Pediatric Cardiology

, Volume 34, Issue 5, pp 1130–1151 | Cite as

Home-Based Rehabilitation Enhances Daily Physical Activity and Motor Skill in Children Who Have Undergone the Fontan Procedure

  • Patricia E. Longmuir
  • Pascal N. Tyrrell
  • Mary Corey
  • Guy Faulkner
  • Jennifer L. Russell
  • Brian W. McCrindle
Original Article


This randomized trial compared physical activity enhancing exercise prescription and education programs in 61 children (36 male) with single-ventricle physiology after Fontan. After Fontan, children are less active than recommended for optimal health. They are often geographically dispersed and unable to attend weekday programs. Participants, 5.9–11.7 years of age who were status 5.3 years post-Fontan, received 12-month, parent-delivered home programs to enhance physical activity, motor skill, fitness, and activity attitudes. Daily moderate-to-vigorous physical activity (MVPA) was measured at baseline and again at 6, 12, and 24 months. Secondary outcomes were gross motor skill, fitness, and activity attitudes. Gross motor skill (p = .01) was significantly greater at the end of the 2-year study period for both intervention groups combined. MVPA at 2 years was significantly greater (p = .03) than the predicted decrease with age. Spring season (85 ± 25 min), male sex (69 ± 21 min), greater baseline activity (0.3 ± 0.1 min/baseline minute), and better gross motor skill (1.1 ± 0.4 min/percentile) increased weekly MVPA in a multivariable repeated-measures regression model adjusted for intervention, maturation during the 2-year study, sex, season, and baseline activity. Benefits were not influenced by type of rehabilitation, compliance, or rural/urban location. Home-based, pediatric physical activity rehabilitation enhances physical activity, gross motor skill, exercise capacity, and physical fitness among preadolescent children after Fontan regardless of rural/urban location. Prescribed education and exercise programs are similarly effective for providing the important health benefits of daily physical activity. Enhanced gross motor skill is associated with increased MVPA despite exercise capacity limitations after Fontan. Rehabilitation attenuates the expected decrease in MVPA with age.


Cardiac rehabilitation Children Physical activity Fontan Exercise capacity Motor skills Attitudes 



The authors acknowledge the support of the families who participated in this research. The contributions of Laura Banks, Stephanie Wong, Gareth Smith, Susan Iori, Laura De Souza, Laura Fenwick, and Faith Bangawan to the data collection are also appreciated. This research project was supported by the Heart and Stroke Foundation of Ontario (Toronto, Ontario), Grant No. NA 5950. P.E.L. was supported by a Doctoral Research Award from the Canadian Institutes of Health Research (Ottawa, Ontario, Canada).


