Long-lasting benefits of exercise for those living with a Fontan circulation

Purpose of review In recent decades, the physiology and late outcomes of the Fontan circulation have become better characterized and interest has turned to interventions that might improve exercise capacity and clinical sequelae. No therapy has currently been shown to be more effective for improving exercise capacity in the setting of a Fontan circulation than exercise. This review examines the current evidence supporting exercise as therapy for this group. Recent findings People living with a Fontan circulation are at increased risk for reduced skeletal muscle mass and exercise capacity with important implications for clinical outcomes. Small studies suggest that performing moderate-to-vigorous aerobic and resistance exercise improves exercise capacity through unique mechanisms such as superior respiratory and skeletal muscle function and venous return. Summary Despite traditional concerns about moderate-to-vigorous physical activity, current evidence suggests that exercise is beneficial for the Fontan circulation and that, after appropriate screening, we should be encouraging regular moderate-to-vigorous physical activity. Multicentre randomized controlled trials are needed that further explore mechanisms, late impact for end-organ function and strategies to optimize long-term moderate-to-vigorous physical activity levels.