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Exercise in patients with repaired tetralogy of Fallot: a systematic review and meta-analysis
  1. Art Schuermans1,
  2. Melissa Boerma2,
  3. Gabriela A Sansoni3,
  4. Jef Van den Eynde1,
  5. Johanna J M Takkenberg4,
  6. Willem A Helbing5,
  7. Tal Geva6,
  8. Philip Moons7,8,
  9. Alexander Van De Bruaene1,9,
  10. Werner Budts1,9
  1. 1Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium
  2. 2Faculty of Medical Sciences, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
  3. 3Faculty of Medicine and Surgery, Università degli Studi di Milano, Milan, Italy
  4. 4Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  5. 5Department of Pediatrics, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  6. 6Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
  7. 7Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
  8. 8Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Västra Götaland, Sweden
  9. 9Congenital and Structural Cardiology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
  1. Correspondence to Art Schuermans, Department of Cardiovascular Sciences, KU Leuven, Leuven, Flanders, Belgium; schuermans.art{at}gmail.com

Abstract

Objective Children and adults with repaired tetralogy of Fallot (rTOF) have an impaired exercise capacity, a less active lifestyle and an increased long-term risk of adverse outcomes compared with healthy peers. This study aimed to summarise the current evidence for the effectiveness and safety of exercise training interventions in patients with rTOF.

Methods PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and reference lists of relevant articles were searched for prospective studies published by November 2021. Random-effects meta-analysis and descriptive synthesis were performed to assess the effectiveness and safety of exercise training in patients with rTOF.

Results Of the 9677 citations identified, 12 articles were included that reported on 10 unique studies and covered 208 patients with rTOF (range of mean/median age: 7.4–43.3 years). All studies implemented 2 to 7 aerobic or respiratory training sessions per week with durations ranging from 6 to 26 weeks. Meta-analysis of the included randomised controlled trials showed that exercise training was associated with a significant improvement in peak VO2 (pooled mean difference: +3.1 mL/min/kg; 95% CI: 0.76 to 5.36 mL/min/kg, p=0.019). Cardiac imaging studies revealed no subclinical adverse remodelling after the exercise interventions. No serious adverse events including arrhythmias were reported in these studies.

Conclusion Current evidence suggests that exercise training can improve exercise capacity in patients with rTOF with a low risk for adverse events. Exercise prescription may be a safe and effective tool to help improving outcomes in patients with rTOF.

PROSPERO registration number CRD42021292809.

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @artschuermans, @JefVandenEynde, @MoonsPhilip, @alexvdbruaene, @WernerBudts

  • Contributors AS: concept/design, data collection, data interpretation, statistical analysis, drafting article, critical revision of article, approval of article. MB: data collection, data interpretation, critical revision of article, approval of article. GAS: data collection, data interpretation, critical revision of article, approval of article. JVdE: concept/design, data interpretation, critical revision of article, approval of article. JJMT: data interpretation, critical revision of article, approval of article. WAH: data interpretation, critical revision of article, approval of article. TG: data interpretation, critical revision of article, approval of article. PM: data interpretation, critical revision of article, approval of article. AVDB: data interpretation, critical revision of article, approval of article. WB: data interpretation, critical revision of article, approval of article. AS accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.