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Valderrama P, Carugati R, Sardella A, Flórez S, de Carlos Back I, Fernández C, Abella IT, Grullón A, Ribeiro Turquetto AL, Fajardo A, Chiesa P, Cifra B, Garcia-Cuenllas L, Honicky M, Augustemak De Lima LR, Franco Moreno YM, Salinas ME, de Carvalho T, Hülle Catani L, Huertas-Quiñones M, Yáñez-Gutiérrez L. 2024 SIAC guidelines on cardiorespiratory rehabilitation in pediatric patients with congenital heart disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00154-3. [PMID: 38750931 DOI: 10.1016/j.rec.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 05/31/2024]
Abstract
The 2024 Interamerican Society of Cardiology (SIAC) guidelines on cardiorespiratory rehabilitation (CRR) in pediatric patients with congenital heart disease aim to gather and evaluate all relevant evidence available on the topic to unify criteria and promote the implementation of CRR programs in this population in Latin America and other parts of the world. Currently, there is no unified CRR model for the pediatric population. Consequently, our goal was to create these CRR guidelines adapted to the characteristics of congenital heart disease and the physiology of this population, as well as to the realities of Latin America. These guidelines are designed to serve as a support for health care workers involved in the care of this patient group who wish to implement a CRR program in their workplace. The guidelines include an easily reproducible program model that can be implemented in any center. The members of this Task Force were selected by the SIAC on behalf of health care workers dedicated to the care of pediatric patients with congenital heart disease. To draft the document, the selected experts performed a thorough review of the published evidence.
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Affiliation(s)
- Paulo Valderrama
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile.
| | - Romina Carugati
- División de Cardiología, Hospital de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Angela Sardella
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Sandra Flórez
- Servicio de Cardiología Pediátrica, Clínica Medical Duarte, Cúcuta, Colombia
| | | | - Carlos Fernández
- Centro Cardiovascular Pediátrico, Clínica Santa María, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Inés T Abella
- División de Cardiología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Angelica Grullón
- Departamento de Cardiología Pediátrica, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, República Dominicana
| | - Aida Luiza Ribeiro Turquetto
- Unidade de Cirurgia Cardíaca Pediátrica, Instituto de Coração, Hospital de Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Astrid Fajardo
- Departamento de Medicina Física y Rehabilitación, División de Rehabilitación Cardiaca, Fundación Cardio Infantil, LaCardio, Bogotá, Colombia
| | - Pedro Chiesa
- Facultad de Medicina, Centro Hospitalario Pereira Rossell, Instituto de Cardiología Integral, Montevideo, Uruguay
| | - Barbara Cifra
- Department of Cardiology, The Hospital for Sick Children, Toronto, Canada
| | - Luisa Garcia-Cuenllas
- Servicio de Pediatría, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Michele Honicky
- Programa de Pós-Graduação em Nutrição, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Yara María Franco Moreno
- Servicio de Pediatría, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - María Eugenia Salinas
- Instituto de Educação Física e Desporto da Universidade Federal de Alagoas, Maceio, Brazil
| | | | - Liane Hülle Catani
- Programa de Pós-graduação em Ciências do Movimento Humano, Universidade Estatal de Santa Catarina, Florianópolis, Brazil
| | - Manuel Huertas-Quiñones
- Clínica Ambulatória de Medicina Esportiva para Crianças e Adolescentes, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucelli Yáñez-Gutiérrez
- Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-Instituto de Cardiología. Departamento de Pediatría, Universidad Nacional de Colombia y Universidad del Rosario, Bogotá, Colombia; Servicio de Cardiopatías Congénitas, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Ciudad de México, Mexico
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Wang AP, Griffith G, Otto-Meyer S, Ward K. The Child Opportunity Index 2.0 and Disparities in Pediatric Cardiorespiratory Fitness. J Pediatr 2024; 268:113964. [PMID: 38369240 DOI: 10.1016/j.jpeds.2024.113964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To evaluate the effect of neighborhood-level characteristics on cardiorespiratory fitness (CRF) via peak oxygen consumption (VO2peak) for healthy pediatric patients. STUDY DESIGN The institutional cardiopulmonary exercise testing (CPET) database was analyzed retrospectively. All patients aged ≤ 18 years without a diagnosis of cardiac disease and with a maximal effort CPET were included. Patients were divided into three self-identified racial categories: White, Black, and Latinx. The Child Opportunity Index (COI) 2.0 was used to analyze social determinants of health. CRF was evaluated based on COI quintiles and race. Assessment of the effect of COI on racial disparities in CRF was performed using ANCOVA. RESULTS A total of 1753 CPETs met inclusion criteria. The mean VO2peak was 42.1 ± 9.8 mL/kg/min. The VO2peak increased from 39.1 ± 9.6 mL/kg/min for patients in the very low opportunity cohort to 43.9 ± 9.4 mL/kg/min for patients in the very high opportunity cohort. White patients had higher percent predicted VO2peak compared with both Black and Latinx patients (P < .01 for both comparisons). The racial differences in CRF were no longer significant when adjusting for COI. CONCLUSION In a large pediatric cohort, COI was associated with CRF. Racial disparities in CRF are reduced when accounting for modifiable risk factors.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Garett Griffith
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - Sebastian Otto-Meyer
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Kendra Ward
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Mebarak M, Mendoza J, Romero D, Amar J. Healthy Life Habits in Caregivers of Children in Vulnerable Populations: A Cluster Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:537. [PMID: 38791757 PMCID: PMC11121232 DOI: 10.3390/ijerph21050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 05/26/2024]
Abstract
Intervention programs aimed at mitigating the effects of chronic noncommunicable disease (CNDs) focus on promoting healthy lifestyle habits (HLH), especially in the early stages of life. Because of this, different typologies of caregivers have been identified according to HLH during middle childhood and adolescence. However, the available studies have focused on aspects such as nutrition, physical activity, and rest, ignoring other HLHs that are equally important for children's well-being. Likewise, few studies address HLH during the first five years of life and how caregivers affect children's health. In a sample of 544 caregivers of children aged zero to five years from low-income Colombian communities, we established a typology of attitudes toward different HLHs. The results indicate the presence of three clusters that grouped caregivers with (1) positive attitudes toward all HLHs, (2) toward some HLHs, and (3) relatively low positive attitudes toward all HLHs. Membership in clusters with less positive attitudes toward HLHs was also found to be associated with low educational levels and living in rural areas. This study detected profiles of caregivers who may have unhealthy lifestyles, so the results would allow social workers to design differential interventions on HLHs in non-industrialized countries.
