Rethinking Achievement: Optimal Dose of Supervised Exercise Sessions for a Cardiac Fitness and Rehabilitation Program for Pediatric Congenital Heart Disease Patients

PURPOSE: Pediatric cardiac fitness and rehabilitation for patients with congenital heart disease is an emerging yet underdeveloped field. Adult cardiac rehabilitation programs prescribe 36 sessions, but there are no data regarding the ideal number for a pediatric cardiac fitness program (CFP). This study explored whether there was an optimal range of fitness sessions associated with significant gains following a CFP. METHODS: Pediatric CFP data from January 2017 to December 2022 were analyzed. Number of supervised fitness sessions were categorized into 4 groups (6-11, 12-18, 19-24, and 25-40 sessions) and also analyzed as a continuous variable. Cardiorespiratory fitness, strength, flexibility, and mindset outcome metrics were compared using 1-way analysis of covariance and linear regression, adjusting for baseline values. RESULTS: A total of 62 patients, with median age of 15.5 years (range: 8-21, 50% female), participated in a median of 19 fitness sessions (range: 6-40). Baseline characteristics, congenital heart disease classification, hemodynamic level, and number of sessions/weeks across the 4 groups were similar. Patients improved from pre- to post-CFP in cardiorespiratory fitness, strength, flexibility, and mindset metrics, but no significant differences were found between any of the ranges of sessions or numbers of sessions as a continuous variable. Power was limited due to small sample sizes per group. CONCLUSIONS: Fitness improvements were seen with fewer than 36 sessions, but an optimal dose for a complete program remains unclear. Rethinking program completion as achieving goals rather than a specified number of sessions should be considered. Individualized, personal dosing may yield the most efficient use of patient time and health care resources.