title: Paediatric cardiac rehabilitation in congenital heart disease: a systematic review.
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.
authors.affiliation: Department of Cardiology, Childrens Hospital of Boston, 300 Longwood Avenue, Boston, MA 02115, USA. Ana.UbedaTikkanen@cardio.chboston.org
authors.forename: Ana Ubeda
authors.initials: AU
authors.lastname: Tikkanen
authors.forename: Ainhoa Rodriguez
authors.initials: AR
authors.lastname: Oyaga
authors.forename: Olga Arroyo
authors.initials: OA
authors.lastname: Riaño
authors.forename: Enrique Maroto
authors.initials: EM
authors.lastname: Álvaro
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rhodes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005081:Exercise Therapy / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011788:Quality of Life