{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:49:15Z","timestamp":1790218155934,"version":"4.1.0"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    People with a Fontan circulation usually have moderately impaired exercise performance, although a subset have high physical performance (\u201cSuper-Fontan\u201d), which may represent a low-risk phenotype.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    People with a \u201cSuper-Fontan\u201d phenotype were defined as achieving normal exercise performance [\u226580% predicted peak oxygen uptake (VO\n                    <jats:sub>2<\/jats:sub>\n                    ) and work rate] during cardiopulmonary exercise testing (CPET) and were identified from the Australian and New Zealand Fontan Registry. A Fontan control group that included people with impaired exercise performance (&amp;lt;80% predicted VO\n                    <jats:sub>2<\/jats:sub>\n                    or work rate) was also identified based on a 1:3 allocation ratio. A subset of participants were prospectively recruited and completed a series of physical activity, exercise self-efficacy, and health-related quality of life questionnaires.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Sixty CPETs (\u201cSuper-Fontan\u201d,\n                    <jats:italic>n<\/jats:italic>\n                    = 15; control,\n                    <jats:italic>n<\/jats:italic>\n                    = 45) were included. A subset (\u201cSuper-Fontan\u201d,\n                    <jats:italic>n<\/jats:italic>\n                    = 10; control,\n                    <jats:italic>n<\/jats:italic>\n                    = 13) completed a series of questionnaires. Average age was 29 \u00b1 8 years; 48% were males. Exercise capacity reflected by percent predicted VO\n                    <jats:sub>2<\/jats:sub>\n                    was 67 \u00b1 17% in the entire cohort. Compared to the \u201cSuper-Fontan\u201d phenotype, age at Fontan completion was higher in controls (4.0 \u00b1 2.9 vs. 7.2 \u00b1 5.3 years,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.002). Only one (7%) person in the \u201cSuper-Fontan\u201d group had a dominant right ventricle compared to 15 (33%) controls (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.043). None of those in the \u201cSuper-Fontan\u201d group were obese, while almost a quarter (22%) of controls were obese based on body mass index (\n                    <jats:italic>p<\/jats:italic>\n                    = 0.046). Lung function abnormalities were less prevalent in the \u201cSuper-Fontan\u201d group (20 vs. 70%,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.006). Exercise self-efficacy was greater in the \u201cSuper-Fontan\u201d group (34.2 \u00b1 3.6 vs. 27.9 \u00b1 7.2,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.02). Self-reported sports participation and physical activity levels during childhood and early adulthood were higher in the \u201cSuper-Fontan\u201d group (\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.05). The total average time spent participating in structured sports and physical activity was 4.3 \u00b1 2.6 h\/wk in the \u201cSuper-Fontan\u201d group compared to 2.0 \u00b1 3.0 h\/wk in controls,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.003. There were no differences in self-reported current total physical activity score or health-related quality of life between groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2265 0.05).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The \u201cSuper-Fontan\u201d phenotype is associated with a healthy weight, lower age at Fontan completion, better exercise self-efficacy, and higher overall levels of sport and physical activity participation during physical development.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2021.764273","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T04:33:02Z","timestamp":1638851582000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":47,"title":["The \u201cSuper-Fontan\u201d Phenotype: Characterizing Factors Associated With High Physical Performance"],"prefix":"10.3389","volume":"8","author":[{"given":"Derek L.","family":"Tran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Celermajer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Ayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leeanne","family":"Grigg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carley","family":"Clendenning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Hornung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Justo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen 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