| Abstract [eng] |
Rationale. Due to the Fontan procedure, which is used to correct congenital heart defects involving single-ventricle physiology, the number of individuals living with this type of circulation has increased. Advances in medicine now allow these individuals to live a full and high-quality life. In the past, children with congenital heart defects were commonly advised to restrict physical activity. However, a growing body of research highlights the benefits of physical activity in this population. Despite this, there are still no clear guidelines on exercise recommendations. Given that Fontan circulation is non-physiological and differs significantly from other congenital heart conditions, there remains a lack of literature reviews that synthesize the benefits of various types of physical activity in this pediatric population. Objective. To systematically review the research evaluating the impact of exercise training programs on physical capacity in children with congenital heart defects characterized by single-ventricle physiology. Methods. A systematic literature review was conducted following PRISMA guidelines, using the PubMed and ScienceDirect databases. Included studies involved pediatric Fontan patients who participated in a structured exercise training program, with outcomes assessed using cardiopulmonary exercise testing (CPET) parameters. Data were collected on VO₂ max, VO₂ at anaerobic threshold, and oxygen pulse before and after the intervention. Study quality was evaluated using the modified Downs and Black checklist. An intervention was considered effective if the change was statistically significant (p < 0.05). Results. Out of 2780 initial publications, 19 studies were selected based on inclusion and exclusion criteria. Most of the included studies were rated as high quality after assessing risk of bias. Statistically significant improvements in maximal oxygen uptake (VO2 max) were reported in six of thirteen studies examining aerobic training, three of six studies on resistance training, one of four studies focused on lower-limb strengthening, and one of three studies investigating respiratory training. All three studies that evaluated combined aerobic and resistance training found significant increases in VO2 max. Changes in VO2 at the anaerobic threshold and oxygen pulse were reported less frequently and showed statistically significant improvement in only a few studies. Conclusions. Although some studies demonstrated statistically significant increases in VO₂ max following exercise interventions, the majority showed non-significant changes. It can be hypothesized that the type of training (e.g., aerobic or combined programs) may influence outcomes, but current evidence is insufficient to draw generalized conclusions. Due to the limited reporting of VO2 at anaerobic threshold and oxygen pulse, the assessment of these parameters remains constrained. Higher-quality studies using standardized methods are needed to draw more definitive conclusions. |
