The impact of exercise and cardiac rehabilitation on the outcomes of children with repaired congenital heart disease: A scoping review

Background: Over 90 % of children with congenital heart disease reach adulthood but remain at risk of significant morbidity and comparative early mortality when compared to the general population. These patients have lower exercise capacity, are often restricted by parents and medical practitioners, and are more likely to be obese. Cardiac rehabilitation aims to improve cardiovascular health and quality of life by utilizing exercise prescription, education, and nutritional and psychosocial assessment.Aim of review: Previous meta-analyses have focused on the safety of exercise training and rehabilitation and shown there is insufficient evidence to ascertain the impact of exercise training in patients with CHD. This scoping review will instead aim to determine what impact exercise programs and cardiac rehabilitation can have on the outcomes of children with repaired CHD, identify and analyze gaps in this literature, look at specific subgroups of CHD patients, and make recommendations for future research. Key scientific concepts of review:There is a potential minimum effective cardiac rehabilitation duration of 12 weeks of twice-weekly exercise sessions, each of at least 20 min in duration. CPET can be used to define target HR and judge exercise effect, and utilizing this target HR with some form of patient monitoring can improve concordance. In addition, Fontan patients may be better at submaximal exercise and may benefit the most from exercise rehabilitation with potential long term positive effects.Quality of Life (QoL) scales have significant benefits and can be used as a tool for demonstrating clinical objective effects of exercise training, as well as to show families improvements in psychosocial metrics. Finally, all studies that re-assessed children following completion of the rehab program showed sustained improvement in submaximal, maximal, and QoL metrics, giving reassurance that the rehabilitation effect is not temporary and effects on outcomes are likely to be long-lasting.