title: Effect of complex cardiac rehabilitation on physical activity and quality of life during long-term follow-up after surgical correction of congenital heart disease.
abstract: BACKGROUND
  Comprehensive cardiac rehabilitation (CCR) is an important element of the comprehensive management of grown-up congenital heart disease (GUCH) patients after surgical correction of congenital heart disease (CHD) but access to this treatment is still limited. We still lack Polish guidelines on CCR, including controlled training in young adults several years after surgical correction of CHD.
  
  
  OBJECTIVE
  To assess the effect of a CCR program on physical capacity, exercise tolerance, quality of life, and severity of depressive symptoms in GUCH patients long-term after surgical correction of CHD.
  
  
  METHODS
  We studied 57 CHD patients (30 females, 27 males, mean age 23 ± 3.4 years) at least 12 months after surgical correction of a ventricular septal defect (VSD) or ostium secundum atrial septal defect (ASD II). All patients were offered a CCR program, and 31 of them participated (rehabilitation group [Reh]) and 26 refused (non-rehabilitated group [NReh]). All patients underwent baseline cardiopulmonary exercise testing (CPET) using a cycloergometer and a ramp protocol with an initial load of 20 W followed by 10 W load increments per minute. Psychological evaluation included the Beck Depression Inventory (BDI) and the Euro QoL 5D questionnaire to evaluate quality of life. Patients were reassessed 30 days after the initial evaluation using the same investigations.
  
  
  RESULTS
  During CPET, all patients reached peak exercise intensity at the level of 15-17 in the Borg scale without complications. Resting HR was lower in the Reh group (74 ± 8 bpm) compared to the NReh group (81 ± 14 bpm). During CPET, patients in the Reh group reached significantly higher peak HR and percent maximum HR. Workload increased nonsignificantly (144 W vs. 124 W, p = 0.121), while duration of exercise and peak oxygen consumption was significantly longer in the Reh group compared to the NReh group (14 min vs. 11 min, p = 0.001; and 27.5 mL/kg/min vs. 23 mL/kg/min, p = 0.003, respectively). Patients in the NReh group showed non significantly higher severity of depressive symptoms compared to the Reh group, as evaluated using BDI at 30 days (mean score 4.8 vs. 2.2, respectively, p = 0.59). In contrast, subjectively and objectively rated quality of life was significantly higher in the Reh group compared to the NReh (score 89 vs. 74.4, p < 0.01; and 94 vs. 83, p < 0.01, respectively).
  
  
  CONCLUSIONS
  Implementation of a CCR program improves physical capacity, exercise tolerance, and quality of life and reduces depressive symptoms in patients late after surgical correction of CHD. Introduction of such programs seems reasonable as a supplement to the holistic care for GUCH patients.
authors.affiliation: Chair and Department of Rehabilitation, Medical University of Gdansk, Gdansk, Poland. katarzyna.haponiuk1@gumed.edu.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gierat-Haponiuk
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.forename: Dominika
authors.initials: D
authors.lastname: Szalewska
authors.forename: Maciej
authors.initials: M
authors.lastname: Chojnicki
authors.forename: Radosław
authors.initials: R
authors.lastname: Jaworski
authors.forename: Piotr
authors.initials: P
authors.lastname: Niedoszytko
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Leszczyńska
authors.forename: Stanisław
authors.initials: S
authors.lastname: Bakuła
mesh_terms: D000328:Adult; D000072038:Cardiac Rehabilitation; D003863:Depression; D015444:Exercise; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000534:rehabilitation / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D010101:Oxygen Consumption; D011044:Poland; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult