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Cardiac rehabilitation in the paediatric Fontan population: development of a home-based high-intensity interval training programme

Published online by Cambridge University Press:  27 July 2020

Michael Khoury Open the ORCID record for Michael Khoury [Opens in a new window] ,
Devin B. Phillips ,
Peter W. Wood ,
William R. Mott ,
Michael K. Stickland ,
Pierre Boulanger ,
Gwen R. Rempel Open the ORCID record for Gwen R. Rempel [Opens in a new window] ,
Jennifer Conway ,
Andrew S. Mackie  and
Nee S. Khoo
Michael Khoury*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
Devin B. Phillips
Affiliation:
Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Peter W. Wood
Affiliation:
Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
William R. Mott
Affiliation:
Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
Michael K. Stickland
Affiliation:
Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Pierre Boulanger
Affiliation:
Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
Gwen R. Rempel
Affiliation:
Faculty of Health Disciplines, Athabasca University, Alberta, Canada
Jennifer Conway
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
Andrew S. Mackie
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
Nee S. Khoo
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
*
Author for correspondence: Michael Khoury, MD FRCPC, Assistant Professor, Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, 8440-112th St. NW, Edmonton, ABT6G 2B7, Canada. Tel: +1 (780) 407-8361; Fax: +1 (780) 407-3954. E-mail: Khoury1@ualberta.ca
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Abstract

Introduction:

We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology.

Methods:

The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology.

Results:

There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total.

Conclusion:

The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.

