Healthy Hearts via Live Videoconferencing: An Exercise and Diet Intervention in Pediatric Heart Transplant Recipients

Angela C Chen, Faustine D Ramirez, David N Rosenthal, Sarah C Couch, Samuel Berry, Katie J Stauffer, Jerrid Brabender, Nancy McDonald, Donna Lee, Lynsey Barkoff, Susan E Nourse, Jeffrey Kazmucha, C Jason Wang, Inger Olson, Elif Seda Selamet Tierney, Angela C Chen, Faustine D Ramirez, David N Rosenthal, Sarah C Couch, Samuel Berry, Katie J Stauffer, Jerrid Brabender, Nancy McDonald, Donna Lee, Lynsey Barkoff, Susan E Nourse, Jeffrey Kazmucha, C Jason Wang, Inger Olson, Elif Seda Selamet Tierney

Abstract

Background Pediatric heart transplant recipients have high-risk cardiovascular profiles that can affect their long-term outcomes; however, promoting exercise and healthy diet has not been a major focus in the field. The objective of this study was to test the feasibility and impact of a supervised exercise and diet intervention delivered via live videoconferencing in this population. Methods and Results Patients 8 to 19 years of age at least 1 year post heart transplantation were enrolled. The 12- to 16-week intervention phase included live video-supervised exercise (×3/week) and nutrition (×1/week) sessions. The 12- to 16-week maintenance phase included ×1/week live video-supervised exercise and nutrition sessions and ×2/week self-directed exercise sessions. Cardiac, vascular, nutritional, and functional health indices were obtained at baseline, after intervention, and after maintenance. Fourteen patients (median age, 15.2; interquartile range, 14.3-16.7 years) at a median of 3.3 (interquartile range, 1.5-9.7) years after heart transplant completed the intervention. Patients attended 89.6±11% of exercise and 88.4±10% of nutrition sessions during the intervention and 93.4±11% of exercise and 92.3±11% of nutrition sessions during maintenance. After intervention, body mass index percentile (median, -27%; P=0.02), endothelial function (median, +0.29; P=0.04), maximum oxygen consumption (median, +2 mL/kg per minute; P=0.002). Functional Movement Screening total score (median, +2.5; P=0.002) and daily consumption of saturated fat (median, -6 g; P=0.02) improved significantly. After maintenance, improvements in maximum oxygen consumption (median, +3.2 mL/kg per minute; P=0.02) and Functional Movement Screening total score (median, +5; P=0.002) were sustained. Conclusions In pediatric heart transplant recipients, a live video-supervised exercise and diet intervention is feasible. Our results demonstrate excellent adherence with significant improvements in cardiovascular and functional health. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519946.

Keywords: endothelial function; exercise; heart transplant; live videoconferencing.

Figures

Figure 1
Figure 1
Study overview.
Figure 2
Figure 2
Improved fitness, vascular, and nutritional indices at baseline, after intervention, and after maintenance. A, Body mass index (BMI) percentile and functional movement screening (FMS); (B) arterial stiffness (augmentation index), endothelial function (EndoPAT); (C) percent predicted maximum oxygen uptake (VO 2 max) and VO 2 max, and maximum heart rate; (D) daily intake of potassium, saturated fat, and sodium.

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