Aronoff EB, Chin C, Opotowsky AR, Mays WA, Knecht SK, Goessling J, Rice M, Shertzer J, Wittekind SG, Powell AW.
Pediatr Cardiol. 2024 Oct;45(7):1533-1541. doi: 10.1007/s00246-023-03202-0. Epub 2023 Jun 9. PMID: 37294337
Commentary by:
Dr. Jared Hershenson (Greater Washington DC), section editor of Pediatric Cardiology Journal Watch:
Take-home Points:
- Cardiac rehabilitation in younger patients can likely be successful even with virtual sessions, but improvements may be less robust than with in-person facility-based training.
- Hybrid models may solve some of the problems in facility-based or virtual (alone) programs, but further study is needed.
Cardiac rehabilitation (CR) is considered an essential component of post-surgical care in adult cardiac patients. With data showing improved outcomes in pediatric and adult congenital heart patients who have higher exercise capacity (peak VO2) as measured on cardiopulmonary exercise testing (CPET), there has been a push to create rehabilitation and fitness programs for this population, especially given the often life-long, chronic nature of the cardiac disease. There have been a considerable number of publications showing better adherence to a rehabilitation program with virtual visits, but data in the pediatric population is minimal. Due to the COVID pandemic, facility-based sessions could not be performed for many patients at this single-center program. In younger patients, adherence for facility-based visits may be even more challenging due to school or longer distance of travel to the cardiac center. The goals of this study were to assess the physical and psychosocial outcomes in patients aged 19 +/- 7.3 years old undergoing virtual rehab session and to compare them to patients who received in-person visits.
Between 2020-2022, 73 patients were enrolled, but only 47 total patients completed CR (at least 2-3 sessions per week for 12 weeks). Virtual patients were more likely to complete the program, with 12/15 (80%) virtual and 33/55 (60%) facility-based (3 were hybrid and not included in the final analysis). Each session was 1 hour and included warm-up, 30 min aerobic (facility) or HIIT (virtual), 15 min of low resistance high repetition strength training, and cool-down. The aerobic training goal was sustaining 70-75% of the peak heart rate. Home exercise was encouraged but not tracked. There was a significant increase in peak VO2 (~8-9%), 6-min walk distance (76m), sit to stand repetitions, and arm curls, as well as an improvement in the psychosocial and activity test scores (PHQ-9, PCS, and DASI). When evaluating facility-based vs virtual groups, there was a 10% improvement in peak VO2 in the facility-based group, but no significant difference with the virtual group (see Figure 1). The other physical performance measurements were significantly improved in both groups (see Table 4). There were mixed results for the psychosocial measures (see Figure 2).
While small, this study did show that virtual CR was feasible and had better adherence than traditional facility-based CR. Many physical and emotional outcome measures were improved. It is possible that the type of aerobic training and lack of HR monitoring (and possibly less intensity) in the virtual group affected the findings. Emotional health improved overall but was not entirely significant in the virtual group. This may be due to smaller numbers but possibly could be influenced by the lack of 1:1 in person counseling that would occur in the traditional CR model. A hybrid approach may solve some of the problems seen in either model and should be studied further.
