Skip to main content Accessibility help
×
Home

Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

  • Ana Ubeda Tikkanen (a1), Ainhoa Rodriguez Oyaga (a2), Olga Arroyo Riaño (a2), Enrique Maroto Álvaro (a3) and Jonathan Rhodes (a1)...

Abstract

Background

Advances in medical and surgical care have contributed to an important increase in the survival rates of children with congenital heart disease. However, survivors often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac Rehabilitation Programmes have been extensively studied in adults with acquired heart disease. In contrast, studies of children with congenital heart disease have been few and of limited scope. We therefore undertook a systematic review of the literature on cardiac rehabilitation in children with congenital heart disease to systematically assess the current evidence regarding the use, efficacy, benefits, and risks associated with this therapy and to identify the components of a successful programme.

Methods

We included studies that incorporated a cardiac rehabilitation programme with an exercise training component published between January, 1981 and November, 2010 in patients under 18 years of age.

Results

A total of 16 clinical studies were found and were the focus of this review. Heterogeneous methodology and variable quality was observed. Aerobic and resistance training was the core component of most studies. Diverse variables were used to quantify outcomes. No adverse events were reported.

Conclusions

Cardiac Rehabilitation Programmes in the paediatric population are greatly underutilised, and clinical research on this promising form of therapy has been limited. Questions remain regarding the optimal structure and efficacy of the programmes. The complex needs of this unique population also mandate that additional outcome measures, beyond serial cardiopulmonary exercise testing, be identified and studied.

Copyright

Corresponding author

Correspondence to: Dr A. Ubeda Tikkanen, Childrens Hospital of Boston, 300 Longwood Avenue, Boston, Massachusetts 02115, United States of America. Tel: +1 617 817 4941; Fax: +1 617 734 9930; E-mail: Ana.UbedaTikkanen@cardio.chboston.org

