title: The effect of exercise training on cardiac remodelling in children and young adults with corrected tetralogy of Fallot or Fontan circulation: a randomized controlled trial.
abstract: BACKGROUND
  Exercise can improve physical fitness in children and adults with congenital heart disease. We hypothesized that exercise training would not lead to adverse cardiac remodelling in this population.
  
  
  RESULTS
  This multi-centre randomized controlled trial included children and young adults (10 to 25 years) with either corrected tetralogy of Fallot or Fontan circulation. The exercise-group was enrolled in a 12 week standardized aerobic dynamic exercise training program. The control-group continued their life-style and received care as usual. Both groups underwent cardiopulmonary exercise testing, cardiac magnetic resonance imaging (MRI), echocardiography and neurohormonal assessment, within 2 weeks before and 2 weeks after the intervention period. Fifty-six patients were randomized to the exercise-group and 37 to the control-group. We assessed changes between the pre- and the post-intervention period for the exercise group compared to the changes in the control-group. Peak load increased significantly in the exercise-group compared to the control-group (exercise-group 6.9 ± 11.8 W; control-group 0.8 ± 13.9 W; p=0.047). There were no adverse events linked to the study. Ventricular systolic parameters, cardiac dimensions and neurohormonal markers during follow-up did not change in patients allocated to the exercise-group and control-group. Although there were some isolated minor changes in inflow parameters, there was no consistent pattern of changes, indicating a lack of true change in the diastolic function.
  
  
  CONCLUSIONS
  We demonstrated that no clinically relevant adverse cardiac remodelling occurred after 12 weeks of exercise training in patients with either corrected tetralogy of Fallot or Fontan circulation.
  
  
  BACKGROUND
  www.trialregister.nl, identification NTR2731.
authors.affiliation: Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands; Departments of Radiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Duppen
authors.affiliation: Department of Paediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Paediatrics, Paediatric Cardiology unit, Tel-Aviv Sourasky Medical Centre, Tel Aviv University, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Kapusta
authors.affiliation: Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Y B
authors.initials: YB
authors.lastname: de Rijke
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Snoeren
authors.affiliation: Department of Paediatric Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Kuipers
authors.affiliation: Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands.
authors.forename: L P
authors.initials: LP
authors.lastname: Koopman
authors.affiliation: Department of Paediatric Cardiology, University MC Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Blank
authors.affiliation: Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: N A
authors.initials: NA
authors.lastname: Blom
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Dulfer
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: E M W J
authors.initials: EM
authors.lastname: Utens
authors.affiliation: Department of Integrative Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M T E
authors.initials: MT
authors.lastname: Hopman
authors.affiliation: Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands; Departments of Radiology, Erasmus MC, Rotterdam, The Netherlands. Electronic address: w.a.helbing@erasmusmc.nl.
authors.forename: W A
authors.initials: WA
authors.lastname: Helbing
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome; D020257:Ventricular Remodeling
keywords: Cardiac remodelling; Echocardiography; Exercise; Fontan circulation; Magnetic resonance imaging; Tetralogy of Fallot