Open Access

ARTICLE

Effect of Exercise-Based Cardiac Rehabilitation on Cardiorespiratory Fitness in Adults with Congenital Heart Disease

by Prisca Eser^1,*, Thomas Gruber¹, Thimo Marcin¹, Claudia Boeni^1,2, Kerstin Wustmann³, Christina DeLuigi¹, Matthias Greutmann⁴, Daniel Tobler⁵, Markus Schwerzmann³, Matthias Wilhelm¹

1 Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
2 Department for Neuroscience and Movement Science, University of Fribourg, Fribourg, Switzerland
3 Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
4 Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
5 Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland

* Corresponding Author: Prisca Eser. Email:

Congenital Heart Disease 2021, 16(1), 73-84. https://doi.org/10.32604/CHD.2021.013051

Received 24 July 2020; Accepted 24 September 2020; Issue published 23 December 2020

Abstract

Background: The purpose of this study was to investigate whether patients with adult congenital heart disease (ACHD) benefit from exercise-based cardiac rehabilitation (CR) short- and long-term with regard to improvement of cardiorespiratory fitness. Methods: Cardiopulmonary exercise tests (CPET) completed by ACHD patients between January 2000 and October 2019 were analysed retrospectively. Linear mixed models were performed for peak oxygen consumption (VO₂) with patients as random effect and age, sex, disease classification, preceding surgery (≤3 months) and preceding CR (≤4 weeks for short term and >4 weeks for long term) as fixed effects. Results: 1056 CPETs of 311 ACHD patients with simple (7), moderate (188) or great (116) complexity heart defects were analysed. The 59 patients who completed a CR (median age 27 yrs, 38% females) increased peak VO₂ from before to after CR by a median of 2.7 (IQR –0.6 to 5.5) ml/kg/min. However, in the multivariate mixed model, peak VO₂ was non-significantly increased short-term after CR (β 0.8, 95%CI –0.7 to 2.4), not maintained long-term after CR (β 0.0, 95%CI –1.7 to 1.6) but significantly reduced after surgery (β –5.1, 95%CI –7.1 to –3.1). The 20 CR patients after surgery increased their peak VO₂ by 6.2 (IQR 3.6–9.5) ml/kg/min, while the 39 CR patients without preceding surgery increased it by 0.9 (IQR –1.5 to 3.1) ml/kg/min. Conclusions: The increase in peak VO₂ with CR was mainly due to recovery from surgical intervention. The small independent benefit from CR was not maintained long-term, highlighting the potential to improve current CR concepts in ACHD populations.

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