Children with serious congenital heart defects are typically urged to restrict their activity, but a pilot study at Children's Hospital Boston, published in the December Pediatrics, indicates that most of these children can benefit from cardiac rehabilitation.
The study enrolled 19 children, ages 8 to 17, in a 12-week program of stretching, aerobics and light weight/resistance exercises. All the children had cardiac disease severe enough to consider restricting their activity, and all showed reduced function on exercise tests, but none had test findings that might raise a safety concern, such as arrhythmias or chest pain. Still, all 16 children who completed the program had undergone heart surgery or a nonsurgical procedure in the past, and 11 of the 16 had just one functional ventricle.
The hour-long sessions, held twice weekly, were tailored to the children's interests and included dance, calisthenics, kick boxing and jump rope. Balls, music, games, relay races and age-appropriate prizes helped keep the kids motivated, and sessions were moved outdoors whenever possible. Heart rate was checked initially and two to three times during each session. A pulse oximeter and external defibrillator were available on site, but were never needed, since there were no adverse events.
At the program's end, 15 of 16 children had significantly improved peak work rate, peak oxygen consumption, or both—their hearts pumped more blood with each beat, and their muscles used more oxygen. Functional improvements were as high as 20 percent on some parameters.
Children's cardiologist Jonathan Rhodes, MD, who led the study, believes that some of the reduced exercise capacity in children with congenital heart defects is due to inactivity. In this pilot study, he notes, fewer than 10 percent of children with diminished exercise capacity had conditions that made it dangerous to exercise. "With the approval of a pediatric cardiologist, and after careful exercise testing, exercise is generally safe and tolerable," he says.
Follow-up exercise testing, roughly 7 months after program completion, showed that participants' cardiac benefits were sustained, whereas non-participating children had a slight decline in cardiac function. Participants reported exercising more than in the past and had higher behavioral, emotional and self-esteem scores.
Children's plans to launch a formal cardiac rehabilitation program in fall 2006 or spring 2007, when facilities at Children's Hospital Boston at Waltham are complete. Rhodes believes that some two-thirds of children with serious congenital heart disease will be eligible to participate.
