Exercise training in adults with congenital heart disease: Feasibility and benefits

Abstract

Background

Regular physical activity is associated with a range of health benefits; however the influence of regular exercise training on exercise capacity and quality of life in adults with congenital heart disease [ACHD] has not been previously reported.

Methods

Prospective study of patients attending the ACHD clinic in a supra-regional centre, assessing feasibility and effects of exercise training. There were 3 phases: Phase I: Initial assessment including quality of life and physical activity questionnaires; treadmill exercise test; physical activity assessment with accelerometers [Caltrac^® and Actigraph^®]; Phase II: Exercise training (home-based walking 5/7 days) for 10 weeks; Phase III: Re-assessment.

Results

Sixty-one adults [36 males; mean age 31.7 +/− 10.9 yrs] were divided into 3 groups according to NYHA class. Fifty patients completed the intervention and all pre-post assessments. Group I (n = 21; 13 males), Group II (n = 16; 10 males), Group III (n = 13, 10 males). Median body mass index was 23.8; 12 were overweight (BMI 25–29.9) and 7 obese (BMI > 30).

The scores of the quality of life and physical activity questionnaires increased significantly after exercise training in all three groups. Similar increases were seen in the treadmill test duration and in physical activity levels assessed by the Caltrac^® and the Actigraph^® in all groups.

Conclusions

A simple physical activity intervention like regular walking is feasible, safe and significantly increases the exercise capacity of adult patients at all stages of congenital heart disease. It is also helpful in improving the quality of life by improving physical self-perception, satisfaction with life, physical activity levels and general health.

Introduction

Physical exercise for a healthy lifestyle is being increasingly recognised and recommended by official bodies [1], [2]. The consensus document of the European Society of Cardiology states that regular exercise at recommended levels can be performed and should be encouraged in all patients with congenital heart disease [3].

Regular physical activity [PA] lowers adult mortality, improves quality of life [4] and is beneficial in chronic heart failure [5], obesity and diabetes [6]. Several studies have shown that regular PA improves mental health, reduces depression [7] and can improve self-esteem, anxiety, resilience to stress and sleep pattern [8]. The role of exercise training in patients with heart disease is rapidly being accepted [9], [10]. Walking remains the mainstay of exercise prescription for adult cardiac patients as part of home-based programs [10].

Although surgery improves the heart function and exercise capacity in children with congenital heart disease (CHD), overall exercise capacity usually remains lower than subjects with normal hearts [11], [12]. Similar findings have been reported in adults with CHD [13], [14]. In addition, adults with CHD may have poorer quality of life, more psychosocial problems and may feel physically impaired by their CHD [15], [16]. There is evidence that structured exercise intervention in the period after CHD surgery may improve exercise capacity which may be maintained for months without further intervention [17], [18] and there can be psychological benefit in young people with CHD [19].

Exercise capacity has routinely been assessed through treadmill testing and measuring the maximal oxygen [VO₂] uptake [18]. A variety of validated questionnaires are now available to assess habitual PA and quality of life [20], [21]. Similarly, free-living PA can now be reliably and objectively monitored “at home” using activity monitors (accelerometers) [22], [23]. An effective way to build up activity levels after surgery for CHD is to do twice weekly training sessions for a period of 10–12 weeks [24]. However, this is not yet routine practice.

A recent study showed that although adults with CHD may do some form of light exercise, 30% had received contradictory advice [25]. A recent review recommended that advice on physical activity and sports should be included in adult CHD clinic consultations [26]. In a preliminary study, we demonstrated that adults with CHD have a range of physical activity levels between normal and severely limited. Most of these patients showed a willingness to participate in exercise but were uncertain of the safety or benefit. Hence we concluded that an intervention to increase physical activity levels might be a low risk, low cost treatment strategy [27].

This study provides the first attempt to assess the feasibility and effects of a simple home-based exercise program in adults with varying degrees of congenital heart disease.