High intensity interval training in patients with tetralogy of Fallot

Rationale: Tetralogy of Fallot is the most common type of cyanotic congenital heart disease.
The main problems of this patient population are heart failure related to chronic pulmonary
regurgitation, arrhythmias and sudden cardiac death. A major gap in our knowledge is how
coupling between the RV and pulmonary artery affects outcomes. A promising method to
investigate RV-PA coupling is by looking at pulse wave velocity and wave reflection patterns
in the main pulmonary artery and proximal branches non-invasively. It has been shown that
left sided pulse wave velocity can be improved by exercise training in Tetralogy of Fallot by
exercise training.
Objective: Primary Objective: To examine the effect of an online based exercise training
protocol on ventriculo-arterial coupling , as assessed by pulse wave velocity in the aorta and
pulmonary artery in patients operated for Tetralogy of Fallot.
Secondary Objective(s): To examine the effect of an online based exercise training protocol
on the increase in exercise capacity and quality of life in patients with Tetralogy of Fallot.
Study design: The design of our study is a cross-over interventional study. All children and
young adults will be randomized in 2 groups. One group will start with care/exercise as usual,
the other group will start with an online exercise training. After 12 weeks the groups will
change from protocol. Before start of measurements, after 12 weeks and group 2 after 24
weeks, all participants will undergo a number of tests, including echocardiogram,
cardiopulmonary exercise test, and cardiac magnetic resonance imaging.
Study population: 12-30 years of age, after surgical repair of tetralogy of Fallot (TOF), being
followed at one of the 2 locations of the Academic Center for Congenital Heart disease
(ACAHA) (Erasmus MC, Sophia children’s hospital, Radboud UMC Amalia children’s
hospital).
Intervention (if applicable): 12 weeks of online based interval training 3 times a week.
Main study parameters/endpoints: Decrease in pulse wave velocity in the aorta and
pulmonary artery measured by MRI.

HIIT can lower PWV in the Aorta and pulmonary Artery in patients with Tetralogy of Fallot

Group A
Baseline (week 0)
After excercise program (week 12)

Group B
Baseline (week 0)
After control period (week 12)
After excercise program (week 24)

Trainings intervention:
Due to the ongoing COVID-19 pandemic we prefer an online intervention (example
shown at: https://pedcardio.shinyapps.io/TOFHIIT-example/), in this pandemic it is not
clear if/when gyms and physiotherapists will be available.One training a week
consists of jump roping (training 1), one training are body weight exercises (training 2)
and the last training is one of the choosing of the participants such as running or bike
riding (training 3). All trainings are approximately 30 minutes in length Training 1 and
2 will be monitored in a MS teams session and via heart rate monitor (HRM), training
3 can be done at a time of the choosing of the participant and the heart rate
monitoring file will be sent to the researcher. Training 1 and 3 will be done using the
10-20-30 HIIT protocol which has been shown to be more effective compared to
continues moderate intensity training. This protocol can be used in different
activities in short it consists of 10 seconds of high intensity followed by 20 seconds of
moderate intensity followed by 30 seconds of very light intensity.