Thousands of sick children regain the opportunity to exercise and explore regular and effective cardiac rehabilitation

"Do not participate in strenuous exercise" and "Do not attend physical education classes" are advice that many children and their families with heart disease and postoperative heart disease have heard from doctors. Therefore, these children are often "overprotected", but is this really effective for their recovery and growth? The reporter learned that Shanghai Children's Medical Center is actively exploring the use of physical therapy this year to provide cardiac rehabilitation treatment for children with heart disease with the goal of improving their overall quality of life.

Han Han, a Jiangxi boy in his second year of junior high school this year, underwent two heart surgeries at the age of 6 months and 3 due to congenital single ventricle. Faced with imperfect heart function, my mother will protect Han Han and keep him away from all sports. Last August, upon learning that Shanghai Children's Medical Center had cardiac rehabilitation treatment, the mother and son rushed to Shanghai from Jiangxi. After a complete cardiac rehabilitation assessment by doctors, a personalized "home exercise prescription" allowed Han Han, who had never been exposed to sports in 12 years, to walk on the treadmill for the first time and feel the help of exercise for growth. Unexpectedly, in October last year, the child underwent cardiology ablation surgery due to the development of preexcitation syndrome, and had to suspend cardiac rehabilitation home exercise prescriptions. After a period of recovery from ablation surgery, the mother and son returned to Shanghai to strive for a new round of cardiac rehabilitation.

According to Cai Xiaoman, the attending physician of the cardiothoracic surgery department at Shanghai Children's Medical Center, "Han Han's assessment of static heart function last year was about level 2 to 3, which was poor. The results of cardiopulmonary exercise experiments showed that the oxygen release rate was less than 40%, which strictly speaking meets the standards for heart transplantation. Therefore, we developed a low-intensity exercise prescription based on his worst condition at the time, and then re examined the oxygen release rate data, which increased by 5%. This time, we have re formulated an exercise prescription for him based on the new assessment results."

Facing parents of children with congenital heart disease, it is often difficult for outpatient doctors to provide specific exercise assessment guidance, as traditional cardiac ultrasound, electrocardiogram, and cardiac CT/MRI examinations are conducted in the child's resting state. However, the cardiovascular function of the human body is completely different during rest and exercise, especially in children with heart disease. Therefore, most families of children with heart disease tend to choose excessive protection. Postoperative children with heart disease often have lower physical activity abilities, and may even cause varying degrees of malnutrition or obesity, leading to a decline in physical fitness.

"Before going to school, I basically greeted the teacher and said that I wouldn't let my child attend physical education classes, and I wouldn't knock or touch them in daily life. I didn't participate in outdoor play, but later I realized that this concept was wrong. In the past, my child's physical strength was relatively poor in all aspects, except for weight gain. My physical strength was not good at all, and my belly was also very big. Now that I have recovered from exercise, my child's belly is smaller, and my mental state has improved a lot." Han Han's mother told reporters.

Dr. Cai Xiaoman said that it is understandable for parents to feel overly protective because they do not know the standards for postoperative exercise safety for their children. In fact, long-term, regular, safe, and effective exercise can actually help improve the cardiovascular function of children with heart disease in a stepwise manner.

To assist in the physical recovery of this group of special children, the Shanghai Children's Medical Center opened the "Children's Heart Rehabilitation Clinic" on March 1, 2021. By relying on cardiopulmonary exercise tests, children are required to wear special monitoring devices such as metabolic masks and electrocardiograms, ride bicycles, and gradually increase their load at a constant speed to monitor various cardiopulmonary functions and metabolic parameters, detect the maximum cardiopulmonary function of the child, measure their exercise ability to determine exercise risk, identify and analyze the causes of exercise restriction, and develop a home exercise prescription. At present, the outpatient department has collaborated with over 1000 children who have undergone cardiac surgery for home practice, with the goal of improving overall quality of life in cardiac rehabilitation treatment.

"We will provide parents with a range of safety and effectiveness, and it can be operated at home. In addition, we have found in clinical practice that children with more complex conditions will have stronger compliance, so education is important. We need half an hour for evaluation, and it may take more than half an hour to educate and guide parents," said Dr. Cai Xiaoman.

Text: Li Li

Photography: Min Di