title: Does exercise training improve cardiopulmonary fitness and daily physical activity in children and young adults with corrected tetralogy of Fallot or Fontan circulation? A randomized controlled trial.
abstract: BACKGROUND
  Many patients with congenital heart disease do not meet current public health guidelines to participate in moderate-to-vigorous physical activity for ≥60 minutes per day. They are less fit than their healthy peers. We hypothesized that exercise training would increase cardiopulmonary fitness and daily physical activity in these patients. We therefore assessed effects of an exercise training program on cardiopulmonary fitness and daily physical activity in patients with corrected tetralogy of Fallot (ToF) or Fontan circulation.
  
  
  METHODS
  In a multicenter prospective controlled trial, patients with ToF or Fontan circulation (age 10-25 years) were randomized, 56 patients to the exercise group and 37 to the control group. The exercise group participated in a 12-week standardized aerobic exercise training program. The control group continued lifestyle as usual. Cardiopulmonary exercise testing and activity measurements were performed before and after 12 weeks.
  
  
  RESULTS
  Peak oxygen uptake increased in the exercise group by 5.0% (1.7 ± 4.2 mL/kg per minute; P = .011) but not in the control group (0.9 ± 5.2 mL/kg per minute; P = not significant). Workload increased significantly in the exercise group compared with the control group (6.9 ± 11.8 vs 0.8 ± 13.9 W; P = .047). Subgroup analysis showed a significant increase in pre-to-post peak oxygen uptake in the exercise group of ToF patients but not in the exercise group of Fontan patients. Percentage of measured time spent in moderate-to-vigorous activity at baseline was 13.6% ± 8.6%, which did not significantly change after training.
  
  
  CONCLUSIONS
  Aerobic exercise training improved cardiopulmonary fitness in patients with ToF but not in patients with Fontan circulation. Exercise training did not change daily physical activity.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: Duppen
authors.affiliation: Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Etnel
authors.affiliation: Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Spaans
authors.affiliation: Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Takken
authors.affiliation: Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Rita J
authors.initials: RJ
authors.lastname: van den Berg-Emons
authors.affiliation: Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Department of Pediatrics Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Schokking
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Karolijn
authors.initials: K
authors.lastname: Dulfer
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Utens
authors.affiliation: Department of Pediatrics, Division of Cardiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: w.a.helbing@erasmusmc.nl.
authors.forename: Willem
authors.initials: W
authors.lastname: Helbing
authors.affiliation: Department of Integrative Physiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Hopman
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010809:Physical Fitness; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult