Cardiopulmonary, Chronic Illness, and Cancer Rehabilitation
Congenital heart disease and pulmonary disease
Children with repaired congenital heart disease usually tolerate and benefit from exercise; those with Fontan circulation have limited cardiac output reserve, chronotropic incompetence, and reduced exercise capacity, so prescribe interval activity with adequate hydration and avoid sustained high-intensity isometric work. Eisenmenger physiology warrants caution with exertion. Cystic fibrosis rehabilitation centers on airway clearance (oscillating positive expiratory pressure, high-frequency chest wall oscillation), inhaled therapies, and aerobic and strength exercise to preserve lung function and bone density. Asthma care includes inhaler technique, trigger control, and warm-up to prevent exercise-induced bronchospasm.
Pediatric cancer rehabilitation
Impairments are treatment-specific. Vincristine causes a painful, areflexic peripheral neuropathy with foot drop. Methotrexate can produce leukoencephalopathy and cognitive slowing. Anthracyclines and chest radiation cause cardiomyopathy, so monitor exercise tolerance and ejection fraction. Corticosteroids cause myopathy, weight gain, and avascular necrosis, especially of the femoral head. Brain tumors, particularly posterior fossa tumors, may cause ataxia and cerebellar mutism. Osteosarcoma may require amputation or limb salvage, with prosthetic or gait training and close wound surveillance. Fatigue and deconditioning are treatable, not simply accepted.
Traps
Do not restrict activity reflexively; most children with cancer or heart disease benefit from moderate exercise. Sternal precautions after median sternotomy limit upper-extremity resistance work for weeks. Distinguish disease-related fatigue from deconditioning, anemia, and depression.
Worked rule of thumb
Prescribe moderate-intensity aerobic exercise three times weekly plus resistance work, using the OMNI or Borg rating of perceived exertion to self-regulate intensity when heart rate targets are unreliable.