Physical activity interventions for people with congenital heart disease

Congenital heart disease (ConHD) is considered the most common type of birth defect, involving about 1% of all live births. People with ConHD are affected by a complex disease, and both environmental and genetic factors play important roles. The proportion of ConHD patients surviving into adulthood increased over the past decades, due to increases in prenatal diagnoses, surgical advances, and earlier medical care. For a long time, people with ConHD avoided participating in sports or other physical activities (PA) due to the risk of worse clinical outcomes. Therefore, cardiorespiratory fitness (CRF) is poor and psychosocial health is compromised in this population. Moreover, a sedentary lifestyle encouraged higher incidence of obesity and cardiovascular disease in ConHD patients, with consequences on both mortality and morbidity. To date, growing evidence supports exercise and, in general, PA interventions for this condition, although the effectiveness and safety of these programmes still are not defined for people with long-term disease.

This Cochrane Systematic Review (CSR) is important for people with ConHD, their loved ones/caregivers, health professionals caring for this population, general practitioners, researchers, and policymakers.

In this CSR, the authors aimed to assess effectiveness and safety of any type of PA intervention (physical activity promotion, inspiratory muscle training, and exercise training interventions) against control (no physical activity/physical activity as usual) including people with a diagnosis of ConHD, regardless of age or previous medical interventions.

The main outcomes analysed were maximal cardiorespiratory fitness (CRF), health- related quality of life (HRQoL), and device-worn measures of physical activity, with secondary outcomes of submaximal CRF, “subjective” measures of PA, return to work or full-time education, hospital admission, muscular strength, and adverse events.

In the 15 trials with 924 individuals included, results showed that PA interventions probably slightly increase CRF, submaximal CRF, and muscular strength (moderate-certainty evidence) and may slightly improve daily PA (low-certainty evidence) compared to no exercise. Very low-certainty evidence was found as to whether PA interventions improve HRQoL. Moreover, no serious adverse events related to the interventions or adverse cardiac remodelling occurred.

Although these data seem promising, further studies (large and long-term randomised multicentre trials) are needed, including a long-term evaluation of outcomes such as mortality, morbidity, and cost effectiveness. Moreover, investigating effectiveness of PA intervention in specific groups of patients with ConHD, based on their functional capacity, might be interesting to more effectively individualize the intervention.

Comment by Sara Liguori