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Verrall CE, Tran DL, Yang JYM, Lubans DR, Winlaw DS, Ayer J, Celermajer D, Cordina R. Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review. Front Pediatr 2023; 11:1111785. [PMID: 36861078 PMCID: PMC9969110 DOI: 10.3389/fped.2023.1111785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 02/15/2023] Open
Abstract
People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.
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Affiliation(s)
- Charlotte Elizabeth Verrall
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Derek Lee Tran
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), Royal Children's Hospital, Melbourne, VIC, Australia
| | - David Revalds Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - David Scott Winlaw
- Cardiothoracic Surgery, the Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Julian Ayer
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - David Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia
| | - Rachael Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.,Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Callegari A, Faeth K, Pfammatter C, Jung R, Berger F, Burkhardt B, Valsangiacomo Buechel ER. Physical Activity in Fontan Patients Relates to Quality of Life and Sleep Quality. Front Cardiovasc Med 2022; 9:915810. [PMID: 35774372 PMCID: PMC9237319 DOI: 10.3389/fcvm.2022.915810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aim Fontan patients tend to have reduced physical exercise capacity. This study investigates physical activity (PA) and its relationship to exercise capacity, heart rates, cardiac function, biomarkers, health-related quality of life (HRQoL), and sleep quality. Methods Cardiovascular magnetic resonance (CMR), exercise testing (CPET), 24 h-ECG, and blood samples were prospectively performed in 38 patients, age 13 (11–16) years. PA was assessed by accelerometer during 7 consecutive days. HRQoL was self-assessed with KIDSCREEN-27 and SF-36 according to patients' age; sleep quality with Pediatric Sleep Questionnaire (PSQ) and Pittsburgh Sleep Quality Index (PSQI). Results Daily moderate to vigorous physical activity (MVPA) was in median (IQR) 40 (28–57) mins; 7/38 (18%) patients reached the recommended 60 mins/day of MVPA. MVPA did not correlate with gender, age, single ventricle morphology, time from Fontan, heart rate, ventricular volumes, and ejection fraction at CMR, biomarkers, or CPET. Physical wellbeing (r = 0.33, p = 0.04), autonomy (r = 0.39, p = 0.03), and social support (r = 0.43, p = 0.009) assessed using the KIDSCREEN-27, and both physical (r = 0.57, p = 0.03) and mental (r = 0.54, p = 0.04) domains of the SF-36 questionnaire correlated with daily minutes of MVPA. PSQI global sleeping score (r = −0.7, p = 0.007), and PSQ scales for behavior (r = −0.36; p = 0.03) correlated with daily minutes of MVPA. Conclusion Only 18% of the Fontan patients meet the recommendation for daily MVPA. Measures of exercise capacity, cardiac function or chronotropic competence are not correlated to daily physical activity. In contrast, HRQoL and sleep quality seem to be associated with regular physical activity.
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Affiliation(s)
- Alessia Callegari
- University Children's Hospital Zurich, Pediatric Heart Centre, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Kathrin Faeth
- University Children's Hospital Zurich, Pediatric Heart Centre, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Charlène Pfammatter
- University Children's Hospital Zurich, Pediatric Heart Centre, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Ruedi Jung
- University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), Zurich, Switzerland
| | - Florian Berger
- University Children's Hospital Zurich, Pediatric Heart Centre, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Barbara Burkhardt
- University Children's Hospital Zurich, Pediatric Heart Centre, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Emanuela R. Valsangiacomo Buechel
- University Children's Hospital Zurich, Pediatric Heart Centre, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- *Correspondence: Emanuela R. Valsangiacomo Buechel
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