DID YOU KNOW...
Canada does not have a Paediatric
Cardiac Rehabilitation Program for Children
and Adolescents?

By: John Sawdon Director of Public Education & Special Projects and Justin Ian Mah Volunteer Cardiac Health Foundation of Canada

What is Paediatric Cardiac Rehabilitation?

The goal of paediatric cardiac rehabilitation programs is different than adult cardiac rehabilitation programs. The focus for adults is a comprehensive chronic disease management program designed to enhance and maintain cardiovascular health through the delivery of individualized, but integrated inter-professional care.(1) The focus of paediatric cardiac rehabilitation programs is the healthy development of the whole child through to adulthood. This holistic approach which strives to contribute to the development of the whole child and adolescent involves a multi-programmatic approach including exercise therapy, dietary counselling, stress management, education on healthy heart living, motivational counselling, family support and psychosocial therapy. The ultimate goal of these components delivered by a multidisciplinary team under the direction of a paediatric cardiologist utilizing a holistic approach is to help children and adolescents achieve their full potential as individuals.

What are the objectives of a paediatric cardiac rehabilitation program?

  1. reduction of patient readmissions
  2. improved patient satisfaction
  3. improved exercise capacity and activities of daily living
  4. decreased symptoms
  5. improved quality of life and holistic development as an individual
  6. improved knowledge and awareness of cardiac events
  7. long-term health-enhancing behaviour change self-management

Who is eligible for paediatric cardiac rehabilitation?

Currently Children aged 6-18 with a pre-existing heart condition (congenital heart disease, etc) and/or have suffered a cardiac event and/or have gone through some type of cardiac surgery as specified through a national coverage determination are eligible for Paediatric Cardiac Rehabilitation in the United States. During our research we found that many Hospitals in the United States due to funding restrictions combine paediatric cardiac rehabilitation programs with pulmonary hypertension rehabilitation programs. Within this research we spoke with Cardiologists and Exercise Physiologists from Boston Children’s Hospital, Cincinnati Children’s Hospital, Nationwide Children’s Hospital in Columbus Ohio, Children’s Healthcare of Atlanta, Pittsburgh Children’s Heart Centre, and Peyton Manning Children’s Heart Centre at St. Vincent-Indianapolis.

What are the benefits of paediatric cardiac rehabilitation?

  • Increased confidence and self-esteem in exercise activities
  • Increased self-efficacy in terms of personal ability to exercise and to increase one’s capacity for exercise tolerance
  • support network
  • increased exercise capacities & activities
  • increased heart health & function
  • Increased education and knowledge surrounding cardiac health
  • Overall improved quality of life!

Cardiac rehabilitation has been shown to produce significant & sustained improvements in exercise function, behaviour, self-esteem, and emotional state in children with serious congenital heart disease (2).

What are the program components?

  1. fun and tailored exercise programs!
  2. nutrition & lifestyle modification information
  3. heart health education
  4. emotional support
  5. family support and involvement

What does the multidisciplinary team consist of?

  • paediatric cardiologists
  • exercise physiologists
  • dieticians
  • psychologists & social workers
  • registered nurses
  • occupational and physical therapists
  • program director & program coordinator
  • patient & families

What are the major challenges to the development of a paediatric cardiac
rehabilitation program?

  • lack of funding and lack of funding commitments from the Provincial and Territorial Governments, the LHIN’s and in many cases the Canadian Hospitals themselves. (Currently 10 in 1,000 children are born with congenital heart disease and 257,000 Canadians have congenital heart disease. Of this 33% or 84,810 are children/adolescents. Today 90% of children born with congenital heart disease survive into adulthood)(3)
  • “borrowing” time from various professionals involved in this multidisciplinary activity
  • success of program is strongly dependent on persistent motivation by the provider to encourage paediatric patients to overcome the “I feel OK now, why do I need to participate” attitude
  • Parental fear which can translate to over protection
  • The major challenge is designing a continuum of programs including both Hospital based - phase II programs and home based Phase III programs that are both supervised by a Paediatric Cardiologist. The Hospital Based Phase II program is for individuals who may have more medical complications and be more fragile requiring additional supports. The Home Based Phase III program which addresses Canada’s geographical vastness requires web based monitoring systems and partnerships with existing Child and Family Service agencies.

How long does the program usually last?

Currently in the United States existing programs vary from 12 weeks to 36 weeks. These programs may have the child/adolescent come three days a week or as little as once a week. Following completion of the program, guidance is given to allow continued exercise outside of the paediatric cardiac rehabilitation center, without the need for continued monitoring. As Hospitals move towards a continuum of care model that includes home based paediatric cardiac rehabilitation programs, the length of programs will change dramatically.


References:

  1. Brady, Purdham, Oh, Grace et al. (2013) Clinical and socio demographic correlates of referral for cardiac rehabilitation following cardiac revascularization in Ontario, Heart & Lungs 42 (2013) 320-325
  2. Rhodes et. al. (2006). Sustained Effects of Cardiac Rehabilitation in Children with Serious Congenital Heart Disease. Pediatrics, 118(3), 586‐593.
  3. www.cchaforlife.ca Canadian Congenital Heart Alliance

The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advice. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.