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Enhanced Physiology for Submaximal Exercise in Children after the Fontan Procedure


Medicine & Science in Sports & Exercise: April 2013 - Volume 45 - Issue 4 - p 615–621
doi: 10.1249/MSS.0b013e31827b0b20
Clinical Sciences

Purpose After the Fontan procedure, children exhibit reduced peak exercise capacity, yet their submaximal exercise response remains unclear. This study sought to determine the relationship between submaximal and peak exercise capacity and physical activity in Fontan patients.

Methods This cross-sectional study recruited 50 Fontan patients (59% males) with a median age of 9 yr (range = 6–12 yr). The median age at Fontan procedure was 2.9 yr (range = 1.6–9.1 yr). Study assessments included medical history, exercise testing, and accelerometry.

Results Significantly lower submaximal oxygen consumption (V˙O2) and HR in response to a standardized workload than published values for healthy children (mean ± SD) of −1.72 ± 5.24 (P < 0.001) and −1.45 ± 1.98 (P < 0.001), respectively, suggest enhanced submaximal work efficiency in this group of patients after Fontan. Higher submaximal V˙O2 z-score was associated with higher submaximal HR z-score (P = 0.02) and lower body mass index z-score (P = 0.01). Higher V˙O2peak was associated with higher submaximal V˙O2 z-score (P < 0.01), male sex (P = 0.03), higher RER (P = 0.02), lower submaximal HR z-score (P < 0.01), and higher chronotropic responsiveness (P < 0.0001). Exercise test duration z-score was associated with lower submaximal HR z-score (P = 0.02) and higher chronotropic responsiveness (P = 0.02).

Conclusions Fontan patients exhibited a lower submaximal V˙O2 and HR responsiveness at a given workload than healthy controls did during standardized exercise testing. Thus, they may be better adapted to perform submaximal exercise. Although peak exercise capacity is limited, Fontan patients are able to perform submaximal physical activities at the same level as their healthy peers.

Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CANADA

Address for correspondence: Patricia E. Longmuir, Ph.D., Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Dr., RI#1-214, Ottawa, Ontario, Canada K1H 8L1; E-mail:

Submitted for publication May 2012.

Accepted for publication October 2012.

©2013The American College of Sports Medicine