Effects of Cardiovascular Rehabilitation in Children with Congenital Heart Disease: A Systematic Review and Meta-Analysis

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.