At-Home Cardiac Rehabilitation for Adolescents at Risk for Heart Failure

At-Home Cardiac Rehabilitation for Adolescents at Risk for Heart Failure

The goal of this clinical trial is to explore the impact that an at-home cardio-oncology rehabilitation (CORE) may have on short-term cardiovascular fitness and psychosocial wellness in pediatric cancer survivors. The main question it aims to answer are

• To evaluate the efficacy of an at-home CORE model on short-term cardiovascular fitness and psychosocial wellbeing in adolescent cancer survivors.
• To evaluate the exercise adherence rate among adolescents at risk for heart failure and assess barriers to compliance.
• To explore which specific CORE resources are of most value to patients in creating sustainable healthy lifestyle modifications.
• Hypothesis: Pediatric cancer survivors who implement exercise and dietary recommendations will demonstrate improvement in cardiovascular fitness and general wellness. A multidisciplinary team approach can facilitate adherence to a moderately rigorous exercise prescription, and thus enhance the health benefits of a CORE program at CHLA.

Participants will undergo cardiovascular studies and a quality-of-life survey prior to exercise intervention, and at the end of the 6-month study period.

INCLUSION CRITERIA

• Patients aged of 10-21 years at enrollment
• Parent/legal guardian available for consent (if applicable), and patient available for assent and consent
• History of anthracycline exposure +/- radiation
• Currently in remission, with at least 6 months off chemotherapy
• Able to perform CPET
• Baseline CPET with VO2 <80% (at start of study, or CPET at CHLA after January 2020)
• Smartphone compatible with Fitbit (own or parent/legal guardian's)
• Ability to complete and send diary and Fitbit information on a weekly basis
• Ability to participate in monthly virtual check-in visits
• Baseline activity prior to intervention <30min/day, 2x/week

EXCLUSION CRITERIA

• Inability to obtain consent/assent
• Unable to accurately perform quality of life survey independently
• No other primary medical diagnosis (e.g., Down Syndrome, Wolff-Parkinson-White Syndrome, congenital heart disease) or history of cardiothoracic surgery
• Contraindication to moderate activity (>3 METs). Examples include history of malignant arrhythmias, exercise-induced syncope, severe symptoms of HF (NYHA IV, ACC/AHA Stage D)
• Unable to perform CPET, echocardiogram, EKG, or obtain laboratory studies
• Unable to perform mild activity for at least 0.5h/day and at least 2x/week
• Unable to come to hospital for study visits at 0 and 6 months
• Unable to complete study-related surveys
• Unable to complete and send diary and Fitbit information on a weekly basis
• Unable to check-in monthly on virtual platform
• On beta blockade
• Pregnancy