Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-18T09:46:31.780Z Has data issue: false hasContentIssue false
  • English
  • Français

Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

Published online by Cambridge University Press:  17 January 2012

Ana Ubeda Tikkanen ,
Ainhoa Rodriguez Oyaga ,
Olga Arroyo Riaño ,
Enrique Maroto Álvaro  and
Jonathan Rhodes
Ana Ubeda Tikkanen*
Affiliation:
Department of Cardiology, Childrens Hospital of Boston, 300 Longwood Avenue, Boston, Massachusetts 02115, United States of America
Ainhoa Rodriguez Oyaga
Affiliation:
Department of Physical Medicine and Rehabilitation, Hospital Gregorio Marañón, C/Dr Esquerdo 46, 28007, Spain
Olga Arroyo Riaño
Affiliation:
Department of Physical Medicine and Rehabilitation, Hospital Gregorio Marañón, C/Dr Esquerdo 46, 28007, Spain
Enrique Maroto Álvaro
Affiliation:
Department of Paediatric Cardiology, Hospital Materno-Infantil Gregorio Marañón, C/ O'Donnell 48-50, 28009 Madrid, Spain
Jonathan Rhodes
Affiliation:
Department of Cardiology, Childrens Hospital of Boston, 300 Longwood Avenue, Boston, Massachusetts 02115, United States of America
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Exercisequality of lifechildren
Type
Review Article
Information
Cardiology in the Young , Volume 22 , Issue 3 , June 2012 , pp. 241 - 250
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
2.Canobbio, MM. Health care issues facing adolescents with congenital heart disease. J Pediatr Nurs 2001; 16: 363–370.CrossRefGoogle ScholarPubMed
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: 335–352.CrossRefGoogle ScholarPubMed
4.Reybrouck, T, Rogers, R, Weymans, M, et al. Serial cardiorespiratory exercise testing in patients with congenital heart disease. Eur J Pediatr 1995; 154: 801–806.CrossRefGoogle ScholarPubMed
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: 215–221.CrossRefGoogle ScholarPubMed
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: 234–239.CrossRefGoogle ScholarPubMed
7.Limperopoulos, C, Majnemer, A, Shevell, MI, et al. Functional limitations in young children with congenital heart defects after cardiac surgery. Pediatrics 2001; 108: 1325–1331.CrossRefGoogle ScholarPubMed
8.Imms, C. Occupational performance challenges for children with congenital heart disease: a literature review. Can J Occup Ther 2004; 71: 161–172.CrossRefGoogle ScholarPubMed
9.Linde, LM. Psychiatric aspects of congenital heart disease. Psychiatr Clin North Am 1982; 5: 399–406.CrossRefGoogle ScholarPubMed
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: 532–537.CrossRefGoogle ScholarPubMed
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: 845–875.CrossRefGoogle ScholarPubMed
12.Somarriba, G, Extein, J, Miller, TL. Exercise rehabilitation in pediatric cardiomyopathy. Prog Pediatr Cardiol 2008; 25: 91–102.CrossRefGoogle ScholarPubMed
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: 175–180.CrossRefGoogle ScholarPubMed
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: 1462–1467.CrossRefGoogle ScholarPubMed
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: 1548–1555.CrossRefGoogle ScholarPubMed
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: 159–173.CrossRefGoogle ScholarPubMed
17.Rhodes, J, Ubeda Tikkanen, A, Jenkins, KJ. Exercise testing and training in children with congenital heart disease. Circulation 2010; 122: 1957–1967.CrossRefGoogle ScholarPubMed
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: 571–584; e572.CrossRefGoogle ScholarPubMed
19.Heran, BS, Chen, JM, Ebrahim, S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011: CD001800.Google ScholarPubMed
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: 369–376.CrossRefGoogle ScholarPubMed
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: 347–357.CrossRefGoogle Scholar
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: 766–768.CrossRefGoogle ScholarPubMed
