Efficiency of the home cardiac rehabilitation program for adults with complex congenital heart disease.

Bhasipol A; Sanjaroensuttikul N; Pornsuriyasak P; Yamwong S; Tangcharoen

Congenital Heart Disease. 13(6):952-958, 2018 Nov.

OBJECTIVE: We aimed to study the efficiency and safety of once-a-week
outpatient rehabilitation followed by home program with tele-monitoring in
patients with complex cyanotic congenital heart disease.

DESIGN: Prospective nonrandomized study.

METHOD: Patients who have been diagnosed either Eisenmenger’s syndrome or
inoperable complex cyanotic heart disease and able to attend 12-week
cardiac rehabilitation program were included. Training with treadmill
walking and bicycling under supervision at cardiac rehabilitation unit
once-a-week in the first 6 weeks followed by home-based exercise program
(bicycle and walking) with a target at 40%-70% of maximum heart rate
(HRmax) at pretraining peak exercise for another 6 weeks was performed in
the intervention group. Video and telephone calls were scheduled for
evaluation of compliance and complication. Data from cardiopulmonary
exercise testing (CPET) on cycle ergometry including peak oxygen
consumption (peakVO2 ), oxygen pulse (O2 pulse), ventilatory equivalent
for carbon dioxide (VE/CO2 at anaerobic threshold), constant work-rate
endurance time (CWRET) at 75% of peak VO2 , and 6-minute walk distance
(6MWD) were compared between baseline and after training by paired t test.

RESULT: Of the 400 patients in our adult congenital heart disease clinic,
60 patients met the inclusion criteria. Eleven patients who could follow
program regularly were assigned home program. There was a statistically
significant improvement of CWRET, O2 pulse, and 6MWD after finishing the
program (P = .003, .039, and .001, respectively). The mean difference of
6MWD change in the home-program group was significantly higher than in the
control group (69.3 +/- 47.9 meters vs. 4.1 +/- 43.4 meters, P = .003). No
serious adverse outcomes were reported during home training.

CONCLUSION: Once-a-week outpatient hospital-based exercise program
followed by supervised home-based exercise program showed a significant
benefit in improvement of exercise capacity in adults with complex
cyanotic congenital heart disease without serious adverse