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Affiliation(s)
- Moisés Mebarak
- Human Development Research Center, Universidad del Norte, Barranquilla 080020, Colombia; (M.M.); (J.A.)
- Department of Psychology, Universidad del Norte, Barranquilla 080020, Colombia;
| | - Juan Mendoza
- Department of Psychology, Universidad del Norte, Barranquilla 080020, Colombia;
| | - Duban Romero
- Human Development Research Center, Universidad del Norte, Barranquilla 080020, Colombia; (M.M.); (J.A.)
| | - José Amar
- Human Development Research Center, Universidad del Norte, Barranquilla 080020, Colombia; (M.M.); (J.A.)
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Buchanan M, Spence C, Keir M, Khoury M. Physical Activity Promotion Among Individuals With Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:322-334. [PMID: 38161681 PMCID: PMC10755793 DOI: 10.1016/j.cjcpc.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 01/03/2024]
Abstract
In the general population, the most cited barriers to physical activity (PA) are time, energy, and motivation. Consequently, despite the significant contribution of PA to health and well-being, many individuals are insufficiently active. Physical inactivity and sedentary lifestyles increase the risk of acquired cardiometabolic disease, a risk that may complicate and is compounded by the anatomic and physiologic features inherent in the patient with repaired tetralogy of Fallot (ToF). Individuals with ToF commonly present with reduced exercise capacity and PA levels. In light of historically PA restrictive management of their heart disease, known reductions in exercise capacity among individuals with ToF are combined with psychosocial barriers to their participation, potentially establishing a cycle of further detraining, inactivity, and disease progression/health decline. To this end, children and young adults with ToF are known to have reduced self-efficacy towards PA, defined as their confidence in their ability to participate. In this review, we apply self-efficacy as an overarching mediator of PA participation and explore trends and determinants of PA participation among individuals with ToF and its subsequent impact on exercise capacity, disease risk, and health-related quality of life. We outline the rationale and strategies aimed at improving PA in children and adults with ToF and highlight current knowledge gaps and future directions in the promotion of PA in the population with ToF.
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Affiliation(s)
- Mackenzie Buchanan
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher Spence
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Keir
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Leo DG, Lane DA, Riley M, Lotto AA, Lotto RR. Facilitators and barriers of physical activity participation in children with a single ventricle physiology: a mixed-methods study. Cardiol Young 2023; 33:1992-1999. [PMID: 36484131 DOI: 10.1017/s1047951122003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present study focuses on assessing the physical activity level of children with Fontan circulation for Hypoplastic Left Heart Syndrome and identifying potential barriers and facilitators toward their participation in physical activity. PATIENTS AND METHODS Seven children aged 5-16 years (mean (SD) 8.8 (3.7) years) with a Fontan procedure for hypoplastic left heart syndrome, their parents (n = 7), and siblings (n = 1) were recruited. Data were collected using a mixed-methods approach: (i) children wore an activity monitor for 7 days to record physical activity, with sedentary time and level of activity calculated from accelerometer data; (ii) children completed a bespoke questionnaire recording limitations in physical activity; (iii) parents completed a semi-structured interview discussing perceptions about their child's physical activity participation. Qualitative data were analysed using thematic analysis. RESULTS Activity monitors data recorded highly active children with a mean (SD) of 153(36) minutes/day spent in moderate-to-vigorous physical activity. Time spent in sedentary behaviour was also high (57.5% of total accelerometer wearing-time). Four key themes relating to parental perceptions of physical activity were identified: (i) A new lease of life -post-Fontan; (ii) Setting limits - managing limitations; (iii) The wider world - how others set limits; and (iv) "I fear the future" - parental concerns. CONCLUSION Following completion of the Fontan circulation, children engaged in higher levels of physical activity in comparison to the national average. However, more than half their time was spent in sedentary behaviour. Fears and anxiety from parents and teachers may act as a barrier toward physical activity participation.
