| Background:Congenital heart disease(CHD)is a defect in the structure of the heart and great vessels which is present at birth.In recent years,the incidence of congenital heart disease has been ranked first in birth defects in China.With the improvement of the level of cardiothoracic surgical team,the survival rate of the children increased significantly,but there were many problems such as impaired motor ability and low level of physical activity,which affected the quality of life.In the past,physical activity advice for patients with CHD was centered on restriction.However,with the research progress of exercise rehabilitation,increasingly there is an appreciation that promoting exercise training will benefit the health and well-being of children with CHD.At present,the researches of exercise rehabilitation at home and abroad are mostly concentrated in the field of adult heart disease.There is little research and practice on exercise rehabilitation for children with CHD in China,and there is still no related research on early exercise rehabilitation after discharge.Therefore,this study will carry out exercise rehabilitation for children with CHD,and evaluate its effect,so as to provide evidence for clinical application.Objective:To preliminarily design a home-based exercise rehabilitation program suitable for children with CHD;To explore the effects of exercise rehabilitation on cardiac function,exercise endurance and muscle strength in children with simple CHD and complex congenital heart disease(CCHD).And its safety is also discussed.Methods:This is a quasi-experimental study,84 children with ventricular septal defect/atrial septal defect repair/Fontan operation in the pediatric cardiac surgery ward took part in the study from April 2017 to February 2018.They were divided into the intervention group and control group,each group had 42 children.The control group accepted the routine discharge education in the ward,and the intervention group,in addition to that,also received postoperative exercise rehabilitation education and guidance from researcher and received 12 weeks of exercise rehabilitation at home.Before discharge and 12 weeks after discharge,the heart function index were collected,and exercise endurance and muscle strength were measured to evaluate the effects of the interventions.Results:A total of 74 children completed the whole study,including 37 cases in intervention group and 37 cases in control group.The results were as follows:(1)To form home-based exercise rehabilitation program for children with CHD after operation:the content is aerobic exercise combined with resistance training.(2)After the intervention of children with simple CHD,the results of comparison between the two groups were as follows:? There was no significant difference in LVED,LVEF,ALVED and ALVEF between the intervention group and the control group(P>0.05).? The 6MWT distance of the children in the intervention group was significantly higher than that of the control group,which was(477.18±68.22 VS 411.47±40.76)m(P<0.01),and the distance of ?6MWT in the intervention group was significantly higher than that of the control group,which was 122.00(80.00,187.50)m VS 75.00(50.00,110.00)m(P<0.05).There was no significant difference in resting heart rate and maximum heart rate between the two groups(P>0.05).? There was no significant difference in the right hand 1-RM between the two groups(P>0.05),and the left hand 1-RM in the intervention group was significantly greater than the control group,which was 2.50(2.50,3.00)kg and 2.00(2.00,2.63)kg(P<0.05).(3)After the intervention of children with CCHD,the results of comparison between the two groups were as follows:? There was no significant difference in LVEF and ?LVEF between the intervention group and the control group(P>0.05).? The 6MWT distance of the children in the intervention group was significantly greater than that of the control group,which was(449.29±66.48 VS 349.86±22.82)m(P<0.O01,and the distance of ?6MWT in the intervention group was significantly higher than that of the control group,which was 180.00(115.00,190.00)m VS 65.00(20.00,120.00)m(P<0.05);There was no significant difference in resting heart rate and maximum heart rate between the two groups(P>0.05).? There was no significant difference between the two groups in both upper limbs' 1-RM(P>0.05).Conclutions:(1)Home-based exercise rehabilitation program during the first 12 weeks after discharge is safe and feasible for children with CHD.(2)Home-based exercise rehabilitation program during the first 12 weeks after discharge has no significant effect on the improvement of cardiac function in children with CHD.(3)Home-based exercise rehabilitation can improve the 6MWT distance and exercise tolerance of children with CHD.(4)Home-based exercise rehabilitation can increase the left hand muscle strength of children after simple CHD surgery,but it has no significant effect on the muscle strength growth of children after Fontan surgery. |
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