From Surviving to Thriving: A Roadmap for Reinventing Cardiac Rehabilitation in Pediatric Congenital Heart Disease.

Abstract

Exercise is an essential component of the cardiac care of children with congenital heart disease (CHD), and safe and effective exercise counseling by the medical team is important early in life to develop positive physical activity and exercise (PAE) habits. Without it, children are at risk for sedentariness and related comorbidities in childhood and adulthood. Pediatric cardiologists can guide patients to a cycle of positive fitness through exercise counseling, promotion, and prescription, and/or supervised exercise training similar to adult cardiac rehabilitation (ACR). ACR has improved exercise capacity, mortality, and quality of life in adults with acquired heart disease. Similar outcomes have been demonstrated in exercise training for adult and pediatric CHD. Exercise training specific to pediatric CHD is not widely available but is expanding in response to growing need and increasing demand. While ACR provides a framework for structured exercise training, approaches to pediatric exercise training must be individualized and innovated upon to be successful for children. I propose that the ACR model must be reinvented for children with CHD by integrating six missing pieces. First, the underlying goal should be to optimize fitness, not rehabilitate to a prior state of health. Second and third are training mental skills and motor skills. Fourth, play-based exercise training is needed to foster a positive relationship with exercise. Fifth, family-focused exercise-interventions can address root-causes of sedentariness. Finally, building communities in which positive fitness is a priority will be essential to long-term sustainability.