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Leone D, Buber J, Shafer K. Exercise as Medicine: Evaluation and Prescription for Adults with Congenital Heart Disease. Curr Cardiol Rep 2023; 25:1909-1919. [PMID: 38117446 DOI: 10.1007/s11886-023-02006-1] [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] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Understanding exercise physiology as it relates to adult congenital heart disease (ACHD) can be complex. Here we review fundamental physiologic principles and provide a framework for application to the unique ACHD patient population. RECENT FINDINGS ACHD exercise participation has changed dramatically in the last 50 years. A modern approach focuses on exercise principles and individual anatomic and physiologic considerations. With an evolving better understanding of ACHD exercise physiology, we can strategize plans for patients to participate in dynamic and static exercises. Newly developed technologies including wearable devices provide additive information for ACHD providers for further assessment and monitoring. Preparation and assessment for ACHD patients prior to exercise require a thoughtful, personalized approach. Exercise prescriptions can be formulated to adequately meet the needs of our patients.
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Affiliation(s)
- David Leone
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Jonathan Buber
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Keri Shafer
- Boston Children's Hospital, Boston, MA, USA.
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2
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Shekhar S, Agrawal A, Pampori A, Lak H, Windsor J, Ramakrishna H. Mortality in Adult Congenital Heart Disease: Analysis of Outcomes and Risk Stratification. J Cardiothorac Vasc Anesth 2022; 36:3379-3388. [DOI: 10.1053/j.jvca.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022]
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Novaković M, Prokšelj K, Jug B. Exercise capacity, cardiac and endothelial function in adults with repaired tetralogy of Fallot. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Thompson SE, Whitehead CA, Notley AS, Guy IA, Kasargod Prabhakar CR, Clift P, Hudsmith LE. The impact of the COVID-19 pandemic on application of European Society of Cardiology (ESC) guidelines for exercise in adults with CHD: a data-based questionnaire. Cardiol Young 2022; 32:270-275. [PMID: 33902783 PMCID: PMC8129687 DOI: 10.1017/s1047951121001864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/17/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Regular physical activity is safe and effective therapy for adults with CHD and is recommended by European Society of Cardiology guidelines. The COVID-19 pandemic poses enormous challenges to healthcare teams and patients when ensuring guideline compliance. We explored the implications of COVID-19 on physical activity levels in adult CHD patients. MATERIALS AND METHODS A data-based questionnaire was distributed to adult CHD patients at a regional tertiary centre from October to November 2020. RESULTS Prior to the COVID-19 pandemic, 96 (79.3%) of 125 respondents reported participating in regular physical activity, with 66 (52.8%) meeting target levels (moderate physical activity for at least 150 minutes per week). Commonest motivations for physical activity were general fitness (53.6%), weight loss (36.0%), and mental health benefits (30.4%). During the pandemic, the proportion that met target levels significantly decreased from 52.8% to 40.8% (p = 0.03). The commonest reason was fear of COVID-19 (28.0%), followed by loss of motivation (23.2%) and gym/fitness centre closure (15.2%). DISCUSSION The COVID-19 pandemic has negatively impacted exercise levels of adult CHD patients. Most do not meet recommended physical activity levels, mainly attributable to fear of COVID-19. Even before the pandemic, only half of respondents met physical activity guidelines. Availability of online classes can positively impact exercise levels so could enhance guideline compliance. This insight into health perceptions and behaviours of adult CHD patients may help develop quality improvement initiatives to improve physical activity levels in this population.
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Affiliation(s)
- Sophie E. Thompson
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, UK
| | - Caitlin A. Whitehead
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Alex S. Notley
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Isabel A. Guy
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, UK
| | | | - Paul Clift
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, UK
| | - Lucy E. Hudsmith
- Adult Congenital Heart Disease Unit, University Hospitals Birmingham, Birmingham, UK
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Budts W, Pieles GE, Roos-Hesselink JW, Sanz de la Garza M, D'Ascenzi F, Giannakoulas G, Müller J, Oberhoffer R, Ehringer-Schetitska D, Herceg-Cavrak V, Gabriel H, Corrado D, van Buuren F, Niebauer J, Börjesson M, Caselli S, Fritsch P, Pelliccia A, Heidbuchel H, Sharma S, Stuart AG, Papadakis M. Recommendations for participation in competitive sport in adolescent and adult athletes with Congenital Heart Disease (CHD): position statement of the Sports Cardiology & Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2021; 41:4191-4199. [PMID: 32845299 DOI: 10.1093/eurheartj/ehaa501] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/16/2019] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Improved clinical care has led to an increase in the number of adults with congenital heart disease (CHD) engaging in leisure time and competitive sports activities. Although the benefits of exercise in patients with CHD are well established, there is a low but appreciable risk of exercise-related complications. Published exercise recommendations for individuals with CHD are predominantly centred on anatomic lesions, hampering an individualized approach to exercise advice in this heterogeneous population. This document presents an update of the recommendations for competitive sports participation in athletes with cardiovascular disease published by the Sports Cardiology & Exercise section of the European Association of Preventive Cardiology (EAPC) in 2005. It introduces an approach which is based on the assessment of haemodynamic, electrophysiological and functional parameters, rather than anatomic lesions. The recommendations provide a comprehensive assessment algorithm which allows for patient-specific assessment and risk stratification of athletes with CHD who wish to participate in competitive sports.
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Affiliation(s)
- Werner Budts
- Department of Congenital and Structural Cardiology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium.,Department of Cardiovascular Sciences, Catholic University Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium
| | - Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Maria Sanz de la Garza
- Cardiovascular Institute, Hospital Clinic, Calle Villarroel, 170, 08036 Barcelona, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, 546 37 Thessaloniki, Greece
| | - Jan Müller
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, German Heart Center, Technical University Munich, Georg-Brauchle-Ring 60/62 80992 München, Germany
| | - Renate Oberhoffer
- Department of Sport and Health Sciences, Institute of Preventive Pediatrics, German Heart Center, Technical University Munich, Georg-Brauchle-Ring 60/62 80992 München, Germany
| | - Doris Ehringer-Schetitska
- Department of Pediatrics and Adolescent Medicine, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Vesna Herceg-Cavrak
- Pediatric Cardiology Department, Faculty of Dental Medicine and Health Osijek, Children's Hospital Zagreb, Libertas International University and University of Applied Health Sciences, Klaićeva 16, 10000 Zagreb, Croatia
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna/General Hospital Vienna, 1090 Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via Giustiniani 2, 35121 Padova, Italy
| | - Frank van Buuren
- Department of Internal Medicine, Catholic Hospital Southwestfalia-St. Martinus-Hospital Olpe, Angiology and Intensive Care Unit, Hospitalweg 6, 57462 Olpe, Germany
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Mats Börjesson
- Department of Neuroscience and Physiology, Sahlgrenska Academy and Center for Health and Performance, Göteborg University and Sahlgrenska University Hospital/Ostra, Medicinaregatan 11-13, 413 90 Göteborg, Sweden
| | - Stefano Caselli
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Seestrasse 220, 8027 Zürich, Switzerland
| | - Peter Fritsch
- Institute for Paediatric Cardiology, University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT, UK
| | - A Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT, UK
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Iung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJ, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K, Ernst S, Ladouceur M, Aboyans V, Alexander D, Christodorescu R, Corrado D, D’Alto M, de Groot N, Delgado V, Di Salvo G, Dos Subira L, Eicken A, Fitzsimons D, Frogoudaki AA, Gatzoulis M, Heymans S, Hörer J, Houyel L, Jondeau G, Katus HA, Landmesser U, Lewis BS, Lyon A, Mueller CE, Mylotte D, Petersen SE, Petronio AS, Roffi M, Rosenhek R, Shlyakhto E, Simpson IA, Sousa-Uva M, Torp-Pedersen CT, Touyz RM, Van De Bruaene A. Guía ESC 2020 para el tratamiento de las cardiopatías congénitas del adulto. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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7
