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Remotely delivered cardiac rehabilitation for children and adolescents with congenital heart disease

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Adolescents with congenital heart disease [CHD], including repair of tetralogy of Fallot [TOF], dextro-transposition of the great vessels [d-TGA], or functionally univentricular heart physiology [Fontan], have lower cardiorespiratory fitness [FIT] compared with healthy peers. FIT is a well-established predictor of morbidity, quality of life [QOL], and heart transplantation and is among the strongest predictors of mortality in this population. However, adolescents with CHD have significantly lower FIT when compared to cardio-typical peers, due to abnormal hemodynamics as well as low durations and intensities of physical activity [PA] and exercise. Pediatric cardiac rehabilitation [CR] programs which prescribe aerobic and resistance exercise over 12-wks. have demonstrated improvements in FIT for patients with CHD which persist months after completion of the program. Unfortunately, few hospitals/clinics offer CR programming for children and adolescents due to the financial costs of building and maintaining a CR facility, as well as the travel cost, time requirement, and burden for parents/caregivers to transport their child to/from a hospital for CR exercise sessions multiple times per week. In-home CR reduces barriers related to patient access and the financial burden for hospitals, though data supporting the effectiveness of in-home CR for youth is limited. The use of group video conferencing technology via tablet computer represents a novel and potentially transformational strategy for delivering real-time, live, supervised CR to groups of adolescents with CHD in their homes. The goal of this K23 research plan is to evaluate the effectiveness of video conferencing for the delivery of real-time CR to groups of adolescents with CHD in their homes. We propose a 12-wk. randomized-controlled clinical trial assigning 74 adolescents [12-19 years old] with 1 of 3 CHD diagnoses [Fontan, TOF, or d-TGA] to Remote CR [RCR] [in-home, live, remote group exercise, 3-45-min sessions/week.] or Active control [in-home, self-directed exercise]. Our aims will assess the effectiveness of the RCR approach by comparing between-group changes [0-12 weeks] in: FIT, cardiac function, lean body mass, and frailty. Exploratory aims will assess between group differences [0-12 weeks] in physical function, QOL, PA self-efficacy, and will evaluate the impact of demographic characteristics on program participation and satisfaction, and daily PA. We hypothesize the RCR intervention will elicit greater improvements in each outcome compared to the control group.
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