23.Shephard, RJ, Balady, GJ. Exercise as cardiovascular therapy. Circulation 1999; 99: 963–972.CrossRefGoogle ScholarPubMed
24.Dimmeler, S, Zeiher, AM. Exercise and cardiovascular health: get active to “AKTivate” your endothelial nitric oxide synthase. Circulation 2003; 107: 3118–3120.CrossRefGoogle ScholarPubMed
25.Group OLoEW. Levels of Evidence 2011.Google Scholar
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: 227–230.CrossRefGoogle Scholar
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: 1339–1345.CrossRefGoogle ScholarPubMed
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: 604–611.CrossRefGoogle ScholarPubMed
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: 695–698.CrossRefGoogle ScholarPubMed
30.Rhodes, J, Curran, TJ, Camil, L, et al. Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics 2006; 118: e586–e593.CrossRefGoogle ScholarPubMed
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: 150–152.CrossRefGoogle ScholarPubMed
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: 107–114.CrossRefGoogle ScholarPubMed
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: 188–200.CrossRefGoogle Scholar
34.Balfour, IC, Drimmer, AM, Nouri, S, Pennington, DG, Hemkens, CL, Harvey, LL. Pediatric cardiac rehabilitation. Am J Dis Child 1991; 145: 627–630.Google ScholarPubMed
35.Miller, TL, Horgan, S, Lipschultz, S. Exercise rehabilitation of pediatric patients with cardiovascular disease. Prog Pediatr Cardiol 2005; 20: 27–37.CrossRefGoogle Scholar
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: 489–495.CrossRefGoogle ScholarPubMed
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: 142–147.CrossRefGoogle ScholarPubMed
38.Calzolari, A, Turchetta, A, Biondi, G, et al. Rehabilitation of children after total correction of tetralogy of Fallot. Int J Cardiol 1990; 28: 151–158.CrossRefGoogle ScholarPubMed
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: 85–94.CrossRefGoogle ScholarPubMed
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: 19–24.CrossRefGoogle ScholarPubMed
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: 691–699.CrossRefGoogle ScholarPubMed
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: 219–222.CrossRefGoogle ScholarPubMed
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: 126–130.CrossRefGoogle Scholar
44.Longmuir, PE, Turner, JA, Rowe, RD, Olley, PM. Postoperative exercise rehabilitation benefits children with congenital heart disease. Clin Invest Med 1985; 8: 232–238.Google ScholarPubMed
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: 816–818.CrossRefGoogle ScholarPubMed
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: 503–508.CrossRefGoogle ScholarPubMed
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: 483–485.Google Scholar
48.Fitzgerald, DA, Sherwood, M. Long-term cardio-respiratory consequences of heart disease in childhood. Paediatr Respir Rev 2007; 8: 313–321.CrossRefGoogle ScholarPubMed
49.Greenwood, RD, Rosenthal, A, Parisi, L, Fyler, DC, Nadas, AS. Extracardiac abnormalities in infants with congenital heart disease. Pediatrics 1975; 55: 485–492.Google ScholarPubMed
50.Jaiyesimi, F, Antia, AU. Extracardiac defects in children with congenital heart disease. Br Heart J 1979; 42: 475–479.CrossRefGoogle ScholarPubMed
51.Collins, CE, Okely, AD, Morgan, PJ, et al. Parent diet modification, child activity, or both in obese children: an RCT. Pediatrics 2011; 127: 619–627.CrossRefGoogle ScholarPubMed
52.Woolford, SJ, Sallinen, BJ, Clark, SJ, Freed, GL. Results from a clinical multidisciplinary weight management program. Clin Pediatr (Phila) 2011; 50: 187–191.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
54.Clapp, EL, Bevington, A, Smith, AC. Exercise for children with chronic kidney disease and end-stage renal disease. Pediatr Nephrol 2011.Google ScholarPubMed
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: 2041–2049.CrossRefGoogle ScholarPubMed