale Bambino Gesù, Roma.
Insights
Pediatric cardiac rehabilitation, a supervised exercise program, enhances aerobic fitness and quality of life in children with complex heart conditions. It improves exercise capacity and psychosocial integration, enabling safe athletic participation.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Rehabilitation
- Exercise Physiology
Context:
- Cardiac rehabilitation is crucial for children with repaired complex congenital heart diseases.
- These children often experience residual functional and psychological challenges.
- Supervised, progressive exercise training is the core of rehabilitation.
Purpose:
- To enhance exercise efficiency, aerobic capacity, and overall quality of life.
- To decrease the incidence of sudden cardiac death in young patients.
- To facilitate safe and effective participation in athletic activities.
Summary:
- Guidelines for organizing pediatric cardiac rehabilitation programs include protected environments, functional evaluation, and specific session protocols.
- The psychosocial aspect is vital for social integration and improved quality of life, though challenging to quantify.
- A global census revealed limited pediatric cardiac rehabilitation centers, with Italy having only two.
Impact:
- Personal experience with 20 patients showed increased exercise capacity, cardiac output, O2 uptake, and exercise duration post-rehabilitation.
- The study underscores the benefits of cardiac rehabilitation programs.
- Highlights the necessity of an interdisciplinary approach and larger case series for further research.
Abstract:
The concept of rehabilitation has been defined by the authors as a supervised process of progressive exercise training to improve aerobic fitness. Cardiac rehabilitation in children should be dedicated to patients with repaired complex congenital heart diseases who have residual functional and psychological problems. The basic objectives for rehabilitation are defined: to improve exercise efficiency, aerobic capacity and quality of life, to reduce the incidence of sudden death, to enable young patients to take part safely and effectively in athletics. The guidelines for organising a cardiac rehabilitation programme are specified. First of all the need of protected environments, functional evaluation before starting the programme, the description of the rehabilitation session and staff needed. Equally important is the psychosocial aspect. It is difficult to quantify, in a scientific manner, the effectiveness of psychosocial intervention, but it helps the children to integrate into social life thus enhancing their quality of life. The results of a census of 110 world-wide centres offering regular cardiac rehabilitation programmes are presented. Italy currently has only two centres suitable for pediatric cardiac rehabilitation: they treat a small number of patients. Personal experience, with 20 patients, agrees with that of Galioto, about an increase in exercise capacity of these patients after rehabilitation programme, with an increased cardiac output at rest and at peak of exercise, an increased O2 uptake and an increased duration of exercise testing. The usefulness of cardiac rehabilitation programmes, the need of interdisciplinary approach and increasing the case series are stressed.