Resistance training improves cardiac output, exercise capacity and tolerance to positive airway pressure in Fontan physiology

• Published in: International journal of cardiology Vol. 168; no. 2; pp. 780 - 788
• Main Authors: Cordina, Rachael L., O'Meagher, Shamus, Karmali, Alia, Rae, Caroline L., Liess, Carsten, Kemp, Graham J., Puranik, Raj, Singh, Nalin, Celermajer, David S.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 30.09.2013; Elsevier
• Subjects: Adult; Biological and medical sciences; Cardiac function; Cardiac Output - physiology; Cardiac rehabilitation; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Congenital heart disease; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Exercise - physiology; Exercise Test - methods; Exercise Tolerance - physiology; Exercise training; Female; Fontan operation; Fontan Procedure; Heart; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Defects, Congenital - therapy; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Positive-Pressure Respiration - methods; Resistance Training - methods; Single ventricle; Single ventricle; Congenital heart disease; Exercise training; Fontan operation; Cardiac function; Cardiac rehabilitation; Heart; Physical exercise; Cardiac performance; Cardiovascular disease; Artificial ventilation; Improvement; Positive pressure; Capacity; Exercise tolerance test; Physiology; Cardiology; Tolerance; Congenital disease; Resistance; Malformation; Rehabilitation(human); Circulatory system; Cardiac output; Hemodynamics; Congenital cardiopathy; Mechanical ventilation
• DOI: 10.1016/j.ijcard.2012.10.012
• ISSN: 0167-5273; 1874-1754

Subjects with Fontan-type circulation have no sub-pulmonary ventricle and thus depend exquisitely on the respiratory bellows and peripheral muscle pump for cardiac filling. We hypothesised that resistance training to augment the peripheral muscle pump might improve cardiac filling, reduce inspiratory-dependence of IVC return to the heart and thus improve exercise capacity and cardiac output on constant positive airway pressure (CPAP). Eleven Fontan subjects (32+/−2years, mean+/−SEM) had cardiac magnetic resonance imaging (MRI) and exercise testing (CPET); six underwent 20weeks of high-intensity resistance training; others were non-exercising controls. After training, CPET was repeated. Four trainers had MRI with real-time flow measurement at rest, exercise and on CPAP in the trained state and following a 12-month detrain. In the trained state, muscle strength increased by 43% (p=0.002), as did total muscle mass (by 1.94kg, p=0.003) and peak VO2 (by 183ml/min, p=0.02). After detraining, calf muscle mass and peak workload had fallen significantly (p<0.03 for both) as did peak VO2 (2.72 vs. 2.18l/min, p<0.001) and oxygen pulse, a surrogate for SV (16% lower, p=0.005). Furthermore after detraining, SV on MRI decreased at rest (by 11ml, p=0.01) and during moderate-intensity exercise (by 16ml, p=0.04); inspiratory-dependent IVC blood return during exercise was 40% higher (p=0.02). On CPAP, cardiac output was lower in the detrained state (101 vs. 77ml/s, p=0.03). Resistance muscle training improves muscle mass, strength and is associated with improved cardiac filling, stroke volume, exercise capacity and cardiac output on CPAP, in adults with Fontan-type circulation.