Exercise Helps Children With Congenital Heart Defects

Exercise is good for the heart, even a child’s heart damaged by a birth defect, say researchers here.

Results from a small study suggest that regular exercise can improve cardiac function and reduce morbidity in children with congenital heart disease.

Fifteen of 16 children with congenital heart disease achieved significant improvement in peak oxygen consumption and peak work rate with a 12-week long cardiac rehabilitation program, according to results reported by Jonathan Rhodes, M.D., of Children’s Hospital Boston and colleagues in the December issue of Pediatrics.

In the past children with congenital heart disease were excluded from exercise programs by physicians, parents and teachers, they noted. Even after repair of defects these children often have residual hemodynamic defects, but they theorized that this deficit is due to deconditioning secondary to physical inactivity.

The 19 children in the study, ages 8 to 17, had congenital heart disease severe enough to consider restricting their activity and showed reduced cardiac function on exercise testing. Exercise testing found that peak oxygen consumption and/or peak work rate was less than 80% of predicted value. Children with no evidence of angina or arrhythmia on exercise testing were referred for cardiac rehabilitation.

The patients were referred to a 12-week-long twice-weekly structured exercise program that included aerobic and weight/resistance exercises. The program also included child-friendly exercise such as dance, games, and relay races as well as calisthenics, jump rope, and kick-boxing. In order to keep the children motivated, prizes were regularly awarded and the exercise sessions were moved outside when weather permitted, he said.

One particularly popular game was “punch the doctor” in which the children threw punches at pieces of matting labeled “doctor”.

“A lot of the kids were timid in the beginning, but they were really moving by the end,” Dr. Rhodes said. “Being with other kids with heart disease who had never exercised helped melt away a lot of their anxiety. It was quite a metamorphosis.”

Sixteen children (11 Fontan patients and five with other congenital defects) completed the program. In 15 children peak oxygen consumption increased from 26.4±9.1 to 30.7±9.2 ml/kg/min (P=0.005) and work rate from 93±32 to 106 ±34 W (P<0.001).

Additionally, ventilatory anaerobic threshold increased from 14.2±4.8 to 17.4±4.5 ml/kg/min (p<0.001) and peak oxygen pulse rose from 7.6±2.8 to 9.7±4.1 ml/beat (p<0.01), an improvement that Dr. Rhodes wrote “is only due to an increase in stroke volume and/or oxygen extraction at peak exercise.”

There were no changes in peak heart rate or peak respiratory exchange ratio, which implies that “the improvements were not due merely to an increased effort.”

Based on these results, Dr. Rhodes concluded that children with congenital heart disease should be evaluated for cardiac rehabilitation programs, and he predicted that two-thirds of those children could participate safely in exercise-training programs.

One limitation of the study pointed out by the authors is that it “examined only the immediate impact of cardiac rehabilitation on children with congenital heart disease. Additional studies are necessary to determine whether the benefits identified in this study are sustained over an extended period of time, and whether they produce improved activity levels and lifestyles. It must also be noted that the patients in this study were a highly selected group.”

Source: Pediatrics

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