Effects of Cardiovascular Rehabilitation in Children with Congenital Heart Disease: A Systematic Review and Meta-Analysis
Flavia Cristina Navarro
Postgraduate Program in Medicine Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.
Mariana Oliveira
Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.
Luciana Maria Malosa Sampaio *
Postgraduate Program in Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.
Fernanda Marciano Consolim Colombo
Postgraduate Program in Medicine Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Background: Home-based physical training is a promising alternative to conventional supervised training for patients with congenital heart disease (CHD). Although the beneficial effects of exercise interventions are well established in patients with CHD, there is still a lack of knowledge about the variety and utility of existing programs.
Aims: Therefore, the aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials publications on the population of children with CHD, which analyzes outpatient and home cardiopulmonary rehabilitation in children with congenital heart disease.
Study Design: Systematic review and meta-analysis.
Methodology: The searches were carried out in the MEDLINE and PEDro databases. The PICO search strategy was adopted: P (patient) = Child with CHD; I (intervention) = Outpatient rehabilitation and home rehabilitation; C (control) = no activity; O (result) = peak VO2.
Results: Six studies were included in the narrative analysis and all were published in English. RCTs were performed in Canada (n = 2), France (n = 2), Norway (n = 1) and Holland (n = 1). The total number of participants analyzed in all studies was 321 participants (conventional rehabilitation 81 and 63 control; home rehabilitation 98 and 79 control). Regarding gender discrimination, 150 boys and 171 girls were reported. The age range of participants was 6 to 15 years, with most studies reporting mean ages ≤15. A total of six studies involving 578 participants were included. The three studies reporting the peak VO2 at the beginning and after training, which included 144 patients (Rehabilitation 81 patients / Control 63 patients). This comparison was statistically significant 2.81 [0.89, 4.74]; Z = 2.86 (p <0.004) and I2 = 49%. The other three studies reported peak VO2 at baseline and after home rehabilitation, including 177 patients (Reab 98 patients / Control 70 patients). This comparison, however, was not statistically significant (p = 0.66).
Conclusion: The present data suggest that outpatient rehabilitation in children is more effective than home rehabilitation when oxygen consumption analyses is considered.
Keywords: Congenital heart disease, cardiopulmonary rehabilitation