Can endurance training improve physical capacity and quality of life in young Fontan patients?

Objective: Children after Fontan palliation have reduced exercise capacity and quality of life. Our aim was to study whether endurance training could improve physical capacity and quality of life in Fontan patients. Methods: Fontan patients (n=30) and healthy age-and gender-matched control subjects (n=25) performed a 6-minute walk test at submaximal capacity and a maximal cycle ergometer test. Quality of life was assessed with Pediatric Quality of Life Inventory Version 4.0 questionnaires for children and parents. All tests were repeated after a 12-week endurance training programme and after 1 year. Results: Patients had decreased submaximal and maximal exercise capacity (maximal oxygen uptake 35.0 +/- 5.1 ml/minute per.kg versus 43.7 +/- 8.4 ml/minute.per.kg, p<0.001) and reported a lower quality of life score (70.9 +/- 9.9 versus 85.7 +/- 8.0, p<0.001) than controls. After training, patients improved their submaximal exercise capacity in a 6-minute walk test (from 590.7 +/- 65.5 m to 611.8 +/- 70.9 m, p<0.05) and reported a higher quality of life (p<0.01), but did not improve maximal exercise capacity. At follow-up, submaximal exercise capacity had increased further and improved quality of life was sustained. The controls improved their maximal exercise capacity (p<0.05), but not submaximal exercise capacity or quality of life after training. At follow-up, improvement of maximal exercise capacity was sustained. Conclusions: We believe that an individualised endurance training programme for Fontan patients improves submaximal exercise capacity and quality of life in Fontan patients and the effect on quality of life appears to be long-lasting.