Healthy hearts in pediatric heart transplant patients with an exercise and diet intervention via live video conferencing—Design and rationale

• Published in: Pediatric transplantation Vol. 23; no. 1; pp. e13316 - n/a
• Main Authors: Chen, Angela C., Rosenthal, David N., Couch, Sarah C., Berry, Samuel, Stauffer, Katie J., Brabender, Jerrid, McDonald, Nancy, Lee, Donna, Barkoff, Lynsey, Nourse, Susan E., Kazmucha, Jeffrey, Wang, C. Jason, Olson, Inger, Selamet Tierney, Elif Seda
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01-02-2019
• Subjects: Adolescent; Allergies; Arteries; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Child; Diet; Diet Therapy - methods; endothelial function; exercise; Exercise Therapy - methods; Feasibility Studies; Female; Graft rejection; Health Behavior; Health Promotion - methods; Healthy Lifestyle; heart transplant; Heart Transplantation; Humans; Hyperemia; Latex; live video conferencing; Male; Patient Compliance - statistics & numerical data; Pediatrics; Postoperative Complications - prevention & control; Quality of life; Research Design; Sodium; Telemedicine - methods; Transplants & implants; Treatment Outcome; Video teleconferencing; Videoconferencing; Young Adult; endothelial function; exercise; heart transplant; live video conferencing
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.13316

Background
Pediatric heart transplant (PedHtx) patients have increased cardiovascular risk profiles that affect their long‐term outcomes and quality of life. We designed a 12‐ to 16‐week diet and exercise intervention delivered via live video conferencing to improve cardiovascular health. Our methodology and baseline assessment of the first 13 enrolled patients are reported.
Methods
Inclusion criteria are as follows: (a) 8‐19 years old; (b) heart transplant >12 months; (c) ability to fast overnight; (d) cardiac clearance by cardiologist; and (e) presence of an adult at home during exercise sessions for patients <14 years old. Exclusion criteria are as follows: (a) acute illness; (b) latex allergy; (c) transplant rejection <3 months ago; and (d) multi‐organ transplantation. The intervention consists of one diet and three exercise sessions weekly via live video conferencing. Study visits are conducted at baseline, intervention completion, and end of maintenance period.
Results
A total of 13 participants (15.2 [2.3] years) have been enrolled. Median percent‐predicted VO2 max was 56.8 [20.7]% (10 patients <70%). Ten patients had abnormal endothelial function (reactive hyperemia index <1.9; 1.4 [0.325]) and 11 patients had stiff arteries (pulse wave velocity ≧5.5 m/s for 15‐19 years, ≧4.5 m/s for 8‐14 years; 5.6 [0.7] m/s). Patients had suboptimal diets (saturated fat: 22.7 [23.8] g/d, sodium: 2771 [1557] mg/d) and were sedentary at a median of 67.5 [13.8]% of their time.
Conclusions
Baseline assessment confirms that PedHtx patients have abnormal cardiac, vascular, and functional health indices, poor dietary habits, and are sedentary. These results support the rationale to test the feasibility and impact of a non‐pharmacologic lifestyle intervention in this patient population.