Exercise Intolerance, Benefits, and Prescription for People Living With a Fontan Circulation: The Fontan Fitness Intervention Trial (F-FIT)-Rationale and Design.

Autor:	Tran DL; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.; Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Gibson H; Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia., Maiorana AJ; School of Allied Health, Curtin University, Perth, WA, Australia.; Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia., Verrall CE; The University of Sydney Westmead Clinical School, Sydney, NSW, Australia.; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia., Baker DW; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia., Clode M; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia., Lubans DR; School of Education, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia., Zannino D; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia., Bullock A; Paediatric and Adult Congenital Cardiology, Perth Children's Hospital, Perth, WA, Australia., Ferrie S; Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia., Briody J; Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia., Simm P; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia., Wijesekera V; Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia., D'Almeida M; Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia., Gosbell SE; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.; Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia., Davis GM; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia., Weintraub R; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.; Department of Cardiology, The Royal Children's Hospital, Melbourne, VIC, Australia., Keech AC; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia., Puranik R; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia., Ugander M; Royal North Shore Hospital, The Kolling Institute, Sydney, NSW, Australia., Justo R; Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, QLD, Australia., Zentner D; The University of Melbourne Medical School, Melbourne, VIC, Australia.; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia., Majumdar A; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.; Australian National Liver Transplant Unit, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia., Grigg L; The University of Melbourne Medical School, Melbourne, VIC, Australia.; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia., Coombes JS; School of Human Movement and Nutrition Sciences, Centre for Research on Exercise, Physical Activity, and Health, The University of Queensland, Brisbane, QLD, Australia., d'Udekem Y; Division of Cardiac Surgery, Children's National Hospital, Washington, DC, United States., Morris NR; Allied Health Collaborative and Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia., Ayer J; The University of Sydney Westmead Clinical School, Sydney, NSW, Australia.; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia., Celermajer DS; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.; Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia., Cordina R; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.; Central Clinical School, The University of Sydney School of Medicine, Sydney, NSW, Australia.; Charles Perkins Centre, Heart Research Institute, Sydney, NSW, Australia.; Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Jazyk:	angličtina
Zdroj:	Frontiers in pediatrics [Front Pediatr] 2022 Jan 06; Vol. 9, pp. 799125. Date of Electronic Publication: 2022 Jan 06 (Print Publication: 2021).
DOI:	10.3389/fped.2021.799125
Abstrakt:	Background: Despite developments in surgical techniques and medical care, people with a Fontan circulation still experience long-term complications; non-invasive therapies to optimize the circulation have not been established. Exercise intolerance affects the majority of the population and is associated with worse prognosis. Historically, people living with a Fontan circulation were advised to avoid physical activity, but a small number of heterogenous, predominantly uncontrolled studies have shown that exercise training is safe-and for unique reasons, may even be of heightened importance in the setting of Fontan physiology. The mechanisms underlying improvements in aerobic exercise capacity and the effects of exercise training on circulatory and end-organ function remain incompletely understood. Furthermore, the optimal methods of exercise prescription are poorly characterized. This highlights the need for large, well-designed, multi-center, randomized, controlled trials. Aims and Methods: The Fontan Fitness Intervention Trial (F-FIT)-a phase III clinical trial-aims to optimize exercise prescription and delivery in people with a Fontan circulation. In this multi-center, randomized, controlled study, eligible Fontan participants will be randomized to either a 4-month supervised aerobic and resistance exercise training program of moderate-to-vigorous intensity followed by an 8-month maintenance phase; or usual care (control group). Adolescent and adult (≥16 years) Fontan participants will be randomized to either traditional face-to-face exercise training, telehealth exercise training, or usual care in a three-arm trial with an allocation of 2:2:1 (traditional:telehealth:control). Children (<16 years) will be randomized to either a physical activity and exercise program of moderate-to-vigorous intensity or usual care in a two-arm trial with a 1:1 allocation. The primary outcome is a change in aerobic exercise capacity (peak oxygen uptake) at 4-months. Secondary outcomes include safety, and changes in cardiopulmonary exercise testing measures, peripheral venous pressure, respiratory muscle and lung function, body composition, liver stiffness, neuropsychological and neurocognitive function, physical activity levels, dietary and nutritional status, vascular function, neurohormonal activation, metabolites, cardiac function, quality of life, musculoskeletal fitness, and health care utilization. Outcome measures will be assessed at baseline, 4-months, and 12-months. This manuscript will describe the pathophysiology of exercise intolerance in the Fontan circulation and the rationale and protocol for the F-FIT. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Tran, Gibson, Maiorana, Verrall, Baker, Clode, Lubans, Zannino, Bullock, Ferrie, Briody, Simm, Wijesekera, D'Almeida, Gosbell, Davis, Weintraub, Keech, Puranik, Ugander, Justo, Zentner, Majumdar, Grigg, Coombes, d'Udekem, Morris, Ayer, Celermajer and Cordina.)
Databáze:	MEDLINE
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