Abstract
Introduction: Patients after Fontan operation for complex congenital heart disease (CHD) have reduced exercise capacity and health-related quality of life (HRQOL). Studies suggest hospital-based cardiac rehabilitation programs can improve exercise capacity and HRQOL in patients with CHD; however, these programs have variable adherence rates. The impact of a home-based cardiac rehabilitation program in Fontan survivors is unclear. This pilot study evaluated the safety, feasibility, and benefits of an innovative home-based physical activity program on HRQOL in Fontan patients. Methods: A total of 14 children, 8-12 yr, with Fontan circulation enrolled in a 12-week moderate/high intensity home-based cardiac physical activity program, which included a home exercise routine and 3 formal in-person assessments at 0, 6, and 12 weeks. Subjects and parents completed validated questionnaires to assess HRQOL. The Shuttle Test Run was used to measure exercise capacity. A Fitbit® Flex Activity Monitor was used to assess adherence to the home activity program. Results: Of the 14 subjects, 57% were male and 36% had a dominant left ventricle. Overall, 93% completed the program. There were no adverse events. Parents reported improvement in their child’s overall HRQOL (p<0.01), physical function (p<0.01), school function (p=0.01), and psychosocial function (p<0.01). Exercise capacity, measured by Shuttle Run time, improved progressively from baseline to the 6 and 12 week follow up sessions (Figure). Monthly Fitbit® data suggested good adherence to the program. Conclusion: This 12-week home-based cardiac physical activity program is safe and feasible in Fontan patients. Parent proxy-reported HRQOL and objective measures of exercise capacity significantly improved. A 6 month follow up session is scheduled to assess sustainability. A larger study is anticipated to determine applicability and reproducibility of these findings in other age groups and forms of complex CHD.
Published Version
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