At the congress on "European Practicum on Cardiopulmonary Exercise Testing" Celina Fritz received the "International Young Investigators Award". This science prize is awarded for outstanding achievements in the field of spiroergometrics by CPX International (the international Society for Exercise Intolerance Research and Education). Fritz, who is a staff member at the German Heart Centre, attained her doctorate under the Dean, Prof. Dr. Renate Oberhoffer, on the "Improvement of physical efficiency in patients with congenital heart defects".
A training study with people suffering from univentricular hearts
Fritz carried out a training study. All participants in the investigation had a so-called univentricular heart. Here, either the separation of both ventricles is lacking or one ventricle only exists suggestively and cannot sufficiently fulfill the oxygen demands of the body. In order to create the most optimal adjustment, an operation is performed on the patient, which results in a so-called Fontan circulation. The existing ventricle supplies both the body and the pulmonary system with blood in these patients. "This is a relatively complicated operation for children who only have one ventricle and is only performed at a few centers in Europe, among them also the German Heart Centre of the TUM," explains Prof. Oberhoffer, who is a Full Professor at the Chair of Preventive Pediatrics.
"Studies have shown that patients with a Fontan circulation demonstrate a poorer function of the heart and lungs when under physical stress," explains Fritz. At the same time, a reduced efficiency also results in weaker skeletal musculature. However, the skeletal musculature can be improved through individual long-term training - and in this way the efficiency as well. That is at least the theory. "This approach of training the musculature through respiratory training and thereby contributing to a better flow of the blood back to the heart, is very interesting and, in this form, has not yet been investigated in adult patients with congenital heart defects," explains Oberhoffer.
Training of the diaphragm and costal musculature between the ribs
To recruit the test subjects, Fritz held discussions with more than 300 adult heart patients suffering from a Fontan circulation. Forty-two of these declared themselves ready to participate. Fritz conceived a training to address the diaphragm and costal musculature between the ribs, which are important for respiration. "The test subjects inhaled through an artificial resistance - a breathing trainer. Each participant completed three sets daily of from ten to thirty repetitions over a period of six months," explains Fritz.
After six months, no significant results were found. "Neither the physical efficiency seen on the ergometer nor the lung capacity showed any significant differences. Presumptions from studies in other patient groups indicate interpretations in this direction, however, but there is still an urgent need for further research on patients with congenital heart defects," explains Fritz.
In the future, other training programs as well as breathing trainers are to be examined in further studies in order to be able to develop a program on this basis, which makes it possible to improve the patients' efficiency.
To the Homepage of the Chair of Preventive Pediatrics
To the Homepage of the German Heart Centre
To the Homepage of the CPX International Society
Contact:
Celina Fritz
German Heart Centre of Munich
Lazarettstr. 36
80636 Munich
Email: Fritz(at)dhm.mhn.de
Text: Dr. Fabian Kautz
Photo: Private