Factors Associated With Increased Exercise in Adults With Congenital Heart Disease

Associations of physical activity with cognitive function and daily physical function among Chinese individuals with heart disease: A cross-sectional study

Background

To investigate the associations between different dimensions of physical activity (PA), cognitive function, and daily physical function in Chinese individuals with heart disease.

Materials and methods

This study included 2,792 individuals from the China Health and Retirement Longitudinal Study conducted in 2015. Physical activity (PA) was divided into vigorous PA (VPA), moderate PA (MPA), and light PA (LPA). Linear and logistic regression models were established to assess the associations among the indicators.

Results

Compared with taking no PA, MPA, and VPA at a frequency of 6-7 d/w had lower risks of impaired daily physical function (OR = 0.47, 95% CI: 0.25, 0.91; OR = 0.57, 95% CI: 0.37, 0.88) and higher cognitive function scores (β = 1.22, 95% CI: 0.42, 2.03; β = 1.08, 95% CI: 0.43, 1.73), while VPA at 3-5 d/w had lower cognitive function scores (β = -1.96, 95% CI: -3.51, -0.40). Light PA (LPA) with a duration of 30-119 min/d had a lower risk of impaired daily physical function (OR = 0.59, 95% CI: 0.36, 0.97). Moderate PA (MPA) and VPA of 30-119 min/d had higher cognitive function scores (β = 1.43, 95% CI: 0.49, 2.37; β = 1.30, 95% CI: -0.56, 2.06). The 1,800-2,999 METs had the lowest risks of impaired daily physical function and the highest cognitive function scores (OR = 0.18, 95% CI: 0.04, 0.75; β = 2.94, 95% CI: 1.67, 4.21).

Conclusion

Moderate PA (MPA) and LPA with a frequency of 6-7 d/w and a duration of 30-119 min/d, and PA in 1,800-2,999 MET min/week were most closely related to better cognitive and daily physical function, while VPA (3-5 d/w; ≥300 min/w) may be related to low cognition, but high-quality research is necessary to prove causality.

Trial registration

IRB00001052-11015.

Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis

BACKGROUND

Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults.

METHOD

Studies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD.

RESULT

Out of 1537 articles screened, we identified 11 (N = 104,585 participants, 10,487 with CHD), 10 (N = 167,470 participants, 11,820 with CHD), and 8 (N = 150,813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR = 1.38, 95% CI [1.16, 1.65]), complete secondary education (OR = 1.33, 95% CI [1.09, 1.61]) or vocational training (OR = 1.11, 95% CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity.

CONCLUSION

This systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.

Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review

BACKGROUND

Social determinants of health (SDH) can substantially impact health outcomes. A systematic review, however, has never been conducted on associations of SDH with congenital heart disease (CHD) outcomes. The aim, therefore, was to conduct such a systematic review.

METHODS

Seven databases were searched through May 2020 to identify articles on SDH associations with CHD. SDH examined included poverty, uninsurance, housing instability, parental educational attainment, immigration status, food insecurity, and transportation barriers. Studies were independently selected and coded by two researchers based on the PICO statement.

RESULTS

The search generated 3992 citations; 88 were included in the final database. SDH were significantly associated with a lower likelihood of fetal CHD diagnosis, higher CHD incidence and prevalence, increased infant mortality, adverse post-surgical outcomes (including hospital readmission and death), decreased healthcare access (including missed appointments, no shows, and loss to follow-up), impaired neurodevelopmental outcomes (including IQ and school performance) and quality of life, and adverse outcomes for adults with CHD (including endocarditis, hospitalization, and death).

CONCLUSIONS

SDH are associated with a wide range of adverse outcomes for fetuses, children, and adults with CHD. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan.

IMPACT

Social determinants of health (SDH) are associated with a wide range of adverse outcomes for fetuses, children, and adults with congenital heart disease (CHD). This is the first systematic review (to our knowledge) on associations of SDH with congenital heart disease CHD outcomes. SDH screening and referral to appropriate services has the potential to improve outcomes for CHD patients across the lifespan.

Enablers and barriers for being physically active: experiences from adults with congenital heart disease

BACKGROUND

In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify.

AIM

To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active.

METHODS

A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis.

RESULTS

The analysis revealed four categories considered enablers and barriers - encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active.

CONCLUSION

It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites.