A Personalized Aerobic Exercise Intervention for Chinese Adolescents with Congenital Heart Disease: A Methodological Framework for a Three-Year Longitudinal Study
DOI:
https://doi.org/10.62051/5xfxfc62Keywords:
Congenital Heart Disease; Exercise Intervention; Adolescents; Study Protocol.Abstract
The population of adolescents with congenital heart disease (CHD) is expanding. With medical advances, the group of people who survive to adolescence with CHD continues to grow. In China, the challenges are further magnified by a sedentary lifestyle as a result of academic pressures and parental over-protection, underscoring how timely exercise interventions that are both safe and efficacious are needed. To meet this need, this paper presents a methodological framework for a three-year longitudinal study aimed at assessing an individualized aerobic exercise intervention. Methods/Design: The proposed study is a single-arm pre-post intervention and will recruit a target sample size of 1,000 Chinese adolescents (ages 15-18 years) who have been diagnosed with CHD. The intervention is guided by the FITT (Frequency, Intensity, Time, Type) principle which prescribes 150 min/week of aerobic exercise at the individualized intensity level defined according to both Heart Rate Reserve (HRR) and Rate of Perceived Exertion (RPE). The primary outcome will include the changes in cardiorespiratory fitness and the Health-Related Quality of Life (HRQoL) scores. This study protocol will close this gap by providing a written, evidence-based and culturally relevant exercise protocol rather than just general advice. Although conducted as a foundational study, the research is intended to draw information on whether and how exercise can be safely applied to individuals with this condition aiming at improved clinical care for the vulnerable population. The results likely will affect future edits of clinical guidelines.
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[1] K.K. Stout, C.J. Daniels, J.A. Aboulhosn, et al., 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, J. Am. Coll. Cardiol. 73 (2019) e81-e192.
[2] I. Nederend, M.R.M. Jongbloed, E.J.C. de Geus, N.A. Blom, A.D.J. Ten Harkel, Postnatal cardiac autonomic nervous control in pediatric congenital heart disease, J. Cardiovasc. Dev. Dis. 3 (2016) 16.
[3] C.A. Warnes, The adult with congenital heart disease: born to be bad?, J. Am. Coll. Cardiol. 46 (2005) 1-8.
[4] M. Gomes-Neto, M.B. Saquetto, C.M. da Silva e Silva, C.S. Conceição, V.O. Carvalho, Impact of exercise training in aerobic capacity and pulmonary function in children and adolescents after congenital heart disease surgery: A systematic review with meta-analysis, Pediatr. Cardiol. 37 (2016) 217-224.
[5] K. Dulfer, W.A. Helbing, E.M.W.J. Utens, The influence of exercise training on quality of life and psychosocial functioning in children with congenital heart disease: A review of intervention studies, Sports (Basel) 5 (2017) 13.
[6] J. Bouchardy, J. Therrien, L. Pilote, et al., Atrial arrhythmias in adults with congenital heart disease, Circulation 120 (2009) 1679-1686.
[7] B.S. Lowe, J. Therrien, R. Ionescu-Ittu, L. Pilote, G. Martucci, A.J. Marelli, Diagnosis of pulmonary hypertension in the congenital heart disease adult population impact on outcomes, J. Am. Coll. Cardiol. 58 (2011) 538-546.
[8] R. Ionescu-Ittu, A.S. Mackie, M. Abrahamowicz, et al., Valvular operations in patients with congenital heart disease: increasing rates from 1988 to 2005, Ann. Thorac. Surg. 90 (2010) 1563-1569.
[9] P.M. Hendriks, A.E. van den Bosch, J.A. Kors, et al., Heart rate: an accessible risk indicator in adult congenital heart disease, Heart 110 (2024) 402-407.
[10] G. Wernovsky, J. Newburger, Neurologic and developmental morbidity in children with complex congenital heart disease, J. Pediatr. 142 (2003) 6-8.
[11] Y.K. Cho, J.S. Ma, Right ventricular failure in congenital heart disease, Korean J. Pediatr. 56 (2013) 101-106.
[12] Z. Koyak, L. Harris, J.R. de Groot, et al., Sudden cardiac death in adult congenital heart disease, Circulation 126 (2012) 1944-1954.
[13] J.M. Saef, J. Ghobrial, Valvular heart disease in congenital heart disease: a narrative review, Cardiovasc. Diagn. Ther. 11 (2021) 818-839.
[14] C.M. Otto, R.A. Nishimura, R.O. Bonow, et al., 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease, Circulation 143 (2020).
[15] C.A. Warnes, R. Liberthson, G.K. Danielson, et al., Task force 1: the changing profile of congenital heart disease in adult life, J. Am. Coll. Cardiol. 37 (2001) 1170-1175.
[16] D.M. Pickles, K. Keller, P. Andreu, N.J. Atay, The Cost of Complex Congenital Heart Disease in the US, Additional Ventures, IQVIA, 2024.
[17] J.I.E. Hoffman, The global burden of congenital heart disease, Cardiovasc. J. Afr. 24 (2013) 141-145.
[18] A. Arvanitaki, G. Diller, G. Giannakoulas, The right heart in congenital heart disease, Curr. Heart Fail. Rep. 20 (2023) 471-483.
[19] O.I. Woudstra, J.M. Kuijpers, F.J. Meijboom, et al., High burden of drug therapy in adult congenital heart disease: polypharmacy as marker of morbidity and mortality, Eur. Heart J. Cardiovasc. Pharmacother. 5 (2019) 216-225.
[20] K. Julian, N. Garg, N. Hibino, R. Jain, Stem cells and congenital heart disease: The future potential clinical therapy beyond current treatment, Curr. Cardiol. Rev. 19 (2023).
[21] P.P. Heinisch, S. Michel, D. Zimpfer, J. Hörer, Editorial: Emerging opportunities in congenital cardiac surgery, Front. Cardiovasc. Med. 10 (2023) 1343354.
[22] W.W. Lai, D. Vervoort, D. Bradley, et al., Pediatric and Congenital Cardiac Services: An Innovative and Empowering Approach to Global Training and Equitable Care, J. Am. Heart Assoc. 14 (2025) e040003.
[23] N.H. Amir, D.M. Dorobantu, C.A. Wadey, et al., Exercise training in paediatric congenital heart disease: fit for purpose?, Arch. Dis. Child. 107 (2022) 525-534.
[24] S. Kodama, Cardiorespiratory fitness as a quantitative predictor of All-Cause mortality and cardiovascular events in healthy men and women, JAMA 301 (2009) 2024.
[25] A.L. Baggish, K. Yared, F. Wang, et al., The impact of endurance exercise training on left ventricular systolic mechanics, AJP Heart Circ. Physiol. 295 (2008) H1109-H1116.
[26] A. Arbab-Zadeh, E. Dijk, A. Prasad, et al., Effect of aging and physical activity on left ventricular compliance, Circulation 110 (2004) 1799-1805.
[27] R. Yoshihara, Y. Kanejima, M. Kitamura, K. Ishihara, K.P. Izawa, Optimal exercise training for children with congenital heart disease: A systematic review, Am. Heart J. Plus 13 (2022) 100119.
[28] G. Liguori, American College of Sports Medicine, ACSM's guidelines for exercise testing and prescription, Lippincott Williams & Wilkins, 2020.
[29] D. Riebe, B.A. Franklin, P.D. Thompson, et al., Updating ACSM's recommendations for exercise preparticipation health screening, Med. Sci. Sports Exerc. 47 (2015) 2473-2479.
[30] D. Tran, A. Maiorana, J. Ayer, et al., Recommendations for exercise in adolescents and adults with congenital heart disease, Prog. Cardiovasc. Dis. 63 (2020) 350-366.
[31] C.A. Williams, C. Wadey, G. Pieles, G. Stuart, R.S. Taylor, L. Long, Physical activity interventions for people with congenital heart disease, Cochrane Library 2021 (2020).
[32] N. Duppen, T. Takken, M.T. Hopman, et al., Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease, Int. J. Cardiol. 168 (2013) 1779-1787.
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