title: Can a Home-based Cardiac Physical Activity Program Improve the Physical Function Quality of Life in Children with Fontan Circulation?
abstract: OBJECTIVE
  Patients after Fontan operation for complex congenital heart disease (CHD) have decreased exercise capacity and report reduced health-related quality of life (HRQOL). Studies suggest hospital-based cardiac physical activity programs can improve HRQOL and exercise capacity in patients with CHD; however, these programs have variable adherence rates. The impact of a home-based cardiac physical activity program in Fontan survivors is unclear. This pilot study evaluated the safety, feasibility, and benefits of an innovative home-based physical activity program on HRQOL in Fontan patients.
  
  
  METHODS
  A total of 14 children, 8-12 years, with Fontan circulation enrolled in a 12-week moderate/high intensity home-based cardiac physical activity program, which included a home exercise routine and 3 formalized in-person exercise sessions at 0, 6, and 12 weeks. Subjects and parents completed validated questionnaires to assess HRQOL. The Shuttle Test Run was used to measure exercise capacity. A Fitbit Flex Activity Monitor was used to assess adherence to the home activity program.
  
  
  RESULTS
  Of the 14 patients, 57% were male and 36% had a dominant left ventricle. Overall, 93% completed the program. There were no adverse events. Parents reported significant improvement in their child's overall HRQOL (P < .01), physical function (P < .01), school function (P = .01), and psychosocial function (P < .01). Patients reported no improvement in HRQOL. Exercise capacity, measured by total shuttles and exercise time in the Shuttle Test Run and calculated VO2 max, improved progressively from baseline to the 6 and 12 week follow up sessions. Monthly Fitbit data suggested adherence to the program.
  
  
  CONCLUSIONS
  This 12-week home-based cardiac physical activity program is safe and feasible in preteen Fontan patients. Parent proxy-reported HRQOL and objective measures of exercise capacity significantly improved. A 6-month follow up session is scheduled to assess sustainability. A larger study is needed to determine the applicability and reproducibility of these findings in other age groups and forms of complex CHD.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis, USA.
authors.forename: Roni M
authors.initials: RM
authors.lastname: Jacobsen
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis, USA.|Division of Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wis, USA.
authors.forename: Salil
authors.initials: S
authors.lastname: Ginde
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wis, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mussatto
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Neubauer
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis, USA.|Division of Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wis, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Earing
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wis, USA.|Program in Exercise Science, College of Health Sciences, Marquette University, Milwaukee, Wis, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Danduran
mesh_terms: D002648:Child; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D006699:Home Care Services; D006801:Humans; D008297:Male; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Congenital Heart Disease; Exercise; Fontan; Physical Activity; Quality of Life; Rehabilitation