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Affiliation(s)
- Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest, Liverpool, UK
| | - Marlene Riley
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Attilio A Lotto
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest, Liverpool, UK
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Robyn R Lotto
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest, Liverpool, UK
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Vertematti S. Physical Activity and Quality of Life in Children with Congenital Heart Diseases: A Public Health Issue. Arq Bras Cardiol 2023; 120:e20230634. [PMID: 37878881 PMCID: PMC10567081 DOI: 10.36660/abc.20230634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Silvana Vertematti
- Instituto de Assistência Médica ao Servidor Público EstadualSão PauloSPBrasil Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo , SP – Brasil
- Universidade Federal de São PauloSão PauloSPBrasil Universidade Federal de São Paulo (UNIFESP), São Paulo , SP – Brasil
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Mansfield LK, Reichman JR, Crowley DI, Flyer JN, Freeman K, Gauvreau KK, Mackie SA, Marino BS, Newburger JW, Ziniel SI, Brown DW. Living with Congenital Aortic Stenosis: Exercise Restriction, Patterns of Adherence, and Quality of Life. Pediatr Cardiol 2023:10.1007/s00246-023-03165-2. [PMID: 37344559 DOI: 10.1007/s00246-023-03165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/16/2023] [Indexed: 06/23/2023]
Abstract
Modern consensus panel guidelines recommend restriction from most organized sports for patients with moderate or severe aortic stenosis (AS). However, there is little published data on how frequently physicians deviate from guidelines, how well patients adhere to exercise restrictions, or the effect of restriction on patient-reported quality of life. In this study, we surveyed 93 subjects with AS and their cardiologists regarding participation in organized sports, physical activity, weightlifting, and exercise restriction. Subjects completed the pediatric quality of life inventory (PedsQL) and the pediatric cardiac quality of life inventory (PCQLI). We found that subjects with severe AS (n = 3) were commonly, but not universally, restricted from organized sports (n = 2, 66%). Subjects with moderate AS (n = 40) were rarely restricted from organized sports (n = 6, 17%). No physician-specific characteristics were associated with increased likelihood of recommending exercise restriction. Subjects were more likely to be restricted if they were older (16 years vs. 13 years, p 0.02) and had moderate versus mild AS (p 0.013). PCQLI scores for teens and young adults with AS (age 13-25) were lower than a comparison group of patients with mild congenital heart disease. For all age groups, the PedsQL social functioning score was lower for subjects with exercise restriction (p 0.052). In summary, cardiologists apply consensus guidelines leniently when restricting patients with moderate/severe AS from organized sports and weightlifting. Patients with AS routinely adhere to exercise restriction recommendations. Children and young adults with AS and exercise restriction have lower QOL scores in the social functioning domain.
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Affiliation(s)
- Laura K Mansfield
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Jeffrey R Reichman
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - David I Crowley
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jonathan N Flyer
- Division of Pediatric Cardiology, Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Kaitlyn Freeman
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kimberlee K Gauvreau
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Stewart A Mackie
- Division of Pediatric Cardiology Department of Pediatrics and Medical Social Sciences Department of PediatricsBaystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA
| | - Bradley S Marino
- Divisions of Cardiology and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jane W Newburger
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Sonja I Ziniel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - David W Brown
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
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White DA, Layton AM, Curran T, Gauthier N, Orr WB, Ward K, Vernon M, Martinez MN, Rice MC, Hansen K, Prusi M, Hansen JE. ehealth technology in cardiac exercise therapeutics for pediatric patients with congenital and acquired heart conditions: a summary of evidence and future directions. Front Cardiovasc Med 2023; 10:1155861. [PMID: 37332590 PMCID: PMC10272804 DOI: 10.3389/fcvm.2023.1155861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Many children and adolescents with congenital and acquired heart disease (CHD) are physically inactive and participate in an insufficient amount of moderate-to-vigorous intensity exercise. Although physical activity (PA) and exercise interventions are effective at improving short- and long-term physiological and psychosocial outcomes in youth with CHD, several barriers including resource limitations, financial costs, and knowledge inhibit widespread implementation and dissemination of these beneficial programs. New and developing eHealth, mHealth, and remote monitoring technologies offer a potentially transformative and cost-effective solution to increase access to PA and exercise programs for youth with CHD, yet little has been written on this topic. In this review, a cardiac exercise therapeutics (CET) model is presented as a systematic approach to PA and exercise, with assessment and testing guiding three sequential PA and exercise intervention approaches of progressive intensity and resource requirements: (1) PA and exercise promotion within a clinical setting; (2) unsupervised exercise prescription; and (3) medically supervised fitness training intervention (i.e., cardiac rehabilitation). Using the CET model, the goal of this review is to summarize the current evidence describing the application of novel technologies within CET in populations of children and adolescents with CHD and introduce potential future applications of these technologies with an emphasis on improving equity and access to patients in low-resource settings and underserved communities.
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Affiliation(s)
- David A. White
- Ward Family Heart Center, Children’s Mercy Kansas City, Kansas City, MO, United States
- School of Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - Aimee M. Layton
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - Tracy Curran
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Naomi Gauthier
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - William B. Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Kendra Ward
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Meg Vernon
- Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA, United States
| | - Matthew N. Martinez
- Division of Pediatric Cardiology, Department of Pediatrics, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, United States
| | - Malloree C. Rice
- Division of Pediatric Cardiology, Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Katherine Hansen
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
| | - Megan Prusi
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI, United States
| | - Jesse E. Hansen
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI, United States
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Life satisfaction, health-related quality of life and physical activity after treatment for valvular aortic stenosis. Cardiol Young 2023; 33:403-409. [PMID: 35351216 DOI: 10.1017/s1047951122000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate health-related quality of life and life satisfaction in children and adolescents treated for isolated congenital valvular aortic stenosis compared to healthy peers. Our second aim was to investigate the relationship between objectively measured physical activity, health-related quality of life and life satisfaction in the same group. METHODS Forty-eight patients, 8-18 years of age, were recruited, as well as 43 healthy peers matched for age, gender and residential area. Health-related quality of life was assessed by the KIDSCREEN-52 self-report and parent proxy report, and life satisfaction was evaluated with the Satisfaction With Life Scale. Physical activity was measured with an accelerometer for 7 days. Sports participation was self-reported. RESULTS No differences in the health-related quality of life domains were found between patients and controls in the self-reports. In the proxy reports, parents of the adolescents rated their child's autonomy lower than did the parents of the healthy controls. A negative relationship was found between moderate to vigorous physical activity, sports participation, life satisfaction and the psychological well-being domain in adolescent patients. In children there was a positive relationship between moderate physical activity and the physical and psychological well-being domains. CONCLUSION Overall, children and adolescents treated for valvular aortic stenosis reported similar life satisfaction and health-related quality of life as their healthy peers. The negative relationships between intense physical activity and sports participation with health-related quality of life and life satisfaction in adolescent patients might be explained by both physical and psychological factors in these teenagers with complex, lifelong heart disease.
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Effects of Sports, Exercise Training, and Physical Activity in Children with Congenital Heart Disease-A Review of the Published Evidence. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020296. [PMID: 36832425 PMCID: PMC9955038 DOI: 10.3390/children10020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
Children and adolescents with congenital heart disease (CHD) should be encouraged to adopt a physically active lifestyle, ideally by participating in sports activities at school and sports clubs. Children with complex CHD or other risk factors (for example, pacemakers, cardioverter-defibrillators, channelopathies) may, however, need specific individualized training programs. This review article summarizes the current knowledge regarding the clinical effects of sports and exercise training on CHD and its pathophysiologic mechanisms. An evidence-based approach based on a literature search, using PubMed, Medline, CINHAL, Embase, and the Cochrane Library was conducted, last completed on 30 December 2021. In studies with 3256 CHD patients in total, including 10 randomized controlled trials, 14 prospective interventional trials, 9 observational trials, and 2 surveys, exercise training has been shown to improve exercise capacity and physical activity, motoric skills, muscular function, and quality of life. Sports and exercise training appears to be effective and safe in CHD patients. Despite being cost-efficient, training programs are currently scarcely reimbursed; therefore, support from healthcare institutions, commissioners of healthcare, and research-funding institutions is desirable. There is a strong need to establish specialized rehabilitation programs for complex CHD patients to enhance these patients' access to this treatment intervention. Further studies may be desirable to confirm these data to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.
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Gavotto A, Ladeveze M, Avesani M, Huguet H, Guillaumont S, Picot MC, Requirand A, Matecki S, Amedro P. Aerobic fitness change with time in children with congenital heart disease: A retrospective controlled cohort study. Int J Cardiol 2023; 371:140-146. [PMID: 36181952 DOI: 10.1016/j.ijcard.2022.09.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To evaluate the change in aerobic fitness (VO2max), measured by cardio-pulmonary exercise test (CPET), in children with congenital heart disease (CHD), compared to matched healthy controls, and identify predictors of VO2max change with time in this specific population. METHOD This longitudinal retrospective multicentre cohort study was carried out from 2010 to 2020. We included CHD paediatric patients from the cohort of a previous cross-sectional study, who had a second CPET at least 1 year after the first one, during their follow-up. RESULTS We included 936 children, 296 in the CHD group and 640 controls. Mean time between baseline and final CPET was 4.4 ± 1.7 years. After matching on age and gender and adjustment for age and BMI, the mean VO2max group difference was 10.5% ± 1.0% of percent-predict VO2max at baseline and increased to 19.1% ± 1.3% at final assessment. In the CHD group, the proportion of children with impaired aerobic fitness was significantly higher at final than at baseline CPET assessment (51.4% vs 20.3%; P < 0.01). The mean annual VO2max decrease was significantly worse in the CHD group than in controls (-1.88% ± 0.19% of percent-predict VO2max/year vs. -0.44% ± 0.27% of percent-predict VO2max/year, P < 0.01, respectively). In multivariate analyse, male gender, a high initial VO2max, a high BMI, and the number of cardiac surgical procedures ≥2, were predictors of the VO2max decrease with time. CONCLUSION The VO2max decrease with time is more pronounced in children with CHD compared to healthy matched controls. This study highlighted the importance of serial CPET assessment in children with CHD. Trial registration NCT04815577.
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Affiliation(s)
- Arthur Gavotto
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Manon Ladeveze
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM U1411, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM U1411, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France; Paediatric Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, University of Bordeaux, Bordeaux, France.
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12
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Liang ZD, Zhang M, Wang CZ, Yuan Y, Liang JH. Association between sedentary behavior, physical activity, and cardiovascular disease-related outcomes in adults-A meta-analysis and systematic review. Front Public Health 2022; 10:1018460. [PMID: 36339165 PMCID: PMC9632849 DOI: 10.3389/fpubh.2022.1018460] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023] Open
Abstract
Background Sedentary behavior (SB) and physical activity (PA) are modifiable risk factors for cardiovascular disease (CVD); however, previous research on the effects of PA and SB on CVD has been relatively homogeneous. Our study investigated the association between PA, SB, and CVD-related outcomes. Methods A comprehensive search strategy was conducted in the MEDLINE, Embase, Cochrane Library, and Web of Science databases from their inception to September 2022. We identified eligible studies according to PICOS: the populations comprised healthy adults, the interventions or exposures were PA or SB, the outcomes were CVD-related outcomes, and the study designs were randomized controlled trials (RCTs) and longitudinal studies (LS). Outcomes were pooled using fixed or random effects models, and the quality of individual studies was assessed by the Cochrane Risk of Bias Instrument and the Newcastle Ottawa Scale. Results A total of 148 RCTs and 36 LS were included, comprising a total of 75,075 participants. The study quality was rated as low to moderate. We found an increased hazard ratio (HR) for CVD in the population with SB (HR = 1.34; 95% confidence interval [CI]: 1.26 to 1.43; I2 = 52.3%; Pheterogeneity < 0.001, random model) and a decreased HR for CVD in those who performed long-term PA (HR = 0.71; 95% CI: 0.66 to 0.77; I2 = 78.0%, Pheterogeneity < 0.001, random model). Long-term PA improved the lipid profiles in healthy adults; participants in this group exhibited increased high-density lipoprotein (weighted mean difference [WMD] = 2.38; 95% CI: 1.00 to 3.76; I2 = 84.7%; Pheterogeneity < 0.001, random model), decreased triglycerides (WMD = -7.27; 95% CI: -9.68 to -4.87; I2 = 0%, Pheterogeneity = 0.670, fixed model), and lower total-cholesterol (WMD = -6.84; 95% CI: -9.15 to -4.52; I2 = 38.4%, Pheterogeneity < 0.001, random model). Conclusions Long-term SB increases the risk of CVD in healthy adults, whereas PA reduces the risk of CVD and improves indicators associated with CVD. However, the ability of PA to improve blood lipids appeared to be limited. The detailed association of SB and PA on CVD needs to be further investigated in the future.
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Affiliation(s)
- Zhi-de Liang
- Cancer Institute of The Affiliated Hospital of Qingdao University and Qingdao Cancer Institute, Qingdao, China
| | - Meng Zhang
- Postgraduate Department, Xi'an Physical Education University, Xi'an, China
| | - Chuan-zhi Wang
- Department of Physical Education, College of Physical Education, Qingdao University, Qingdao, China
| | - Yang Yuan
- Cancer Institute of The Affiliated Hospital of Qingdao University and Qingdao Cancer Institute, Qingdao, China,*Correspondence: Yang Yuan
| | - Jing-hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China,Jing-hong Liang
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13
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Assessment of Hypertension, Guideline-Directed Counseling, and Outcomes in the ACHD Population. Pediatr Cardiol 2022; 43:1615-1623. [PMID: 35380216 DOI: 10.1007/s00246-022-02890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
Guidelines for the diagnosis and treatment of hypertension were published by the American Heart Association (AHA) in 2017. The prevalence of hypertension in adults with congenital heart disease (ACHD) under these guidelines has yet to be characterized. We sought to assess the prevalence, impact, and provider response to hypertension under current guidelines. Data were obtained retrospectively from records of routine clinic visits over a 10 year period. Potential hypertension-related adverse outcomes including stroke, myocardial infarction, surgical intervention for aortic aneurysm, aortic dissection, atrial fibrillation or flutter, cardiac transplantation and death were recorded. The 1070 patients who met inclusion criteria had a mean age of 30.8 ± 10.0 years. The prevalence of hypertension under the 2017 guidelines was 46.6%. Multivariate modeling identified cyanosis, male gender, older age, and overweight/obesity as independent risk factors for hypertension. Guideline-directed management of hypertension in ACHD patients occurred more frequently in ACHD and adult cardiology clinics than in pediatric cardiology clinics (44.1% and 45.1% vs. 24.0%, p < 0.01, respectively). Adverse outcomes were reported in 217 (20%) patients, the most prevalent of which was atrial fibrillation or flutter (11%). Multivariable modelling for any adverse outcome identified older age, hypertension, cyanosis, greater complexity ACHD, and obesity as risk factors. Modifiable risk factors for atherosclerotic cardiovascular disease are common and often under addressed in the ACHD population.
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14
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Kuan MT, Hemphill NM, Harris KC. Reduced Physical Activity During COVID-19 in Children With Congenital Heart Disease: A Longitudinal Analysis. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:219-225. [PMID: 37969428 PMCID: PMC9213038 DOI: 10.1016/j.cjcpc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) was associated with a reduction in physical activity in children with congenital heart disease (CHD) in early 2020. Given the increased cardiovascular risk of this population, optimizing cardiovascular health behaviour is important. The aim of the study is to determine how the ongoing COVID-19 pandemic has impacted longitudinal physical activity measures in children with CHD. Methods As part of a prospective cohort study, children and adolescents aged 9-16 years old with moderate-to-complex CHD were recruited from British Columbia Children's Hospital and partnership clinics across British Columbia and the Yukon territory. Daily step counts were measured continuously over 3 years (2018-2021) with Fitbit Charge 2. School status during the COVID-19 pandemic was assessed with parent- or self-report survey. Results A total of 102, 114, and 93 participants had valid Fitbit data during 2018, 2019, and 2020, respectively. There was a significant reduction in the annual mean step count for 2020 (8225 ± 4328 steps) compared with both 2018 (9416 ± 3770 steps) and 2019 (9533 ± 4114 steps) (P < 0.001). There was a loss of seasonal variation in physical activity, and reduced levels of physical activity persisted when most children resumed in-person schooling in September 2020. Conclusions We demonstrated a significant decrease in physical activity and loss of seasonal patterns in children with CHD during 2020. These findings represent a worsening of the cardiovascular risk profile in children with CHD, who are already at an increased risk of adverse cardiovascular outcomes. Mitigation strategies are needed to optimize the cardiovascular health status of children with CHD as the pandemic persists.
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Affiliation(s)
- Mimi T.Y. Kuan
- Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Nicole M. Hemphill
- Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kevin C. Harris
- Division of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
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15
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Umapathi KK, Thavamani A, Bosco G, Dhanpalreddy H, Nguyen HH. Prevalence of Metabolic Syndrome in Young Adults With Congenital Heart Disease. Am J Cardiol 2022; 179:90-95. [PMID: 35879153 DOI: 10.1016/j.amjcard.2022.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
Adults with congenital heart disease (ACHD) are at risk of developing metabolic syndrome (MetS) at a younger age. We sought to obtain the prevalence of MetS in ACHD from a large population-based database in the United States. We conducted a retrospective cohort study of patients with ACHD in Explorys (IBM Inc., Armonk, New York) database from 2008 to 2019. The ACHD cohort included patients aged 20 to 39 years, with moderate and severe congenital heart disease, as defined by ACHD anatomic and physiologic classification. Patients were diagnosed with MetS using the modified International Diabetes Federation's diagnostic criteria. Logistic regression analysis was performed to compare the risk of MetS in the ACHD cohort. MetS was diagnosed in 1,860 of 6,720 patients with ACHD (27.6%). Among 7,359,470 controls, MetS was seen in 742,010 (10.1%). The average age of MetS in ACHD was 31.5 and 32.7 years in controls (p <0.001). The risk of MetS was higher in ACHD versus controls (odds ratio [OR] 2.75 [2.61 to 2.89], p <0.001). The risk of MetS in ACHD was higher in men (OR 3.01 [2.78 to 3.26], p <0.001) and those aged <25 years (men OR 7.57 [6.31 to 9.07], women OR 4.66 [3.85 to 5.63]; p <0.001). The risk of MetS was higher in patients with severe versus moderate ACHD (OR 1.4 [1.56 to 1.74], p <0.001). In conclusion, MetS and its risk factors are more common in young ACHD than in the general population.
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Affiliation(s)
- Krishna Kishore Umapathi
- Division of Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois.
| | - Aravind Thavamani
- Department of Pediatrics, Case Western Reserve University Hospital, Cleveland, Ohio
| | - Gianna Bosco
- Division of Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Harshitha Dhanpalreddy
- Division of Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Hoang Hiep Nguyen
- Department of Pediatrics, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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16
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Zoller T, Prioli MA, Clemente M, Pilati M, Sandrini C, Luciani GB, Deganello Saccomani M, Ficial B, Gaffuri M, Piacentini G, Calciano L, Pietrobelli A. Congenital Heart Disease: Growth Evaluation and Sport Activity in a Paediatric Population. CHILDREN 2022; 9:children9060884. [PMID: 35740821 PMCID: PMC9221605 DOI: 10.3390/children9060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
(1) Objective: To evaluate: (i) the associations of age and disease severity with anthropometric indices and weight status, (ii) the difference in the frequency of sports activity among different levels of disease severity in paediatric patients with congenital heart disease (CHD). (2) Methods: Clinical data of Caucasian children (aged 2–18 years) diagnosed with CHD (2005–2018) were retrospectively collected from the electronic register of outpatient visits. Of the 475 children with CHD, 368 children and their 1690 complete anthropometric measurements were eligible for inclusion in our analysis. (3) Results: Significant increase with age was observed for weight z-score [beta (95%CI): 0.03 (0.02, 0.05) for one-unit of age] and BMI z-score [0.06 (0.03, 0.08)] but not for height z-score. The probability of being underweight and overweight/obese increased and decreased with disease severity, respectively. The obesity probability of patients with mild CHD (0.06 [95%CI: 0.03, 0.08]) was not statistically distinguishable from that of patients with moderate CHD (0.03 [95%CI: 0.02, 0.05]), whereas it was lower in patients with severe CHD (0.004 [95%CI: 0.0, 0.009]). No obese patients with a univentricular heart defect were observed. Days spent in sport activities were equal to 1.9 [95%CI: 1.6, 2.2] days/week, 1.9 [1.5, 2.2], 1.4 [1.1, 1.7] and 0.7 [0.1, 1.3] in patients with mild, moderate, severe and univentricular CHD, respectively. (4) Conclusions: The risk of being overweight and obese should not be underestimated in paediatric patients diagnosed with CHD, especially in children with mild or moderate heart defects. It could be prevented or reduced by promoting a healthy lifestyle.
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Affiliation(s)
- Thomas Zoller
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Maria Antonia Prioli
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Maria Clemente
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
- Correspondence:
| | - Mara Pilati
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Camilla Sandrini
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (M.A.P.); (M.P.); (C.S.); (G.B.L.)
| | - Marco Deganello Saccomani
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Benjamim Ficial
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Marcella Gaffuri
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Giorgio Piacentini
- Paediatric Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37126 Verona, Italy; (T.Z.); (M.D.S.); (B.F.); (M.G.); (G.P.)
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37126 Verona, Italy;
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17
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Li Y, Zhou Y, Chen M, Fu MR, Luo B, Yu P, Zheng H, Liu F. A WeChat-Based Rehabilitation Platform for Children and Adolescents with Congenital Heart Disease to Promote Cardiac FITness (HeartFIT): Protocol for a Mixed-Methods Strategy from Evidence-Based Design to Pilot Study. J Multidiscip Healthc 2022; 15:907-920. [PMID: 35519154 PMCID: PMC9064066 DOI: 10.2147/jmdh.s349519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
Progress in medical and surgical care has tremendously improved the survival rates of children with congenital heart disease (CHD). However, reduced aerobic capacity and health-related issues remain a threaten to quality survival and prevention of related complications among children and adolescents with CHD. This research program aims to develop and evaluate a WeChat-based health platform (HeartFIT) to facilitate cardiac rehabilitation and promote physical fitness for this rapidly expanding young population. The study protocol describes the use of an iterative process of using a mixed-methods strategy to develop, refine, and pilot test the proposed HeartFIT platform. A sequential problem-solving process comprising four iterative phases with ongoing end-user input will be implemented. In phase 1, relevant literature was systematically reviewed (completed) and then child-parent dyads will be interviewed to understand the broad context and the requirements and considerations of the target population toward the WeChat-based rehabilitation platform. In phase 2, key features and priority functionalities for the platform will be ideated and refined, and a digital interactive prototype will be created. In phase 3, heuristic evaluation and three rounds of end-user testing will be conducted to ensure further refinement and usability of the prototype. In phase 4, a prospective pilot study will be performed to investigate the feasibility, acceptability, and preliminary efficacy of the developed platform over a 12-week intervention period. If HeartFIT intervention is feasible, acceptable, and demonstrates promising efficacy, an adequately powered randomized controlled trial (future work) will be deployed to test the real-world effectiveness of the intervention.
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Affiliation(s)
- Yuan Li
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China.,West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Yaxin Zhou
- Rehabilitation Medicine Center, Sichuan University, Chengdu, People's Republic of China.,West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Miao Chen
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Mei R Fu
- Rutgers University, School of Nursing, Camden, NJ, USA
| | - Biru Luo
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China.,West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Pengming Yu
- Rehabilitation Medicine Center, Sichuan University, Chengdu, People's Republic of China.,West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, People's Republic of China
| | - Hong Zheng
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Fangfei Liu
- Nursing Department, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China
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18
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Khoury M, Cordina R. Exercise Training for People Living with a Fontan Circulation: An Underutilized Intervention. Can J Cardiol 2022; 38:1012-1023. [PMID: 35041931 DOI: 10.1016/j.cjca.2022.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 12/17/2022] Open
Abstract
Surgical repair for children born with single ventricle congenital heart disease, culminating in the Fontan operation, has resulted in dramatic improvements in survival; children born with these lesions are now typically expected to survive well into adulthood. Most, but not all, individuals with a Fontan circulation have reduced exercise capacity compared with the general population that in turn is associated with increased cardiovascular morbidity and mortality. The cause of reduced exercise capacity is multifactorial. A significant contributor is the absence of a subpulmonary ventricular pump, which limits preload and appropriate cardiac output augmentation to meet the increased metabolic demands that occur with exercise. While in its infancy relative to adults with acquired heart disease, the evidence to date suggests that exercise interventions to improve exercise capacity and Fontan physiology in children and adults with Fontan circulation are safe, effective and well tolerated. However, many knowledge gaps remain, including a detailed understanding of the unique physiological adaptations that occur, the optimal approach to exercise in this population and the effectiveness of home-based interventions utilizing telemedicine and remote physiologic monitoring technologies. Furthermore, the long-term impact of such interventions on the Fontan-cardiovascular system, physical activity levels, health-related quality of life, and late cardiovascular morbidity and mortality are not well characterized. In this review, we outline the factors associated with reduced exercise capacity in individuals with Fontan circulation, review the experience to date of dedicated interventions to improve exercise capacity, and highlight the current knowledge gaps in the field and priorities for further study.
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Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Rachael Cordina
- Sydney Medical School, University of Sydney, Sidney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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19
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Abstract
PURPOSE OF REVIEW Historically, children with congenital heart disease have been restricted from exercise, contributing to a sedentary lifestyle as well as increased cardiovascular risk factors. Given the large benefits and small risks of exercise in this population, guidelines have recently shifted towards exercise promotion. However, these recommendations have yet not gained traction and children with congenital heart disease continue to live sedentary lives. The purpose of this review is to summarize the current literature on exercise and exercise promotion in this population. RECENT FINDINGS New literature reinforces the importance of recommending exercise and improving exercise capacity both in congenital heart disease in general and for specific lesions. Exercise recommendations should be individualized based on functional parameters using a structured methodology to approach the evaluation, risk classification, and prescriptions of exercise and physical activity. SUMMARY Regular exercise is essential for children with congenital heart disease and providers must take an active role in providing exercise recommendations for their patients. Exercise promotion remains a challenge, necessitating novel approaches to promote exercise. Further studies are needed to improve the risk stratification of patients with congenital heart disease, assess the long-term outcomes of specific exercise interventions, and inform individualized recommendations to encourage children with congenital heart disease to safely engage in exercise and establish healthy lifelong habits that will decrease their cardiovascular risk.
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Affiliation(s)
- Katherine Hansen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, 94304, USA
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20
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Wittekind SG, Redington A. Functional outcomes after pulmonary valve replacement: how can we expect patients to rehabilitate if we do not help them? Eur J Cardiothorac Surg 2021; 61:73-74. [PMID: 34329414 DOI: 10.1093/ejcts/ezab292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew Redington
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Voss C. Towards a better understanding of causal factors related to physical activity in children with CHD: some answers, more questions. Can J Cardiol 2021; 38:6-8. [PMID: 34710511 DOI: 10.1016/j.cjca.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christine Voss
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Kelowna, British Columbia, Canada.
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22
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Inactive Lifestyles among Young Children with Innocent Murmurs or Congenital Heart Disease Regardless of Disease Severity or Treatment. Can J Cardiol 2021; 38:59-67. [PMID: 34555459 DOI: 10.1016/j.cjca.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sedentary lifestyle morbidities are common among children with congenital heart disease (CHD). Understanding the physical activity trajectory from early childhood could enhance intervention timing/effectiveness. METHODS 154 children (56% male) were recruited at 12-47 months of age for this prospective, longitudinal, observational study. Physical activity and sedentary behaviour (7-day accelerometry) and motor skill (Peabody Developmental Motor Scales-2) were assessed every 8 months until 5 years of age and then annually. Mixed effect repeated measures regression models described outcome trajectories across study assessments. RESULTS Children had an innocent heart murmur (n=28), CHD with insignificant hemodynamics not requiring treatment (n=47), CHD treated by catheterization or surgery without cardiopulmonary bypass (n=31), or CHD treated surgically with bypass (n=48). Motor skill was age appropriate (Peabody 49.0±8.4) but participants had lower physical activity (143±41 mins/day) and higher sedentary time (598±89 mins/day) than healthy peers, starting at 18 months of age. Movement behaviours were not related to treatment group (p>0.10), and physical activity was below the recommended 180 mins/day. Over time, physical activity, sedentary time and motor skill were primarily related to the baseline measure of each outcome (p<0.001). CONCLUSIONS Children with simple or complex CHD or innocent heart murmurs have an increased risk for sedentary lifestyles. Their physical activity and sedentary behaviours are established prior to 2 years of age, persist until school age, and are unrelated to motor skill. These results emphasize the need for interventions targeting the youngest children seen in a cardiac clinic, regardless of CHD diagnosis or innocent murmur.
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23
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Huang C, Yu Y, Sørensen HT, Liu B, Vested A, Cnattingius S, Qin G, Li J. Maternal education before childbirth and cardiovascular diseases in offspring during early adulthood: a Danish population-based cohort study. Can J Cardiol 2021; 37:1951-1958. [PMID: 34273473 DOI: 10.1016/j.cjca.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is increasing in youths, but there is limited knowledge about the etiology of early-onset CVD. We aimed to examine the association between maternal education before childbirth and CVD risk in offspring during early adulthood (20-40 years old). METHODS AND RESULTS This population-based cohort study included 1123600 individuals born in Denmark during 1977-1996. Compared to offspring born to mothers with high education, offspring born to mothers with low or medium education had 27% (hazard ratio, 1.27; 95% confidence interval, 1.23-1.30) or 12% (1.12; 1.09-1.15) increased overall risk of early-onset CVD, respectively. Increased risks were observed for most type-specific CVDs, in particular for myocardial infarction low [2.03; 1.55-2.65] or medium education [1.52; 1.16-1.99]), heart failure (low [1.59; 1.24-2.03] or medium education [1.51; 1.19-1.92]), and ischemic stroke (low [1.50; 1.28-1.76] or medium education [1.29; 1.10-1.51]). We observed high incidences of CVD in offspring of mothers with comorbid CVD (low [1.67; 1.51-1.86] or medium education [1.46; 1.29-1.64]), compared with those of mothers with high education and no CVD history. CONCLUSIONS Low maternal education before childbirth, especially with maternal comorbid CVD, is significantly associated with increased risk of overall CVD and most type-specific CVDs in offspring in early adulthood. The influence of maternal education on future offspring CVD should be taken into consideration in the assessment of CVD risks from early decades of life.
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Affiliation(s)
- Chen Huang
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
| | - Henrik Toft Sørensen
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Buyun Liu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, USA
| | - Anne Vested
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
| | - Jiong Li
- Department of Clinical Medicine-Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
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Gong YQ, Liu XY, Zhi P, Wei LN, Guo FF, Qian JZ, Wang YX, Dong HL. Exercise training in patients with corrected tetralogy of Fallot: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26108. [PMID: 34032753 PMCID: PMC8154459 DOI: 10.1097/md.0000000000026108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The arrival of transcatheter mitral valve therapies has provided feasible and safe alternatives to medical and surgical treatments for mitral regurgitation. The aim of this study is to estimate the relative efficacy and safety of exercise training in patients with corrected tetralogy of Fallot through meta-analysis. METHODS : A systematic search will be performed using PubMed, EMBASE, the Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP to include random controlled trials or nonrandom controlled trials comparing the efficacy and safety of exercise training in corrected tetralogy of Fallot patients. The risk of bias for the included nonrandom controlled studies will be evaluated according to Risk of Bias in Nonrandomized Studies of Interventions. We will use the Cochrane Collaboration's tool (version 2 of the Cochrane risk of bias tool for randomized trials) to assess risk of bias of included random controlled trials. Revman 5.4 and STATA 15.0 will be used to complete the meta-analysis and generate forest plots. Grading of recommendations assessment, development, and evaluation will be used to assess the quality of evidence. RESULTS : The results of this systematic review and meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION : This study will provide broad evidence of efficacy and safety of exercise training in patients with corrected tetralogy of Fallot and provide suggestions for clinical practice and future research. PROTOCOL REGISTRATION NUMBER INPLASY202150006.
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Affiliation(s)
- Ya-Qin Gong
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Xiao-Yan Liu
- Department of Thoracic Surgery, The First Hospital of Longnan City, Longnan, China
| | - Ping Zhi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Li-Na Wei
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Fang-Fei Guo
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Jin-Zhi Qian
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - Yun-Xia Wang
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
| | - He-Li Dong
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- Congenital Heart Disease Diagnosis and Treatment Gansu Province International Science and Technology Cooperation Base, Lanzhou
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Physical activity in children and adolescents with CHD: review from a measurement methodological perspective. Cardiol Young 2021; 31:518-531. [PMID: 33722326 DOI: 10.1017/s1047951121000627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM To compile a literature overview of physical activity in children with CHD and to critically evaluate the methodology used for physical activity assessment. METHODS A review of the literature was performed using PubMed to identify studies examining accelerometer and subjectively assessed physical activity in children and adolescents with CHD. RESULT A total of 15 studies were included (6 studies using subjective measures and 9 articles using accelerometers for the assessment of physical activity). The patients generally failed to meet the recommendations of physical activity. When compared to healthy controls, the results were widely divergent in the subjectively assessed measures and the accelerometer-based studies showed a tendency of no difference in physical activity. Neither subjective methods nor accelerometer-based studies reported any difference in physical activity in general, in relation to the severity of the heart disease. CONCLUSION Methodological variation and limitations in the assessment of physical activity largely explain the divergent results and the inability to establish differences in physical activity between children with CHD of different severity and compared to healthy controls. Methodological knowledge and guidelines are provided for improved assessment of physical activity using accelerometers in clinical research.
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Harris KC, McCrindle BW. “The Child Is the Father of the Man”—Pediatric Preventive Cardiology. Can J Cardiol 2020; 36:1329-1332. [DOI: 10.1016/j.cjca.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022] Open
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