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Pilot Project: Heart Chargers—A Successful Model for a Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients

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Abstract

Fontan patients have decreased exercise capacity which further declines throughout adolescence. A positive exercise capacity trajectory in children predicts better adult Fontan outcomes. Hospital-based physical activity programs improve exercise capacity and attenuate the age-expected decline in Fontan patients. The purpose of this project was to investigate the feasibility and safety of a partially reimbursable 12-month, home-based, individualized physical activity program (Heart Chargers) for Fontan patients utilizing telemedicine. The Heart Chargers team included a cardiologist, nurse coordinator, and exercise physiologists. Eligible participants with a Fontan completed a baseline cardiopulmonary exercise test (CPET) and consented to participate in Heart Chargers, a 12-month home-based exercise prescription. The individualized exercise prescription focused on skeletal and respiratory muscle strength training and aerobic activities. Participants received a Garmin© device to monitor adherence. Telephone check-ins ranged from weekly to monthly as participants gained independence. Pre- and post-program CPET and informal surveys of physical activity self-efficacy were completed. Nine participants have completed the Heart Chargers program. There was no pre-post difference in maximal or submaximal oxygen consumption (VO2), peak heart rate, or oxygen saturation. There was a significant pre-post increase in systolic blood pressure (p-value 0.004) and minute ventilation (p-value 0.012) at peak exercise. Per subjective report, exercise-related self-efficacy increased after program completion. There were no adverse events. At present, 7 participants remain actively enrolled in the program. Heart Chargers, a novel, home-based, partially reimbursable, 12-month individualized exercise program using telemedicine was successfully implemented in Fontan patients with no adverse events. The lack of decline in exercise capacity for participants is encouraging.

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Acknowledgements

The authors thank Cristine Martinez, Matthew Dominguez-Robinson, Derek Young, and Patrick Reinschmidt for their role in conducting exercise tests and developing personalized exercise prescriptions. Additional thanks to Carey Rafferty, Dr. Michael DiMaria, and Dr. Adel Younoszai for initial program referrals.

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Authors and Affiliations

  1. Children’s Hospital Colorado, Heart Institute, Aurora, Colorado, USA

    Julie C. Fernie, Lisette Wylie, Michal Schäfer, Kara Carnegie, Shelley D. Miyamoto & Roni M. Jacobsen

  2. Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA

    Shelley D. Miyamoto & Roni M. Jacobsen

  3. Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA

    Roni M. Jacobsen

Authors
  1. Julie C. Fernie
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  2. Lisette Wylie
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  3. Michal Schäfer
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  4. Kara Carnegie
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  5. Shelley D. Miyamoto
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  6. Roni M. Jacobsen
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Contributions

JCF participated in concept/design, drafting the article, data collection, and critical revision of the article. LW participated in concept/design, drafting the article, data collection, critical revision, and approval of the article. SDM participated in concept/design and critical revision of the article. MS participated in data interpretation and approval of the article. KC participated in concept/design, data collection, and approval of the article. RMJ participated in concept/design, data interpretation, drafting the article, critical revision of the article, and approval of the article.

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Correspondence to Roni M. Jacobsen.

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The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

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Fernie, J.C., Wylie, L., Schäfer, M. et al. Pilot Project: Heart Chargers—A Successful Model for a Home-Based Physical Activity Program Utilizing Telemedicine for Fontan Patients. Pediatr Cardiol 44, 1506–1513 (2023). https://doi.org/10.1007/s00246-023-03215-9

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  • DOI: https://doi.org/10.1007/s00246-023-03215-9

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