Abstract 5080: Clinical Trial of Home-Based Education Versus Activity Training for Cardiac Rehabilitation for Children After the Fontan Operation
Children after the Fontan operation have reduced exercise capacity and physical activity levels. Traditional cardiac rehabilitation strategies have focused on exercise training programs, which are resource intensive and do not address the determinants of physical activity. We performed a randomized clinical trial of two cardiac rehabilitation interventions aimed at increasing physical activity. N=61 children (24 females) aged 6 to 11 yrs at least 1-year post-Fontan were randomized to either a 12 month individualized educational or activity-based home intervention. The education intervention used stories and games to convey activity options. The activity intervention asked the child to perform specific gross motor and fitness activities. Changes from baseline were assessed for minutes of moderate-to-vigorous physical activity (MVPA) per week (omni-directional accelerometer), exercise capacity (Bruce protocol, treadmill) and gross motor skill (TGMD-2), and unadjusted measures of health-related fitness (CHMS). Changes in weekly MVPA, corrected for age, gender and season, varied with intervention compliance and did not differ between groups. Children who complied with over 2/3 of the intervention performed 97±23 more minutes of weekly MVPA (p=0.003) than less compliant children whose activity decreased. All subjects, regardless of intervention group or compliance, increased peak VO2 (from 64±11% to 69±13% of predicted normal, p=0.003) and gross motor skill (from 26±8% to 68±27%, p<0.0001), faster than expected from maturation. Improvements in health-related aerobic (from 109±8 steps/min to 114±8 steps/min at same heart rate, p=0.0007) and musculoskeletal fitness (handgrip: from 26±8 kg to 30±9 kg, p<0.0001; curl ups: from 11±7 to 15±7, p=0.006) were noted. All parents and all but one child recommended the cardiac rehabilitation program be made available to all families.
Conclusions: We conclude that a cost-effective, home-based cardiac rehabilitation program can significantly improve physical activity, fitness, gross motor skill and exercise capacity of children after Fontan. Both interventions were equally effective, suggesting that families might choose their preferred program and obtain similar benefits.