Cardiopulmonary Rehabilitation Improves Respiratory Muscle Function and Functional Capacity in Children with Congenital Heart Disease. A Prospective Cohort Study

Abstract

Critical surgical and medical advances have shifted the focus of congenital heart disease (CHD) patients from survival to achievement of a greater health-related quality of life (HRQoL). HRQoL is influenced, amongst other factors, by aerobic capacity and respiratory muscle strength, both of which are reduced in CHD patients. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on respiratory muscle strength and functional capacity. Fifteen CHD patients, ages 12 to 16, with reduced aerobic capacity in cardiopulmonary exercise testing (CPET) were enrolled in a CPRP involving strength and aerobic training for three months. Measurements for comparison were obtained at the start, end, and six months after the CPRP. A significant improvement of inspiratory muscle strength was evidenced (maximum inspiratory pressure 21 cm H2O, 23%, p < 0.01). The six-minute walking test showed a statistically and clinically significant rise in walked distance (48 m, p < 0.01) and a reduction in muscle fatigue (1.7 out of 10 points, p = 0.017). These results suggest CPRP could potentially improve respiratory muscle function and functional capacity, with lasting results, in children with congenital heart disease, but additional clinical trials must be conducted to confirm this finding.

Effects of Cardiopulmonary Rehabilitation on the Muscle Function of Children with Congenital Heart Disease: A Prospective Cohort Study

“…Even though some studies have measured the effect of a CPRP in children with CHD, very few have evaluated muscle function. Our group previously evaluated the benefits of cardiac training on respiratory muscle strength in this population, finding an improvement in the Maximum Static Inspiratory Pressure and the distance achieved in a 6 min walking test [27]. Other groups such as Moalla et al have observed a significant increase in the maximal voluntary contraction, despite being a home-based intervention [34].…”

“…To complement the training and to provide the patient with a recreational component, the last sessions sporadically included virtual reality games. (d) Respiratory-training phase (20 min): as a final phase of muscular training, a respiratory musculature workout was performed using an Inspiratory Muscle Trainer Threshold (Respironics Respiratory Drug Delivery, Chichester, UK), working at least 30% of the subjects' Maximum Static Inspiratory Pressure [27]. (e) Cool-down phase (5 min): this included a light walk and body stretching.…”

Peripheral and respiratory muscle strength in children and adolescents with CHD: systematic review and meta-analysis

“…Twelve articles assessed peripheral muscle strength 18,[26][27][28][29][30][31][32][33][34][35][36] and three assessed respiratory muscle strength. 5,8,37 The total sample size of the included studies was 1769. 5,8,18,[26][27][28][29][30][31][32][33][34][35][36][37] The studies comparing patients with CHD and healthy controls included 1202 participants in total, 27,33,34,36 and the studies only included patients with CHD had a total number of 567 participants.…”

“…5,8,37 The total sample size of the included studies was 1769. 5,8,18,[26][27][28][29][30][31][32][33][34][35][36][37] The studies comparing patients with CHD and healthy controls included 1202 participants in total, 27,33,34,36 and the studies only included patients with CHD had a total number of 567 participants. 5,8,18,26,[28][29][30][31][32]35,37 Regarding the studies with evaluation only of patients with CHD, the majority had undergone at least one surgical procedure and submitted it to cardiac training or rehabilitation.…”

“…4 Moreover, the majority of heart defects require surgical intervention, and impairments have been linked to the severity of CHD, the number of surgical, and complications after the procedures. 5,6 Muscle strength can be considered a variable that is related to physical fitness and health status, and a decrease can be associated with significant functional limitations. 7 In adults with CHD, peripheral muscle strength can be considered a predictor of overall strength; however, there are a few reports in paediatric patients.…”