FONTAN Personalised Exercise Prescription at yoUr Place Trial

2018 Vanguard Grant

Years funded: 2019-2021

Babies born with a single ventricle (pumping heart chamber) now commonly survive well into adulthood after they undergo the Fontan operation. Approximately 1,400 people are alive today after this procedure in Australia and New Zealand, and 60,000 worldwide. People with a Fontan circulation have impaired exercise capacity, reduced life expectancy and no available medications with proven long-term benefits. In contrast, several small studies indicate that the only way to improve exercise capacity and cardiac function (which are closely associated with survival) is to improve the function of the muscles through aerobic and resistance exercise.

This is because the muscles play an important role in improving the circulation of blood back to the heart so that it can be pumped around the body. Our previous research in Fontan patients who lived close to a hospital gym, demonstrated that the single ventricle circulation heavily relies on this peripheral muscle pump (the squeezing of veins by muscles during activity), and that closely supervised face-to-face exercise training builds the muscles to help the peripheral muscle pump work more effectively, improving heart function. To date, a model of care that delivers effective exercise training to patients, no matter where they live, has not been established.

We propose a trial of home-based exercise in patients with a Fontan circulation aged 16 years and over. Participants will be randomly allocated to receive a 4-month innovative home-based exercise training program supervised by an exercise physiologist via face-to-face internet sessions to provide guidance and support for exercise, or to usual care (maintaining their usual activity levels). This trial will determine the efficacy and feasibility (defined as recruitment, retention, adherence and satisfaction) of a novel home-based supervised exercise program to improve cardiorespiratory fitness in young people with a Fontan circulation that is scalable and cost-effective.