High intensity interval training in youth with congenital heart disease: a clinical trial of a novel telemedicine video game-linked exercise platform

Children with congenital heart disease (CHD) have reduced exercise capacity compared to their healthy peers that is associated with long-term morbidity and mortality. These children also often lead sedentary lifestyles and have physical activity (PA) levels below current Canadian recommendations. In addition to physiologic limitations, a range of attitudes and perceived barriers to exercise exist among children with CHD and their caregivers leading to low self-efficacy to PA and health-related quality of life (HRQoL). Cardiac rehabilitation (CR) is a well-established secondary prevention strategy in adults with heart disease. Literature regarding CR in the pediatric CHD population is less robust, albeit promising. Current pediatric studies are often limited by lack of randomization, small sample sizes, inconsistent outcomes and absence of sex or gender-based analysis. Studies have largely focused on traditional moderate intensity continuous exercise (MICE) but high intensity interval training (HIIT) has emerged as a safe and promising alternative. Exercise programs can be facility or home based, a particularly important consideration as Canadian pediatric heart centers provide regionalized care to geographically dispersed populations. Thus, we are evaluating the impact of a 12-week, home-based HIIT program using a novel telemedicine-equipped video game-linked cycle ergometer (MedBIKE™) in youth with repaired moderate-complex CHD. This is a randomized crossover trial of 10–18-year-old children with repaired moderate-complex CHD. Participants will undergo a baseline assessment of exercise capacity (including peak VO2 (primary outcome)), and secondary outcomes, including PA (via accelerometer), endothelial function (via EndoPAT), and PA self-efficacy and HRQoL (via questionnaires). Participants will then be randomized to receive either the 12-week MedBIKE™ home HIIT intervention or usual care. Each MedBIKE™ session is supervised with live ECG monitoring and capability for remote modulation of resistance. Following the 12-week program, a repeat assessment will occur, after which participants will crossover, such that those randomized to usual care will receive the MedBIKE™. After 12-weeks, a repeat assessment will again occur, followed by long-term repeat assessments at 6- and 12-months to evaluate for sustained changes. We plan to recruit 44 participants, accounting for potential attrition. Recruitment for this trial has begun and we anticipate preliminary results in the next 6 months. We anticipate significant and sustained improvements in exercise capacity, PA, self-efficacy, and endothelial function in patients with repaired CHD undertaking the 12-week MedBIKE™ HIIT program. The findings from this study will inform the development of an innovative cardiac rehabilitation program for youth with CHD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)