Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review

Charlotte Elizabeth Verrall; Derek Lee Tran; Joseph Yuan-Mou Yang; David Revalds Lubans; David Scott Winlaw; Julian Ayer; David Celermajer; Rachael Cordina

doi:10.3389/fped.2023.1111785

Exercise as therapy for neurodevelopmental and cognitive dysfunction in people with a Fontan circulation: A narrative review

Front Pediatr. 2023 Feb 13:11:1111785. doi: 10.3389/fped.2023.1111785. eCollection 2023.

Authors

Charlotte Elizabeth Verrall^{1

2

3}, Derek Lee Tran^{3

4

5}, Joseph Yuan-Mou Yang^{6

7

8

9}, David Revalds Lubans^{10

11

12}, David Scott Winlaw¹³, Julian Ayer^{1

2}, David Celermajer^{3

4

5}, Rachael Cordina^{3

4

5

14}

Affiliations

¹ Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
² Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
³ Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁴ Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.
⁵ Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.
⁶ Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
⁷ Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
⁸ Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
⁹ Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), Royal Children's Hospital, Melbourne, VIC, Australia.
¹⁰ Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.
¹¹ Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
¹² Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
¹³ Cardiothoracic Surgery, the Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
¹⁴ Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.

Abstract

People with a Fontan circulation are at risk of neurodevelopmental delay and disability, and cognitive dysfunction, that has significant implications for academic and occupational attainment, psychosocial functioning, and overall quality of life. Interventions for improving these outcomes are lacking. This review article discusses current intervention practices and explores the evidence supporting exercise as a potential intervention for improving cognitive functioning in people living with a Fontan circulation. Proposed pathophysiological mechanisms underpinning these associations are discussed in the context of Fontan physiology and avenues for future research are recommended.

Keywords: Fontan; brain injury; cognition; exercise; intervention; neurodevelopment.

Publication types

Review

Grants and funding

This study was supported by the NSW Health Cardiovascular Research Capacity Program—Early-Mid Career Researcher Grant (Ref: H21/174585). DT was supported by the Medical Research Future Fund—Cardiovascular Health Mission—Congenital Heart Disease Grant (ARGCHDG000016). JY receives positional funding from the Royal Children's Hospital Foundation (Grant number: RCHF 2022-1402).