  1. 1.
    Ades PA (2001) Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 345:892–902PubMedCrossRefGoogle Scholar
  2. 2.
    Balady GJ, Williams MA, Ades PA, Bittner V, Cosmoss P, Foody JM et al (2007) Core components of cardiac rehabilitation/secondary prevention programs: 2007 update. Circulation 115:2675–2682PubMedCrossRefGoogle Scholar
  3. 3.
    Bar-Or O, Rowland TW (2004) Pediatric exercise medicine: From Physiologic principles to health care application. Human Kinetics, Champaign, ILGoogle Scholar
  4. 4.
    Basterfield L, Pearce MS, Adamson AJ, Frary JK, Parkinson KN, Wright CM et al (2012) Physical activity, sedentary behavior and adiposity in English children. Am J Prev Med 42:445–451PubMedCrossRefGoogle Scholar
  5. 5.
    Bellinger DC, Wypij D, duPlessis AJ, Rappaport LA, Jonas RA, Wernovsky G et al (2003) Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston Circulatory Arrest Trial. J Thorac Cardiovasc Surg 126:1385–1396PubMedCrossRefGoogle Scholar
  6. 6.
    Bradley RH, McRitchie S, Houts RM, Nader P, O’Brien M (2011) Parenting and the decrease of physical activity from age 9 to 15. Int J Behav Nutr Phys Act 8:33–42PubMedCrossRefGoogle Scholar
  7. 7.
    Canadian Society for Exercise Physiology (2003) Canadian physical activity, fitness and lifestyle approach. Canadian Society for Exercise Physiology, Ottawa, CanadaGoogle Scholar
  8. 8.
    Centers for Disease Control (2000) CDC growth charts for the United States: Methods and development. 246:Google Scholar
  9. 9.
    Connolly D, McClowry S, Hayman L, Mahony L, Artman M (2004) Posttraumatic stress disorder in children after cardiac surgery. J Pediatr 144:480–484PubMedCrossRefGoogle Scholar
  10. 10.
    Cumming GR (1978) Maximal exercise capacity of children with heart defects. Am J Cardiol 42:613–619PubMedCrossRefGoogle Scholar
  11. 11.
    Dollard J, Smith J, Thompson DR, Stewart S (2004) Broadening the reach of cardiac rehabilitation to rural and remote Australia. Eur J Cardiovasc Nurs 3:27–42PubMedCrossRefGoogle Scholar
  12. 12.
    Fredriksen PM, Ingier E, Thaulow E (2000) Physical activity in children and adolescents with congenital heart disease: Aspects of measurements with an activity monitor. Cardiol Young 10:98–106PubMedGoogle Scholar
  13. 13.
    Ginsburg KR (2007) The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics 119:182–191PubMedCrossRefGoogle Scholar
  14. 14.
    Gortmaker SL, Lee R, Cradock AL, Sobol AM, Duncan DT, Wang YC (2012) Disparities in youth physical activity in the United States: 2003–2006. Med Sci Sports Exerc 44:888–893PubMedCrossRefGoogle Scholar
  15. 15.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA et al (2007) Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116:1081–1093PubMedCrossRefGoogle Scholar
  16. 16.
    Hay JA (1992) Adequacy in and predilection for physical activity in children. Clin J Sports Med 2:192–201CrossRefGoogle Scholar
  17. 17.
    Hay J (1996) Predicting the selection of physical education class in grade 10 from self-perceptions reported in grades seven, eight and nine. Brock Educ 6:59–69Google Scholar
  18. 18.
    Hovels-Gurich HH, Konrad K, Skorzenski D, Nacken C, Minkenberg R, Messmer BJ et al (2006) Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy. Ann Thorac Surg 81:958–966PubMedCrossRefGoogle Scholar
  19. 19.
    Kantomaa MT, Purtsi J, Taanila AM, Remes J, Viholainen H, Rintala P, et al. (2011, January 1) Suspected motor problems and low preference for active play in childhood are associated with physical inactivity and low fitness in adolescence. PLoS One 6:e14544–eGoogle Scholar
  20. 20.
    Karsdorp PA, Everaerd W, Kindt M, Mulder BJM (2007) Psychological and cognitive functioning in children and adolescents with congenital heart disease: A meta-analysis. J Pediatr Psychol 32:527–541PubMedCrossRefGoogle Scholar
  21. 21.
    Longmuir PE, Turner JAP, Rowe RD, Olley PM (1985) Postoperative exercise rehabilitation benefits children with congenital heart disease. Clin Invest Med 8:232–238PubMedGoogle Scholar
  22. 22.
    Longmuir PE, Tremblay MS, Goode RC (1990) Postoperative exercise training develops normal levels of physical activity in a group of children following cardiac surgery. Pediatr Cardiol 11:126–130PubMedCrossRefGoogle Scholar
  23. 23.
    Longmuir PE, Russell JL, Corey M, Faulkner G, McCrindle BW (2011) Factors associated with the physical activity level of children who have the Fontan procedure. Am Heart J 161:411–417PubMedCrossRefGoogle Scholar
  24. 24.
    Majnemer A, Limperopoulos C, Shevell M, Rosenblatt B, Rohlicek C, Tchervenkov C (2006) Long-term neuromotor outcome at school entry of infants with congenital heart defects requiring open-heart surgery. J Pediatr 148:72–77PubMedCrossRefGoogle Scholar
  25. 25.
