Leg-focused high-weight resistance training improves ventricular stroke volume, exercise capacity and strength in young patients with a Fontan circulation.

INTRODUCTION: Effective therapy to improve exercise capacity in Fontan patients is lacking. Leg-focused high-weight resistance training might augment the peripheral muscle pump and thereby improve exercise capacity.

METHODS: This randomized semi-cross-over controlled trial investigated effects of a 12-week leg-focused high-weight resistance training plus high-protein diet, on (sub)maximal exercise capacity, cardiac function (assessed with cardiovascular magnetic resonance), muscle strength and quality of life in pediatric Fontan patients.

RESULTS: Twenty-eight pediatric Fontan patients were included, 27 patients, (median age 12.9 [10.5-15.7]), successfully completed the program. Peak oxygen uptake (PeakVO2) at baseline was reduced (33.3 ml/kg/min [27.1-37.4],73% [62-79] of predicted). After training PeakVO2/kg and Peak workload improved significantly with +6.2 ml/kg/min [95%CI: 3.4-9.0](+18%) p<0.001 and +22 Watts [95%CI: 12-32](+18%) p<0.001 respectively, compared to the control period. Indexed single ventricle stroke volume increased significantly (43 ml/beat/m2 [40-49] versus 46 [41-53], p=0.014), as did inferior vena cava flow (21 ml/beat/m2 [18-24] versus 23 [20-28], p=0.015), while superior vena cava flow remained unchanged. Strength of all measured leg muscles increased significantly compared to the control period. Self-reported quality of life improved on the physical functioning and change in health domains of the child health questionnaire, parent-reported quality of life improved on the bodily pain, general health perception, and change in health domains compared to the control period.

CONCLUSION: In a relatively large group of 27 older Fontan children, 12-weeks of leg-focused high-weight resistance training improved exercise capacity, stroke volume, (sub)maximal exercise capacity, muscle strength, and domains of quality of life.