O1010: Going the Distance: Virtual Cardiac Rehab Improves Accessibility and Strength Outcomes in Adolescents with Heart Disease

Background: Adolescents with complex congenital heart disease, including those with Fontan circulation and heart transplants, often experience reduced physical fitness and limited access to traditional cardiac rehabilitation (CR) programs. Virtual cardiac rehabilitation (VCR) offers a promising alternative to improve strength and accessibility while reducing financial and logistical barriers. This study evaluates strength improvements and accessibility benefits of a VCR program for pediatric patients with Fontan circulation or heart transplants.

Methods: Teenagers with Fontan circulation and heart transplants were enrolled in a structured VCR program. Enrollees were scheduled for two virtual fitness sessions per week for four months, and sessions lasted one hour and were led remotely by trained cardiac technologists. Paired Wilcoxon signed-rank tests were used to assess the difference between baseline and graduation values for three strength outcomes: number of push-ups, wall sit time, and plank time. Additionally, travel distance to the exercise laboratory at the children’s hospital and Medicaid insurance status were obtained.

Results: There were 51 patients enrolled from January 2021 to December 2024, and 38 patients (44% male, age range 8.2-20.9 years [median 15.6 years]) graduated the program, having completed >80% of the VCR sessions. Graduates were evenly distributed between those with Fontan circulation (51%) and heart transplant (49%), however adolescents who dropped out of the program were more likely to have undergone a heart transplant (69% vs 31% Fontan circulation). There were no differences between adolescents who graduated versus dropped out when comparing age, gender, distance to the exercise lab, or Medicaid status. Following completion of the VCR program (attendance to at least 24 sessions), graduates had significant improvement in their push up score (transplant median increase of 6 push-ups, p< 0.001, and Fontan increase of 10 push-ups, p< 0.001), wall sit time (transplant median increase of 16 seconds, p=0.007, and Fontan increase of 16 seconds, p=0.04994), and plank time (transplant median increase of 16, p=0.002, and Fontan increase of 18 seconds, p=0.007). Half of the adolescents had Medicaid insurance, and the average travel distance saved through the VCR program was 158 miles per session, significantly reducing travel-related costs and time burdens on the child and their family.

Conclusion: A VCR program effectively improved strength measures in adolescents with Fontan circulation and heart transplants while also offering substantial accessibility benefits. Strength improvement was seen in as few as 24 hour-long sessions. These findings support the broader implementation of VCR as a viable and cost-effective alternative to traditional in-person CR for pediatric patients with significant heart disease. Additional study will be beneficial to identify reasons for attrition and methods to improve session attendance and graduation rates.