Fontan Patients Benefit from Telemedicine Exercise Pilot

Research study background

Patients with Fontan physiology are born with only one effectively functioning ventricle, reducing their ability to exercise compared to healthy peers. Previous research demonstrates home-based physical activity programs can result in long-lasting health benefits for this population and tend to achieve better adherence than hospital-based programs due to their convenience and accessibility.  

A multidisciplinary team from the Heart Institute at Children’s Hospital Colorado created Heart Chargers, a partially reimbursable 12-month, home-based program to encourage physical activity and lifestyle changes for Fontan patients. Their goal was to determine if the program was feasible, safe and would increase participants’ exercise capacity or perceived exercise tolerance. 

To participate in this pilot program, patients were referred from the hospital’s Fontan Multidisciplinary Clinic. After agreeing to adhere to an exercise prescription, participants were given a Garmin tracker to monitor their activity. At enrollment and graduation, participants completed a cardiopulmonary exercise test (CPET), a six-minute walk test (6MWT) and informal surveys about physical activity and self-efficacy.  

Cardiorespiratory fitness and strength training plans were tailored for each participant, incorporating personal preferences like soccer skills or dance. Throughout the program, participants and their families regularly connected with an integrated support team — a cardiologist, nurse coordinator and exercise physiologists — for feedback and guidance via in-person and telemedicine check-ins, phone calls and emails. 

Heart Chargers was implemented safely with no adverse events, and it was evident that active family involvement contributed to graduation success. Of the 26 enrolled patients, nine graduated the program and seven were still participating when the study published. CPETs were performed at enrolled and graduation, and 6MWTs were completed throughout the program to monitor adherence and progress. Although there was no statistically significant pre/post difference in maximal or submaximal oxygen consumption (VO2), peak heart rate or oxygen saturation, these findings are clinically meaningful given peak VO2 progressively declines in Fontan patients without intervention. Minute ventilation at peak exercise was increased at graduation compared to baseline. Self-reported outcomes also showed an increase in exercise-related self-efficacy.

Clinical implications

First implemented during the COVID-19 pandemic, Heart Chargers is a feasible, individualized, partially reimbursable at-home option for enhancing physical fitness for these patients regardless of geographic location.
The enrollment process was revised to incorporate an in-person interview and parental and patient consent/assent, which improved accountability. Bolstered by a devoted and collaborative team, the project is expanding to a three-phase rehabilitation program open to other patients in the Heart Institute. Next steps include integrating nutritional support, physical and occupational therapy, and psychological services.