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?
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
• 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
Exercise half a heart, not half a life!
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
do !
Exercise half a heart, not half a life!
• Recognise and understand the benefit for patients – Social benefits – Psychological benefits
Being in control......!
Exercise half a heart, not half a life!
• Recognise and understand the benefit for patients – Social benefits – Psychological benefits – Patient specific benefits
Med Sci Sports Exer 2010;42(2):388-393
• 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
Exercise half a heart, not half a life!
Exercise half a heart, not half a life!
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!!
Exercise half a heart, not half a life!
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
10
30
20
40
50
<12 12-13 14-15 16-17 >18
boys girls
Exercise half a heart, not half a life!
• 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
Exercise half a heart, not half a life!
How do pacemakers cope with exercise?
How do pacemakers cope with exercise?
How do pacemakers cope with exercise?
How do pacemakers cope with exercise?
I’ll need to learn more ‘bout this….
• 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
Exercise half a heart, not half a life!
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
• 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
Exercise half a heart, not half a life!
What exercise should be avoided?
Different in different people….
What exercise should be avoided?
• Contact sports…..
Warfarin !!!
What exercise should be avoided?
• Magnets …..
? ? ? ? ? ? ?
What exercise should be avoided?
• Repetitive movements
Lead testing – “pinch flex test”
Represents 1st rib/ clavicle crush point
Children change as they get older !
What exercise should be avoided?
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…
• 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’s Research Project
Why is exercise prescription not used?
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!
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
1. set up weight/height/wrist
2. set goal av 2000 points
The Nike + Fuelband
1. set up weight/height/wrist
2. set goal av 2000 points
3. join Nike +
The Nike + Fuelband
1. set up weight/height/wrist
2. set goal av 2000 points
3. join Nike + 4. Sync phone/ computer
The Nike + Fuelband
The Nike + Fuelband
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?