We read with interest the article by Thomas et al.1 However, we are concerned that the presented statement did not consider children and adolescents with congenital heart disease (CHD), as this patient group might also benefit from home-based cardiac rehabilitation.
In childhood, physical activity is particular important, not only for somatic health but also for neurologic, emotional, and psychosocial development. Furthermore, exercise may be beneficial to prevent acquired diseases typical for sedentary individuals, that is, atherosclerotic cardiovascular disease, obesity, hypertension, and type 2 diabetes.
Unfortunately, children with CHD have often reduced levels of physical activity, mainly due to overprotection of parents and caregivers, teachers and sport trainers, physicians, and health care professionals, and also due to misperceptions regarding the relative risks versus benefits of participation.2
In a pilot study in children and adolescents with pulmonary arterial hypertension, we recently were able to show that home-based exercise training in combination with online feedback and motivational phone calls might be a promising approach in this age group.3
In children with CHD, exercise training has been shown to be effective as well4; however, the experience with home-based rehabilitation programs is limited so far. The use of digital media with the aim of developing an online training platform executed by experts in cardiology, sports science, psychology, and physiotherapy may represent an innovative approach and, finally, might be the key to increase the attractiveness of home-based cardiac rehabilitation programs for tech-savvy children and adolescents with CHD who grew up with computer devices.5
Jannos Siaplaouras, MD
Christian Apitz, MD
Division of Pediatric Cardiology
University Childrens Hospital Ulm
Ulm, Germany
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