Keywords

Cardiac rehabilitationFontanhigh-intensity interval trainingtelemedicine
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1409 - 1416
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Khairy, P, Fernandes, SM, Mayer, JE Jr et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 2008; 117: 85–92.CrossRefGoogle ScholarPubMed
d’Udekem, Y, Iyengar, AJ, Galati, JC et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 2014; 130: S32–S38.CrossRefGoogle ScholarPubMed
Goldberg, DJ, Avitabile, CM, McBride, MG, Paridon, SM. Exercise capacity in the Fontan circulation. Cardiol Young 2013; 23: 824–830.CrossRefGoogle ScholarPubMed
Banks, L, Rosenthal, S, Manlhiot, C et al. Exercise capacity and self-efficacy are associated with moderate-to-vigorous intensity physical activity in children with congenital heart disease. Pediatr Cardiol 2017; 38: 1206–1214.CrossRefGoogle ScholarPubMed
McKillop, A, McCrindle, BW, Dimitropoulos, G, Kovacs, AH. Physical activity perceptions and behaviors among young adults with congenital heart disease: a mixed-methods study. Congenit Heart Dis 2018; 13: 232–240.CrossRefGoogle ScholarPubMed
Gomes-Neto, M, Saquetto, MB, da Silva e Silva, CM, Conceicao, CS, Carvalho, VO. Impact of exercise training in aerobic capacity and pulmonary function in children and adolescents after congenital heart disease s–rgery: a systematic review with meta-analysis. Pediatr Cardiol 2016; 37: 217–224.CrossRefGoogle Scholar
Rhodes, J, Tikkanen, AU, Jenkins, KJ. Exercise testing and training in children with congenital heart disease. Circulation 2010; 122: 1957–1967.CrossRefGoogle ScholarPubMed
Sutherland, N, Jones, B, d’Udekem, Y. Should we recommend exercise after the Fontan procedure? Heart, Lung Circ 2015; 24: 753–768.CrossRefGoogle ScholarPubMed
Tikkanen, AU, Oyaga, AR, Riano, OA, Alvaro, EM, Rhodes, J. Paediatric cardiac rehabilitation in congenital heart disease: a systematic review. Cardiol Young 2012; 22: 241–250.CrossRefGoogle ScholarPubMed
Duppen, N, Takken, T, Hopman, MT et al. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int J Cardiol 2013; 168: 1779–1787.CrossRefGoogle Scholar
Costigan, SA, Eather, N, Plotnikoff, RC, Taaffe, DR, Lubans, DR. High-intensity interval training for improving health-related fitness in adolescents: a systematic review and meta-analysis. Br J Sports Med 2015; 49: 1253–1261.CrossRefGoogle ScholarPubMed
Guiraud, T, Nigam, A, Gremeaux, V, Meyer, P, Juneau, M, Bosquet, L. High-intensity interval training in cardiac rehabilitation. Sports Med 2012; 42: 587–605.CrossRefGoogle ScholarPubMed
Logan, GR, Harris, N, Duncan, S, Schofield, G. A review of adolescent high-intensity interval training. Sports Med 2014; 44: 1071–1085.CrossRefGoogle ScholarPubMed
Batacan, RB Jr, Duncan, MJ, Dalbo, VJ, Tucker, PS, Fenning, AS. Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies. Br J Sports Med 2017; 51: 494–503.CrossRefGoogle ScholarPubMed
Wewege, MA, Ahn, D, Yu, J, Liou, K, Keech, A. High-intensity interval training for patients ith cardiovascular disease-is it safe? A systematic review. J Am Heart Assoc 2018; 7: e009305.CrossRefGoogle Scholar
Wisloff, U, Stoylen, A, Loennechen, JP et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 2007; 115: 3086–3094.CrossRefGoogle ScholarPubMed
American Thoracic S and American College of Chest P. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003; 167: 211–277.CrossRefGoogle Scholar
Borg, GA. Psychophysical bases of perceived exertion. Med SciSports Exerc 1982; 14: 377–381.Google Scholar
Cooper, DM, Weiler-Ravell, D, Whipp, BJ, Wasserman, K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol Respir Environ Exerc Physiol 1984; 56: 628–634.Google ScholarPubMed
Tanaka, H, Monahan, KD, Seals, DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol 2001; 37: 153–156.CrossRefGoogle ScholarPubMed
Tomczak, CR, Thompson, RB, Paterson, I et al. Effect of acute high-intensity interval exercise on postexercise biventricular function in mild heart failure. J Appl Physiol (1985) 2011; 110: 398–406.CrossRefGoogle ScholarPubMed
Kyle, WB, Denfield, SW, Valdes, SO, Penny, DJ, Bolin, EH, Lopez, KN. Assessing ST segment changes and ischemia during exercise stress testing in patients with hypoplastic left heart syndrome and Fontan palliation. Pediatr Cardiol 2016; 37: 545–551.CrossRefGoogle ScholarPubMed
Lear, SA. The delivery of cardiac rehabilitation using communications technologies: the “virtual” cardiac rehabilitation program. Can J Cardiol 2018; 34: S278–S283.CrossRefGoogle ScholarPubMed
Martin, BJ, Ross, DB, Aklabi, MA, Harder, J, Dyck, JD, Rebeyka, IM. Post-operative outcomes in children undergoing Fontan palliation in a regionalized surgical system. Pediatr Cardiol 2017; 38: 1654–1662.CrossRefGoogle Scholar
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.Google ScholarPubMed
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
Longmuir, PE, Tyrrell, PN, Corey, M, Faulkner, G, Russell, JL, McCrindle, BW. Home-based rehabilitation enhances daily physical activity and motor skill in children who have undergone the Fontan procedure. Pediatr Cardiol 2013; 34: 1130–1151.CrossRefGoogle ScholarPubMed
Warburton, DE, Sarkany, D, Johnson, M et al. Metabolic requirements of interactive video game cycling. Med Sci Sports Exerc 2009; 41: 920–926.CrossRefGoogle ScholarPubMed
Warburton, DE, Bredin, SS, Horita, LT et al. The health benefits of interactive video game exercise. Appl Physiol Nutr Metab 2007; 32: 655–663.CrossRefGoogle ScholarPubMed
Voss, C, Duncombe, SL, Dean, PH, de Souza, AM, Harris, KC. Physical activity and sedentary behavior in children with congenital heart disease. J Am Heart Assoc 2017; 6: e004665.CrossRefGoogle ScholarPubMed
McCrindle, BW, Williams, RV, Mital, S et al. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509–514.CrossRefGoogle ScholarPubMed
Longmuir, PE, Russell, JL, Corey, M, Faulkner, G, McCrindle, BW. Factors associated with the physical activity level of children who have the Fontan procedure. Am Heart J 2011; 161: 411–417.CrossRefGoogle ScholarPubMed
Longmuir, PE McCrindle, BW. Physical activity restrictions for children after the Fontan operation: disagreement between parent, cardiologist, and medical record reports. Am Heart J 2009; 157: 853–859.CrossRefGoogle ScholarPubMed
Turgeon, L, O’Connor, KP, Marchand, A, Freeston, MH. Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia. Acta Psychiatr Scand 2002; 105: 310–316.CrossRefGoogle ScholarPubMed
Dulfer, K, Duppen, N, Van Dijk, AP et al. Parental mental health moderates the efficacy of exercise training on health-related quality of life in adolescents with congenital heart disease. Pediatric cardiology 2015; 36: 33–40.CrossRefGoogle ScholarPubMed
Bay, A, Lamas, K, Berghammer, M, Sandberg, C, Johansson, B. It’s like balancing on a slackline-A description of how adults with congenital heart disease describe themselves in relation to physical activity. J Clin Nurs 2018; 27: 3131–3138.CrossRefGoogle ScholarPubMed
Moola, F, Fusco, C, Kirsh, JA. The perceptions of caregivers toward physical activity and health in youth with congenital heart disease. Qualitative health research 2011; 21: 278–291.CrossRefGoogle ScholarPubMed
Bjorbaekmo, W, Engelsrud, G. I am almost like a fish: an investigation of how children with congenital heart disease experience and perform movement in daily life. Child Care Health Dev 2008; 34: 781–788.Google Scholar
Longmuir, PE, Brothers, JA, de Ferranti, SD et al. Promotion of physical activity for children and adults with congenital heart disease a scientific statement from the American Heart Association. Circulation 2013; 127: 2147–2159.CrossRefGoogle ScholarPubMed
Moola, F, Faulkner, GE, Kirsh, JA Kilburn, J. Physical activity and sport participation in youth with congenital heart disease: perceptions of children and parents. Adapt Phys Act Q 2008; 25: 49–70.Google ScholarPubMed
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