Walzer Lena, Sallmon Hannes, Kelm Marcus, Dirks Stefan, Meyer Michael, Kramer Peter, Wolfarth Bernd, Thouet Thomas, Ovroutski Stanislav, Berger Felix, Schleiger Anastasia
Deutsches Herzzentrum der Charité, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany.
Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Front Cardiovasc Med. 2024 Sep 23;11:1411758. doi: 10.3389/fcvm.2024.1411758. eCollection 2024.
Regular physical activity is highly recommended for patients with Fontan hemodynamics. Our aim was to investigate the effects of a long-term individualized home-based endurance training (IHET) on a bicycle ergometer in combination with inspiratory muscle training (IMT) in pediatric and adult patients after Fontan palliation. Additionally, factors influencing the trainability of Fontan palliated patients were analyzed.
From 2018 to 2021 a single-center prospective study was performed initially including 25 Fontan palliated patients. During study period nine patients were excluded due to incompliance. A Magbike® bicycle ergometer (DKN Technology, France) was used for IHET and a POWERbreathe® Medic plus device (HaB GmbH, Germany) was utilized for the IMT. Over the study period, bike training was increased from 90 min of basic endurance training per week to additional 25 min of interval training per week. IMT consisted of 30 breaths per day for 6-7 days per week with pressure adaption over time. Patients underwent cardiopulmonary exercise testing (CPET) and body plethysmography including measurement of respiratory muscle strength at baseline and at follow-up examinations at 4, 10 and 22 months.
Follow-up examinations were completed by 18/25 patients (72.0%) at 4 and 10 months and 16/25 patients (64.0%) at 22 months. Median exercise capacity slightly increased by 0.13 W/kg from baseline to last follow-up ( = 0.055, 95%CI: 0.0-0.36). However, a significant increase of oxygen pulse of 0.7 ml/beat ( = 0.006, 95%CI: 0.38-2.22) was detectable. IMT significantly improved respiratory function with an increase of inspiratory vital capacity (VCin/reference) by 4.0% ( = 0.016, 95%CI: 0.8-8). Median maximal inspiratory pressure increased by 1.2 kPa ( = 0.003, 95%CI: 0.64-3.19) and expiratory pressure by 1.5 kPa ( = 0.036, 95%CI: 0.08-2.29). No adverse events or unplanned interventions occurred during the study. Patients' subjective quality of life did not significantly change over the study period.
In Fontan palliated patients, IHET in combination with IMT leads to a significant increase in oxygen pulse, inspiratory vital capacity as well as median maximal inspiratory and expiratory pressure but not to significant improvement of quality of life. Fontan patients should be encouraged to perform regular home-based exercise training.
对于具有Fontan循环血流动力学的患者，强烈推荐进行规律的体育活动。我们的目的是研究长期个体化家庭耐力训练（IHET）结合吸气肌训练（IMT）对接受Fontan姑息手术的儿科和成年患者在自行车测力计上的影响。此外，还分析了影响Fontan姑息患者训练能力的因素。
2018年至2021年进行了一项单中心前瞻性研究，最初纳入25例接受Fontan姑息手术的患者。在研究期间，9例患者因不依从被排除。使用Magbike®自行车测力计（法国DKN技术公司）进行IHET，使用POWERbreathe®Medic plus设备（德国HaB有限公司）进行IMT。在研究期间，自行车训练从每周90分钟的基本耐力训练增加到每周额外25分钟的间歇训练。IMT包括每周6 - 7天，每天30次呼吸，并随时间进行压力调整。患者在基线时以及在4、10和22个月的随访检查时接受心肺运动测试（CPET）和体容积描记法，包括呼吸肌力量测量。
18/25例患者（72.0%）在4个月和10个月时完成了随访检查，16/25例患者（64.0%）在22个月时完成了随访检查。从基线到最后一次随访，运动能力中位数略有增加，增加了0.13W/kg（P = 0.055，95%CI：0.0 - 0.36）。然而，可检测到氧脉搏显著增加了0.7ml/次心跳（P = 0.006，95%CI：0.38 - 2.22）。IMT显著改善了呼吸功能，吸气肺活量（VCin/参考值）增加了4.0%（P = 0.016，95%CI：0.8 - 8）。最大吸气压力中位数增加了1.2kPa（P = 0.003，95%CI：0.64 - 3.19），呼气压力增加了1.5kPa（P = 0.036，95%CI：0.08 - 2.29）。研究期间未发生不良事件或计划外干预。患者的主观生活质量在研究期间没有显著变化。
在接受Fontan姑息手术的患者中，IHET结合IMT可导致氧脉搏、吸气肺活量以及最大吸气和呼气压力中位数显著增加，但生活质量没有显著改善。应鼓励Fontan患者进行规律的家庭运动训练。
