Exercise prescription improves exercise tolerance in young children with CHD: a randomised clinical trial

Abstract

Objective: The main objective of this study was to ascertain if a structured intervention programme can improve the biophysical health of young children with congenital heart disease (CHD). The primary end point was an increase in measureable physical activity levels following the intervention.

Methods: Patients aged 5-10 years with CHD were identified and invited to participate. Participants completed a baseline biophysical assessment, including a formal exercise stress test and daily activity monitoring using an accelerometer. Following randomisation, the intervention group attended a 1 day education session and received an individual written exercise plan to be continued over the 4-month intervention period. The control group continued with their usual level of care. After 4 months, all participants were reassessed in the same manner as at baseline.

Results: One hundred and sixty-three participants (mean age 8.4 years) were recruited, 100 of whom were male (61.3%). At baseline, the majority of the children were active with good exercise tolerance. The cyanotic palliated subgroup participants, however, were found to have lower levels of daily activity and significantly limited peak exercise performance compared with the other subgroups. One hundred and fifty-two participants (93.2%) attended for reassessment. Following the intervention, there was a significant improvement in peak exercise capacity in the intervention group. There was also a trend towards increased daily activity levels.

Conclusion: Overall physical activity levels are well preserved in the majority of young children with CHD. A structured intervention programme significantly increased peak exercise capacity and improved attitudes towards positive lifestyle changes.

Keywords: cardiac rehabilitation; congenital; heart defects; obesity.

Figure 1

Participant undergoing exercise stress test with ECG and oxygen saturation monitoring attached.

Figure 2

Schedule for Fit Kids for Healthy Hearts education day.

Figure 3

Consolidated Standards of Reporting Trials flow diagram demonstrating participant progression through the study.

Figure 4

Marginal means plots demonstrating (A) maximum power output (W), (B) exercise stress test duration (min), (C) average daily moderate to vigorous activity (min), (D) average daily step count at baseline and reassessment for both study groups.