A pilot study indicates that many children with serious congenital heart disease, who are typically urged to restrict their activity, can improve their cardiovascular function and exercise capacity through a cardiac rehabilitation program.

Fifteen of 16 children participating in a 12-week rehabilitation program at Children's Hospital Boston showed significant gains in heart function.

The study is published in the journal Pediatrics.

Congenital heart defects affect about 8 in 1000 newborns. Due to advances in care, more and more children with these defects are surviving. Many have diminished exercise capacity after the defects are repaired, and some of this reduction is caused by a lack of activity, says Jonathan Rhodes, a cardiologist at Children's Hospital who led the study.

The study enrolled 19 children, aged 8 to 17, who had congenital heart disease severe enough to consider restricting their activity and showed reduced cardiac function on exercise testing.
None had findings on exercise testing that might raise a concern about the safety of rehabilitation, such as arrhythmias or chest pain.
However, all 16 children who completed the program had undergone heart surgery or a nonsurgical procedure in the past, and 11 of 16 had only one functional ventricle, or pumping chamber.

The 12-week program consisted of twice-weekly, hour-long sessions combining stretching, aerobics, and light weight/resistance exercises.
Activities were tailored to the children's interests, and included dance, calisthenics, kick boxing and jump rope. Balls, music, games like "capture the flag" and relay races, and age-appropriate prizes were used to keep the kids motivated, and sessions were moved outdoors when weather permitted.

Heart rate was checked before each session, and 2 to 3 times during the session.
For safety, a pulse oximeter and external defibrillator were available on site, but were never needed.

At the end of the program, 15 of 16 children had significantly improved peak work rate, peak oxygen consumption, or both: their hearts were pumping more blood with each beat, and their muscles were using more oxygen. Improvements were as high as 20 percent on some parameters of function. There were no adverse events.

Rhodes's team also conducted follow-up exercise testing 1 year after the pre-program tests ( about 7 months after program completion ).
The results, now under review for publication, showed that participants' cardiac benefits were sustained, whereas non-participating children showed a slight decline in cardiac function. On questionnaires, participants reported exercising more than in the past and had higher behavioral, emotional and self-esteem scores.

Source: Children's Hospital Boston, 2005


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