References

Hide All
1.Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 18901900.
2.Canobbio, MM. Health care issues facing adolescents with congenital heart disease. J Pediatr Nurs 2001; 16: 363370.
3.Casey, FA, Sykes, DH, Craig, BG, Power, R, Mulholland, HC. Behavioral adjustment of children with surgically palliated complex congenital heart disease. J Pediatr Psychol 1996; 21: 335352.
4.Reybrouck, T, Rogers, R, Weymans, M, et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr 1995; 154: 801806.
5.Cooper, DS, Jacobs, JP, Chai, PJ, et al. Pulmonary complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the multi-societal database committee for pediatric and congenital heart disease. Cardiol Young 2008; 18 Suppl 2: 215221.
6.Bird, GL, Jeffries, HE, Licht, DJ, et al. Neurological complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the multi-societal database committee for pediatric and congenital heart disease. Cardiol Young 2008; 18 Suppl 2: 234239.
7.Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Functional limitations in young children with congenital heart defects after cardiac surgery. Pediatrics 2001; 108: 13251331.
8.Imms, C. Occupational performance challenges for children with congenital heart disease: a literature review. Can J Occup Ther 2004; 71: 161172.
9.Linde, LM. Psychiatric aspects of congenital heart disease. Psychiatr Clin North Am 1982; 5: 399406.
10.Casey, FA, Stewart, M, McCusker, CG, et al. Examination of the physical and psychosocial determinants of health behaviour in 4–5-year-old children with congenital cardiac disease. Cardiol Young 2010; 20: 532537.
11.Thijssen, DH, Maiorana, AJ, O'Driscoll, G, Cable, NT, Hopman, MT, Green, DJ. Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol 2010; 108: 845875.
12.Somarriba, G, Extein, J, Miller, TL. Exercise rehabilitation in pediatric cardiomyopathy. Prog Pediatr Cardiol 2008; 25: 91102.
13.Fernandes, SM, McElhinney, DB, Khairy, P, Graham, DA, Landzberg, MJ, Rhodes, J. Serial cardiopulmonary exercise testing in patients with previous Fontan surgery. Pediatr Cardiol 2010; 31: 175180.
14.Giardini, A, Specchia, S, Tacy, TA, et al. Usefulness of cardiopulmonary exercise to predict long-term prognosis in adults with repaired tetralogy of Fallot. Am J Cardiol 2007; 99: 14621467.
15.Giardini, A, Hager, A, Lammers, AE, et al. Ventilatory efficiency and aerobic capacity predict event-free survival in adults with atrial repair for complete transposition of the great arteries. J Am Coll Cardiol 2009; 53: 15481555.
16.Arena, R, Lavie, CJ, Milani, RV, Myers, J, Guazzi, M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant 2010; 29: 159173.
17.Rhodes, J, Ubeda Tikkanen, A, Jenkins, KJ. Exercise testing and training in children with congenital heart disease. Circulation 2010; 122: 19571967.
18.Lawler, PR, Filion, KB, Eisenberg, MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J 2011; 162: 571584; e572.
19.Heran, BS, Chen, JM, Ebrahim, S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011: CD001800.
20.Leon, AS, Franklin, BA, Costa, F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111: 369376.
21.Piepoli, MF, Conraads, V, Corra, U, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011; 13: 347357.
22.Green, DJ, O'Driscoll, G, Joyner, MJ, Cable, NT. Exercise and cardiovascular risk reduction: time to update the rationale for exercise? J Appl Physiol 2008; 105: 766768.
23.Shephard, RJ, Balady, GJ. Exercise as cardiovascular therapy. Circulation 1999; 99: 963972.
24.Dimmeler, S, Zeiher, AM. Exercise and cardiovascular health: get active to “AKTivate” your endothelial nitric oxide synthase. Circulation 2003; 107: 31183120.
25.Group OLoEW. Levels of Evidence 2011.
26.McCall, R, Humphrey, R. Exercise training in a young adult late after a Fontan procedure to repair single ventricle physiology. J Cardiopulm Rehabil 2001; 21: 227230.
27.Rhodes, J, Curran, TJ, Camil, L, et al. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 2005; 116: 13391345.
28.Moalla, W, Maingourd, Y, Gauthier, R, Cahalin, LP, Tabka, Z, Ahmaidi, S. Effect of exercise training on respiratory muscle oxygenation in children with congenital heart disease. Eur J Cardiovasc Prev Rehabil 2006; 13: 604611.
29.Minamisawa, S, Nakazawa, M, Momma, K, Imai, Y, Satomi, G. Effect of aerobic training on exercise performance in patients after the Fontan operation. Am J Cardiol 2001; 88: 695698.
30.Rhodes, J, Curran, TJ, Camil, L, et al. Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics 2006; 118: e586e593.
