Relationship Between Habitual Exercise and Performance on Cardiopulmonary Exercise Testing Differs Between Children With Single and Biventricular Circulations

Abstract

Background Increasing habitual exercise has been associated with improved cardiopulmonary exercise testing (CPET) performance, specifically maximal oxygen consumption in children with operatively corrected congenital heart disease. This has not been studied in children following Fontan palliation, a population in whom CPET performance is dramatically diminished. Methods A single-center cross-sectional study with prospective and retrospective data collection was performed that assessed habitual exercise preceding a clinically indicated CPET in children and adolescents with Fontan palliation, transposition of the great arteries following arterial switch operation (TGA), and normal cardiac anatomy without prior operation. Data from contemporaneous clinical reports and imaging studies were collected. The association between percent predicted VO2max and habitual exercise duration adjusted for known covariates was tested. Results A total of 175 subjects (75 post Fontan, 20 with TGA, and 80 with normal cardiac anatomy) were enrolled. VO2max was lower in the Fontan group than patients with normal cardiac anatomy (p<0.0001) or TGA (p<0.0001). In Fontan subjects, both univariate and multivariate analysis failed to demonstrate a significant association between habitual exercise and VO2max (p=0.6), in sharp contrast to cardiac normal subjects. In multivariate analysis, increasing age was the only independent risk factor associated with decreasing VO2max in the Fontan group (p=0.003). Discussion Habitual exercise was not associated with VO2max in subjects with a Fontan as compared to biventricular circulation. Further research is necessary to understand why their habitual exercise is ineffective and/or what aspects of the Fontan circulation disrupt this association.

Impaired lung function in children and adolescents with Fontan circulation may improve after endurance training

“…This has also been reported by other researchers who may have had too short duration of the intervention (95) hoping that the children would enjoy and continue exercising after the intervention. We did not find a correlation between maximal exercise capacity and quality of life, in line with the study by O'Byrne et al (97). Our results suggest that submaximal exercise capacity is more important for quality of life and, thus, well-being, rather than maximal exercise capacity.…”

Mismatch between self-estimated and objectively assessed exercise capacity in patients with congenital heart disease varies in regard to complexity of cardiac defects

“…Reduced peak oxygen uptake in patients with CHD has previously been described by various studies. 3,[7][8][9][10][11] We could see that in patients with complex cardiac defects, peak oxygen uptake as percentage of reference values was significantly lower than in the group of non-complex defects. There were also differences between the groups separated by diagnosis, in which peak oxygen uptake showed a similar distribution as in the study by Kempny et al, with lowest values seen in patients with Fontan circulation.…”

“…5,6 Multiple studies have shown a reduced cardiopulmonary exercise capacity amongst patients with CHD. 3,[7][8][9][10][11] This phenomenon can in part be traced back to consequences of the cardiac defect itself or its surgical or medical therapy, for example valve stenosis or insufficiencies, 3 stenosis of vessels as in coarctation of the aorta or Tetralogy of Fallot, 12 multiple thoracotomies, 13 or chronotropic incompetence under medical beta-blockade 14 or following Fontan procedure. 15 However, a lack of physical activity amongst these patients has also been identified as part of the reason for their reduced cardiopulmonary exercise capacity.…”

Association of Habitual Activity and Body Mass Index in Survivors of Congenital Heart Surgery: A Study of Children and Adolescents With Tetralogy of Fallot, Transposition of the Great Arteries, and Fontan Palliation

“…Subjects underwent contemporaneous clinical assessment, review of medical history and testing as described previously 15 . The exercise questionnaire has been validated 16 and its application to children and adolescents has been described previously 15,17 . The second study included children and adolescents age 8–17.5 years with 1) transposition of the great arteries following an arterial switch operation (TGA) and 2) single ventricle heart disease who had undergone operative palliation culminating in a Fontan completion who were recruited prospectively between 3/1/2012–12/31/2013 at the time of a clinically indicated cardiopulmoanry exercise test 18 .…”