Sydney Medical School, University of Sydney.
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales.
Curr Opin Cardiol. 2019 Jan;34(1):79-86. doi: 10.1097/HCO.0000000000000582.
In recent decades, the physiology and late outcomes of the Fontan circulation have become better characterized and interest has turned to interventions that might improve exercise capacity and clinical sequelae. No therapy has currently been shown to be more effective for improving exercise capacity in the setting of a Fontan circulation than exercise. This review examines the current evidence supporting exercise as therapy for this group.
People living with a Fontan circulation are at increased risk for reduced skeletal muscle mass and exercise capacity with important implications for clinical outcomes. Small studies suggest that performing moderate-to-vigorous aerobic and resistance exercise improves exercise capacity through unique mechanisms such as superior respiratory and skeletal muscle function and venous return.
Despite traditional concerns about moderate-to-vigorous physical activity, current evidence suggests that exercise is beneficial for the Fontan circulation and that, after appropriate screening, we should be encouraging regular moderate-to-vigorous physical activity. Multicentre randomized controlled trials are needed that further explore mechanisms, late impact for end-organ function and strategies to optimize long-term moderate-to-vigorous physical activity levels.
近几十年来，Fontan 循环的生理学和晚期结果得到了更好的描述，人们对可能改善运动能力和临床后果的干预措施产生了兴趣。目前尚无任何治疗方法被证明比运动更能有效改善 Fontan 循环中的运动能力。这篇综述检查了支持运动作为该人群治疗方法的现有证据。
患有 Fontan 循环的人骨骼肌质量和运动能力降低的风险增加，这对临床结果有重要影响。小型研究表明，进行适度到剧烈的有氧运动和抗阻运动通过改善呼吸和骨骼肌功能以及静脉回流等独特机制来提高运动能力。
尽管传统上对适度到剧烈的体力活动存在担忧，但现有证据表明运动对 Fontan 循环有益，并且在适当的筛选后，我们应该鼓励定期进行适度到剧烈的体力活动。需要进行多中心随机对照试验，进一步探索机制、对终末器官功能的晚期影响以及优化长期适度到剧烈体力活动水平的策略。
