Fitter Fontans for future-Impact of physical exercise on cardiopulmonary function in Fontan patients

Annika Weigelt; Regina Fritsch; Kathrin Rottermann; Wolfgang Wällisch; Julia Moosmann; Sven Dittrich; Ariawan Purbojo; Isabelle Schöffl

doi:10.3389/fcvm.2022.972652

Fitter Fontans for future-Impact of physical exercise on cardiopulmonary function in Fontan patients

Front Cardiovasc Med. 2022 Sep 12:9:972652. doi: 10.3389/fcvm.2022.972652. eCollection 2022.

Authors

Annika Weigelt¹, Regina Fritsch¹, Kathrin Rottermann¹, Wolfgang Wällisch¹, Julia Moosmann¹, Sven Dittrich¹, Ariawan Purbojo², Isabelle Schöffl^{1

3}

Affiliations

¹ Department of Pediatric Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
² Department of Pediatric Heart Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
³ School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.

Abstract

Background: In Fontans, exercise tolerance is poorer compared to their healthy peers. Higher $\dot{V} O_{2} p e a k$ represents a strong predictor for mortality and morbidity in these patients. Cardiac rehabilitation programs have been shown to improve cardiopulmonary function in Fontans. More habitual physical activity should therefore lead to a better exercise tolerance.

Methods: We performed cardiopulmonary exercise testing in 24 Fontan patients who had engaged in physical activity for a minimum of 3 h per week over their lifetime. As a control we performed cardiopulmonary exercise testing in 20 Fontan patients who had undertaken no physical activity or <3 h per week in the past.

Results: A total of 44 Fontan patients was included (mean age 18.1 years). The mean parameters measured at peak exercise differed significantly between the active and inactive group (peak oxygen uptake [ $\dot{V} O_{2} p e a k$ ] of 34.0 vs. 25.0 ml/min/kg, peak heart rate (HR) of 169.8/min vs. 139.8/min). Even though the O₂pulse and the EF did not differ significantly between both groups, N-Terminal-Pro-B-Type Natriuretic Peptide (NT-pro BNP) was significantly higher in the inactive group. The two groups did not differ with respect to their cardiac function determined by magnetic resonance imaging (MRI). $\dot{V} O_{2} p e a k$ was positively correlated with hours of sports performed by Fontans.

Conclusions: $\dot{V} O_{2} p e a k$ and maximum HR were significantly higher in Fontans who had been physically active compared to those who had been inactive. The values reported in this study were higher than in other studies and reached normal values for $\dot{V} O_{2} p e a k$ for most Fontans in the physically active group. The positive correlation between $\dot{V} O_{2} p e a k$ and physical activity is an indicator of the importance of incorporating physical exercise programs into the treatment of Fontan patients.

Keywords: TCPC; V̇O2peak; cardiopulmonary exercise testing (CPET); congenital heart disease; habitual exercise; peak oxygen uptake; sports and exercise medicine.