    McCrindle BW, Williams RV, Mital S, Clark BJ, Russell JL, Klein G et al (2007) Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 92:509–514PubMedCrossRefGoogle Scholar
  26. 26.
    Medical Research Council of Canada, Natural Sciences and Engineering Research Council of Canada, and Sciences and Humanities Research Council of Canada (1998) Tri-council policy statement: Ethical conduct for research involving humans. 90–Google Scholar
  27. 27.
    Olson JM, Zanna MP (1993) Attitudes and attitude change. Annu Rev Psychol 44:117–154CrossRefGoogle Scholar
  28. 28.
    Opocher F, Varnier M, Sanders SP, Tosoni A, Zaccaria M, Stellin G et al (2005) Effects of aerobic exercise training in children after the Fontan operation. Am J Cardiol 95:150–152PubMedCrossRefGoogle Scholar
  29. 29.
    Pinto NM, Marino BS, Wernovsky G, de Ferranti SD, Walsh AZ, Laronde M et al (2007) Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 120:e1157–e1164PubMedCrossRefGoogle Scholar
  30. 30.
    Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47:1102–1114Google Scholar
  31. 31.
    Puyau MR, Adolph AL, Vohra FA, Zakeri I, Butte NF (2004) Prediction of activity energy expenditure using accelerometers in children. Med Sci Sports Exerc 36:1625–1631PubMedGoogle Scholar
  32. 32.
    Rhodes J, Curran TJ, Camil L, Rabideau N, Fulton DR, Gauthier NS et al (2005) Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 116:1339–1345PubMedCrossRefGoogle Scholar
  33. 33.
    Rhodes J, Curran TJ, Camil L, Rabideau N, Fulton DR, Gauthier NS et al (2006) Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics 118:e586–e593PubMedCrossRefGoogle Scholar
  34. 34.
    Rhodes J, Ubeda Tikkanen A, Jenkins KJ (2010) Exercise testing and training in children with congenital heart disease. Circulation 122:1957–1967PubMedCrossRefGoogle Scholar
  35. 35.
    Sherar LB, Esliger DW, Baxter-Jones AD, Tremblay MS (2007) Age and sex differences in youth physical activity: Does physical maturity matter? Med Sci Sports Exerc 39:830–835PubMedCrossRefGoogle Scholar
  36. 36.
    Singh TP, Curran TJ, Rhodes J (2007) Cardiac rehabilitation improves heart rate recovery following peak exercise in children with repaired congenital heart disease. Pediatr Cardiol 28:276–279PubMedCrossRefGoogle Scholar
  37. 37.
    Statistics Canada (2006) Census Tract (CT) Profiles, 2006 CensusGoogle Scholar
  38. 38.
    Statistics Canada (2007) Geography Working Pa/SeriesGoogle Scholar
  39. 39.
    Statistics Canada (2010) Canadian Health Measures Survey (CHMS) data user guide: Cycle 1. Statistics Canada, Ottawa, CanadaGoogle Scholar
  40. 40.
    Takken T, Tacken MHP, Blank AC, Hulzebos EH, Strengers JLM, Helders PJM (2007) Exercise limitation in patients with Fontan circulation: A review. J Cardiovasc Med 8:775–781CrossRefGoogle Scholar
  41. 41.
    Taylor RW, Murdoch L, Carter P, Gerrard DF, Williams SM, Taylor BJ (2009) Longitudinal study of physical activity and inactivity in preschoolers: The FLAME study. Med Sci Sports Exerc 41:96–102PubMedGoogle Scholar
  42. 42.
    Tremblay MS, Langlois R, Bryan S, Esliger D, Patterson J (2007) Canadian health measures survey pretest: Design, methods and results. Health Report no. 82-003-S:24–Google Scholar
  43. 43.
    Tremblay MS, Shields M, Laviolette M, Craig CL, Janssen I, Connor Gorber S (2010) Fitness of Canadian children and youth: Results from the 2007-2009 Canadian Health Measures SurveyGoogle Scholar
  44. 44.
    Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M (2008) Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40:181–188PubMedGoogle Scholar
  45. 45.
    Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC (2000) Using objective physical activity measures with youth: How many days of monitoring are needed? Med Sci Sports Exerc 32:426–431PubMedCrossRefGoogle Scholar
  46. 46.
    Ulrich DA (2000) Test of gross motor development (TGMD-2). PRO-ED, Austin, TXGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Patricia E. Longmuir
    • 1
    • 2
    • 7
  • Pascal N. Tyrrell
    • 1
  • Mary Corey
    • 3
    • 4
  • Guy Faulkner
    • 5
  • Jennifer L. Russell
    • 1
    • 6
  • Brian W. McCrindle
    • 1
    • 6
  1. 1.Labatt Family Heart CentreThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of Physical Therapy, Faculty of MedicineUniversity of TorontoTorontoCanada
  3. 3.Child Health Evaluative Sciences, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  4. 4.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  5. 5.Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoCanada
  6. 6.Department of Paediatrics, Faculty of MedicineUniversity of TorontoTorontoCanada
  7. 7.Healthy Active Living and Obesity Research UnitChildren’s Hospital of Eastern OntarioOttawaCanada

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