31.Opocher, F, Varnier, M, Sanders, SP, et al. Effects of aerobic exercise training in children after the Fontan operation. Am J Cardiol 2005; 95: 150152.
32.Fredriksen, PM, Kahrs, N, Blaasvaer, S, et al. Effect of physical training in children and adolescents with congenital heart disease. Cardiol Young 2000; 10: 107114.
33.Sklansky, M, Pivarnik, J, O'Brian, E, Morris, J, Bricker, J. Exercise training hemodynamics and the prevalence of arrhythmias in children following tetralogy of Fallot repair. Pediatr Exerc Sci 1994; 6: 188200.
34.Balfour, IC, Drimmer, AM, Nouri, S, Pennington, DG, Hemkens, CL, Harvey, LL. Pediatric cardiac rehabilitation. Am J Dis Child 1991; 145: 627630.
35.Miller, TL, Horgan, S, Lipschultz, S. Exercise rehabilitation of pediatric patients with cardiovascular disease. Prog Pediatr Cardiol 2005; 20: 2737.
36.Brassard, P, Bedard, E, Jobin, J, Rodes-Cabau, J, Poirier, P. Exercise capacity and impact of exercise training in patients after a Fontan procedure: a review. Can J Cardiol 2006; 22: 489495.
37.Takken, T, Hulzebos, HJ, Blank, AC, Tacken, MH, Helders, PJ, Strengers, JL. Exercise prescription for patients with a Fontan circulation: current evidence and future directions. Neth Heart J 2007; 15: 142147.
38.Calzolari, A, Turchetta, A, Biondi, G, et al. Rehabilitation of children after total correction of tetralogy of Fallot. Int J Cardiol 1990; 28: 151158.
39.Brassard, P, Poirier, P, Martin, J, et al. Impact of exercise training on muscle function and ergoreflex in Fontan patients: a pilot study. Int J Cardiol 2006; 107: 8594.
40.Ruttenberg, HD, Adams, TD, Orsmond, GS, Conlee, RK, Fisher, AG. Effects of exercise training on aerobic fitness in children after open heart surgery. Pediatr Cardiol 1983; 4: 1924.
41.Goldberg, B, Fripp, RR, Lister, G, Loke, J, Nicholas, JA, Talner, NS. Effect of physical training on exercise performance of children following surgical repair of congenital heart disease. Pediatrics 1981; 68: 691699.
42.McBride, MG, Binder, TJ, Paridon, SM. Safety and feasibility of inpatient exercise training in pediatric heart failure: a preliminary report. J Cardiopulm Rehabil Prev 2007; 27: 219222.
43.Longmuir, PE, Tremblay, MS, Goode, RC. Postoperative exercise training develops normal levels of physical activity in a group of children following cardiac surgery. Pediatr Cardiol 1990; 11: 126130.
44.Longmuir, PE, Turner, JA, Rowe, RD, Olley, PM. Postoperative exercise rehabilitation benefits children with congenital heart disease. Clin Invest Med 1985; 8: 232238.
45.Bradley, LM, Galioto, FM Jr, Vaccaro, P, Hansen, DA, Vaccaro, J. Effect of intense aerobic training on exercise performance in children after surgical repair of tetralogy of Fallot or complete transposition of the great arteries. Am J Cardiol 1985; 56: 816818.
46.Nanas, S, Nanas, J, Kassiotis, C, et al. Respiratory muscles performance is related to oxygen kinetics during maximal exercise and early recovery in patients with congestive heart failure. Circulation 1999; 100: 503508.
47.Nikolic, D, Petronic, I, Cirovic, D, Milincic, Z, Pavicevic, P, Brdar, R. Rehabilitation protocols in children with corrected congenital heart defects due to the presence of pulmonary complications. Bratisl Lek Listy 2008; 109: 483485.
48.Fitzgerald, DA, Sherwood, M. Long-term cardio-respiratory consequences of heart disease in childhood. Paediatr Respir Rev 2007; 8: 313321.
49.Greenwood, RD, Rosenthal, A, Parisi, L, Fyler, DC, Nadas, AS. Extracardiac abnormalities in infants with congenital heart disease. Pediatrics 1975; 55: 485492.
50.Jaiyesimi, F, Antia, AU. Extracardiac defects in children with congenital heart disease. Br Heart J 1979; 42: 475479.
51.Collins, CE, Okely, AD, Morgan, PJ, et al. Parent diet modification, child activity, or both in obese children: an RCT. Pediatrics 2011; 127: 619627.
52.Woolford, SJ, Sallinen, BJ, Clark, SJ, Freed, GL. Results from a clinical multidisciplinary weight management program. Clin Pediatr (Phila) 2011; 50: 187191.
53.Williams, CA, Benden, C, Stevens, D, Radtke, T. Exercise training in children and adolescents with cystic fibrosis: theory into practice. Int J Pediatr 2010; Epub ahead of print.
54.Clapp, EL, Bevington, A, Smith, AC. Exercise for children with chronic kidney disease and end-stage renal disease. Pediatr Nephrol 2011.
55.Tangeraas, T, Midtvedt, K, Cvancarova, M, et al. Cardiorespiratory fitness in young adults with a history of renal transplantation in childhood. Pediatr Nephrol 2011; 26: 20412049.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed