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Home‐based interval training increases endurance capacity in adults with complex congenital heart disease
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
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2018 (Engelska)Ingår i: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 13, nr 2, s. 254-262Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The beneficial effects of exercise training in acquired heart failure and coronary artery disease are well known and have been implemented in current treatment guidelines. Knowledge on appropriate exercise training regimes for adults with congenital heart disease is limited, thus further studies are needed. The aim of this study was to examine the effect of home‐based interval exercise training on maximal endurance capacity and peak exercise capacity.

Design: Randomized controlled trial.

Methods: Twenty‐six adults with complex congenital heart disease were recruited from specialized units for adult congenital heart disease. Patients were randomized to either an intervention group—12 weeks of home‐based interval exercise training on a cycle ergometer (n = 16), or a control group (n = 10). The latter was instructed to maintain their habitual physical activities. An incremental cardiopulmonary exercise test and a constant work rate cardiopulmonary exercise test at 75% of peak workload were performed preintervention and postintervention.

Results: Twenty‐three patients completed the protocol and were followed (intervention n = 13, control n = 10). Postintervention exercise time at constant work rate cardiopulmonary exercise test increased in the intervention group compared to controls (median[range] 12[–4 to 52]min vs 0[–4 to 5]min, P = .001). At incremental cardiopulmonary exercise test, peak VO2 increased 15% within the intervention group (P = .019) compared to 2% within the control group (P = .8). However, in comparison between the groups no difference was found (285[–200 to 535] ml/min vs 17[–380 to 306] ml/min, P = .10). In addition, peak workload at incremental cardiopulmonary exercise test increased in the intervention group compared to controls (20[–10 to 70]W vs 0[–20 to 15]W, P = .003).

Conclusion: Home‐based interval exercise training increased endurance capacity and peak exercise capacity in adults with complex congenital heart disease. Aerobic endurance might be more relevant than peak oxygen uptake with regard to daily activities, and therefore a more clinically relevant measure to evaluate.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2018. Vol. 13, nr 2, s. 254-262
Nyckelord [en]
adult, cardiopulmonary exercise testing, congenital heart disease, constant work rate, exercise training, interval training
Nationell ämneskategori
Kardiologi Sjukgymnastik
Identifikatorer
URN: urn:nbn:se:umu:diva-112857DOI: 10.1111/chd.12562ISI: 000430117100014PubMedID: 29205923OAI: oai:DiVA.org:umu-112857DiVA, id: diva2:882987
Anmärkning

Originally included in thesis in manuscript form.

Tillgänglig från: 2015-12-16 Skapad: 2015-12-16 Senast uppdaterad: 2019-05-17Bibliografiskt granskad
Ingår i avhandling
1. Physical performance, physical activity, body composition and exercise training in adults with congenital heart disease
Öppna denna publikation i ny flik eller fönster >>Physical performance, physical activity, body composition and exercise training in adults with congenital heart disease
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background Adults with congenital heart disease (CHD) is a growing population and related to advances in surgical and medical treatment, they now outnumber the children with corresponding lesions. Since a congenital heart lesion often results in reduced exercise capacity, this population is a potential target for physiotherapy. To what extent this reduction in exercise capacity is caused by abnormal cardiovascular anatomy and physiology or to what degree insufficient physical activity contributes is not known. To support the advancements in paediatric cardiac care, increased knowledge regarding physical performance, physical activity level, body composition and the effects of exercise training among adults with CHD is required.

Methods In a cross-sectional study skeletal- and respiratory muscle function, physical activity level and exercise self-efficacy was investigated among 85 adults with various forms of CHD and 42 control subjects. A second study was conducted to analyse height, weight and body mass index (BMI) in 538 adults with complex CHD and 1886 adults with simple CHD. Data were extracted from the Swedish registry on congenital heart disease (SWEDCON) and compared to data from a national population survey. In a third study, factors associated with self-reported quality of life (QoL) were analysed using SWEDCON data on 315 adults with congenital aortic valve disease. Finally, a randomised controlled trial was conducted to investigate the effects of interval exercise training among adults with complex CHD.

Results Adults with complex CHD showed impaired muscle function compared to both patients with simple CHD and controls. In addition, patients with complex CHD had a lower exercise self-efficacy compared to controls. Patients with CHD were equally active at moderate-to-vigorous level as the controls. However, approximately 50% of both patients and controls failed to reach the recommended physical activity level. In general patients with CHD had the same height, weight and BMI, as the general population. However, compared to the general population, men with CHD were more commonly underweight and less commonly overweight/obese. Additionally, especially male patients with complex CHD were shorter compared to the general population. Among adults with congenital aortic valve disease, a higher physical activity level was associated with better QoL. Furthermore, interval training increased exercise capacity and endurance among adults with complex CHD.

Conclusion A higher physical activity level was associated with better self-reported QoL in patients with congenital aortic valve disease which implies that QoL might be possible to improve, by adopting a physically active life-style. Adults with CHD were equally active as controls at a moderate-to-vigorous physical activity level. However, approximately half of both groups were insufficiently physically active based on current recommendations. This indicates that low physical activity, on group level, does not explain the lower exercise capacity commonly found among patients with CHD. In addition, this is consistent the finding that the majority of patients followed the same pattern regarding BMI as seen in the general population. However, impaired muscle function in combination with the shorter stature and higher prevalence of underweight found in men, especially with complex CHD, implies an altered body composition in this group. The findings of the present thesis suggests an indication for physiotherapy targeting increased physical activity level and individualized exercise training in this patient population. Moreover, regular evaluation of muscle function, exercise self-efficacy and QoL, in addition to exercise capacity, might be useful for monitoring disease development over time.

Ort, förlag, år, upplaga, sidor
Umeå: Print och Media, 2016. s. 101
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1758
Nyckelord
Adult congenital heart disease, physical performance, physical activity, body composition, exercise training
Nationell ämneskategori
Sjukgymnastik Kardiologi
Forskningsämne
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-112846 (URN)978-91-7601-360-1 (ISBN)
Disputation
2016-01-29, Aula, Vårdvetarhuset, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2015-12-18 Skapad: 2015-12-16 Senast uppdaterad: 2018-06-07Bibliografiskt granskad

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