Exercise and the Fontan Heart

transcript

Dr Graham Stuart Cardiologist and Electrophysiologist

Congenital Heart Disease

Exercise

Little Hearts Matter Open Day Birmingham 2015

What is safe when you only have half a heart?

Dr Graham Stuart Cardiologist and Electrophysiologist

Congenital Heart Disease

Little Hearts Matter Open Day Birmingham 2015

Bristol Children’s Hospital Bristol Heart Institute

Exercise what is safe when you only have half a heart?

•  Why is exercise good for us? •  How do Fontan patients cope with exercise? •  What exercise should we do? •  What exercise shouldn’t we do? •  Time for lots of questions

Research project ….

Exercise half a heart, not half a life!

Professor Benji Stuart

Regular Exercise - general health benefits

diabetes mellitus lipid profile colon cancer osteoporosis anxiety neurosis depression hypertension

Regular exercise

incidence

Regular Exercise -specific benefits in heart disease

Exercise is one of the cheapest- and most effective- interventions for reducing the morbidity and mortality of cardiovascular disease B Booth J Appl Physiol 2000;88:774-787

AHA Scientific Statement April 2013 Promotion of Physical Activity in Children and Adults with Congenital Heart Disease Longmuir et al Circulation 2013 DOI:10.1161/CIR.0b013e318293688F

“Most patients with congenital heart defects are relatively sedentary”

“counseling to encourage daily participation in appropriate physical activity should be a core component of every patient encounter….”

How does exercise help ?

Answer Multifactorial -  Improving endothelial function -  Improving cardiac function -  Improving skeletal muscle function

Ontogeny of Endothelial function

Walther et al Exerc Sport Sci Rev 2004

Exercise relaxes blood vessels

= LESS WORK for the heart

to do !

•  “Chronic heart failure is associated with skeletal muscle abnormalities which cause fatigue / lactic acidosis”

Hambrecht et al JACC 1997;29:1067-73

Heart Failure and Exercise

•  “Chronic heart failure is associated with skeletal muscle abnormalities which cause fatigue / lactic acidosis”

•  18 patients 6 months exercise training vs inactive controls

Muscle biopsy 41% increase in mitochondrial density,

shift from type 11 to type 1 fibres

Hambrecht et al JACC 1997;29:1067-73

Heart Failure and Exercise

exercise tests femoral venous lactate related to

mitochondrial density not leg blood flow

regular physical exercise increased oxidative enzyme activity in skeletal muscle

Exercise makes muscles more efficient

= LESS WORK for the heart to

•  Recognise and understand the benefit for patients –  Social benefits –  Psychological benefits

Being in control......!

•  Recognise and understand the benefit for patients –  Social benefits –  Psychological benefits –  Patient specific benefits

Med Sci Sports Exer 2010;42(2):388-393

Heart 2013;99:1530-1534

Muscle aerobic activity

Muscles less efficient post Fontan

= More work for the heart

to do !

Muscles less efficient post Fontan

= Very important

to exercise!!

Müller, J et al (2009). Exercise capacity, quality of life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection. European Heart Journal, 30(23), 2915–20.

Peak VO2

Age group

<12 12-13 14-15 16-17 >18

boys girls

•  Why is exercise good for us? •  How do Fontan patients cope with exercise

– How do pacemakers cope with exercise? ? •  What exercise should we do? •  What exercise shouldn’t we do? •  Time for lots of questions

How do pacemakers cope with exercise?

I’ll need to learn more ‘bout this….

Aerobic exercise……

Swimming, Walking, Running ….

Ideally 30-60 minutes /day

Seems a lot ???

Build up gradually Mums and Dad’s too!

Dr Mark Turner PhD MRCP (ex RN) > 21yrs +++

25hrs 42 - 43rd place

Mr B Douglas VVIR (ex CPB) 19yrs

21hrs 06 20th place

What exercise should be avoided?

Different in different people….

•  Contact sports…..

Warfarin !!!

•  Magnets …..

? ? ? ? ? ? ?

•  Repetitive movements

Lead testing – “pinch flex test”

Represents 1st rib/ clavicle crush point

Children change as they get older !

Know your limitations!

Lots of ways you can take part!

“Referee twins join elite at the double”

I like shopping!

Exercise during day to day activities ! Use stairs not the lift if possible

walk to school/college….

What about Fair Rides? Thorpe Park…

Research project ….

Professor Benji’s Research Project

Why is exercise prescription not used?

1 Most cardiologist don’t know how to prescribe exercise Swan 2000, Lewin 2002

< 20% units had exercise programme Lewin 2002

< 20% patients given exercise advice Swan 2000

Why is exercise prescription not used?

1 Most cardiologist don’t know how to prescribe exercise Lewin 2002, Swan 2002

2 Most exercise prescriptions are ineffective in teenagers Metcalf 2012

Physical activity interventions have only a small effect in children’s overall activity levels (4 mins walking/ running per day ….) Metcalf B et al Br Med J 2012;345:e5888

Teenagers don’t like being told what to do!

Do more exercise … please

The Nike + Fuelband

is a motivational tool for exercise prescription in the teenager with congenital heart disease

Dr AG Stuart

MSc Dissertation Conference June 2013

Hypothesis

The Nike + Fuelband

Gamification “use of game thinking and game mechanics in a non-game context to engage users and solve problems. Used to improve user engagement.”

Marczwski 2012

The Nike + Fuelband

3 axis wrist worn accelerometer -  3 sizes / 2 colours -  Set up using -  Links to mobile phone/ computer -  Output : calories Nike Fuel Points steps

The Nike + Fuelband

1. set up weight/height/wrist

The Nike + Fuelband

2. set goal av 2000 points

The Nike + Fuelband

3. join Nike +

The Nike + Fuelband

3. join Nike + 4. Sync phone/ computer

The Nike + Fuelband

Charts of progress

Rewards

Twitter Facebook

Nike Missions

I still don’t know how much or what exercises to do….

Exercise Prescription Protocol

Questions?

Exercise and the Fontan Heart

Health & Medicine