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Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, Moons P, Mulder BJM, Oechslin E, Roos-Hesselink JW, Schwerzmann M, Sondergaard L, Zeppenfeld K. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J 2021; 42:563-645. [PMID: 32860028 DOI: 10.1093/eurheartj/ehaa554] [Citation(s) in RCA: 903] [Impact Index Per Article: 301.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Leusveld EM, Kauling RM, Geenen LW, Roos-Hesselink JW. Heart failure in congenital heart disease: management options and clinical challenges. Expert Rev Cardiovasc Ther 2020; 18:503-516. [DOI: 10.1080/14779072.2020.1797488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elsbeth M. Leusveld
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M. Kauling
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laurie W. Geenen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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9
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Brudy L, Hock J, Häcker AL, Meyer M, Oberhoffer R, Hager A, Ewert P, Müller J. Children with Congenital Heart Disease Are Active but Need to Keep Moving: A Cross-Sectional Study Using Wrist-Worn Physical Activity Trackers. J Pediatr 2020; 217:13-19. [PMID: 31740142 DOI: 10.1016/j.jpeds.2019.09.077] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/12/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare daily physical activity of children with congenital heart disease (CHD) with healthy peers measured using wearables bracelets in a large cohort. Additionally, subjectively estimated and objectively measured physical activity was compared. STUDY DESIGN From September 2017 to May 2019, 162 children (11.8 ± 3.2 years; 60 girls) with various CHD participated in a self-estimated and wearable-based physical activity assessment. Step-count and moderate-to-vigorous physical activity were recorded with the Garmin vivofit jr. for 7 consecutive days and compared with a reference cohort (RC) of 96 healthy children (10.9 ± 3.8 years; 49 girls). RESULTS Children with CHD were active and 123 (75.9%) achieved 60 minutes physical activity on a weekly average according to the World Health Organization criteria as 81 (84.3%) of the healthy peers did (P = .217). After correction for age, sex, and seasonal effects, only slightly lower step count (CHD: 10 206 ± 3178 steps vs RC: 11 142 ± 3136 steps; P = .040) but no lower moderate-to-vigorous physical activity (CHD: 80.5 ± 25.6 minutes/day vs RC: 81.5 ± 25.3 minutes/day; P = .767) occurred comparing CHD with RC. In children with CHD higher age (P = .004), overweight or obesity (P = .016), complex severity (P = .046), and total cavopulmonary connection (P = .027) were associated with not meeting World Health Organization criteria. Subjective estimation of daily moderate-to-vigorous physical activity was fairly correct in half of all children with CHD. CONCLUSIONS Even though the majority is sufficiently active, physical activity needs to be promoted in overweight or obese patients, patients with complex CHD severity, and in particular in those with total cavopulmonary connection.
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Affiliation(s)
- Leon Brudy
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany; Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany.
| | - Julia Hock
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany
| | - Anna-Luisa Häcker
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany; Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Michael Meyer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany; Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany; Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany
| | - Jan Müller
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Munich, Germany; Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
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Holbein CE, Peugh J, Veldtman GR, Apers S, Luyckx K, Kovacs AH, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Eriksen K, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Soufi A, Fernandes SM, White K, Callus E, Kutty S, Moons P. Health behaviours reported by adults with congenital heart disease across 15 countries. Eur J Prev Cardiol 2019; 27:1077-1087. [DOI: 10.1177/2047487319876231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample. Design This was a cross-sectional observational study. Methods Adults with congenital heart disease ( n = 4028, median age = 32 years, interquartile range 25–42 years) completed self-report measures as part of the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS). Participants reported on seven health behaviours using the Health Behaviors Scale-Congenital Heart Disease. Demographic and medical characteristics were assessed via medical chart review and self-report. Multivariate path analyses with inverse sampling weights were used to investigate study aims. Results Health behaviour rates for the full sample were 10% binge drinking, 12% cigarette smoking, 6% recreational drug use, 72% annual dental visit, 69% twice daily tooth brushing, 27% daily dental flossing and 43% sport participation. Pairwise comparisons indicated that rates differed between countries. Rates of substance use behaviours were higher in younger, male participants. Optimal dental health behaviours were more common among older, female participants with higher educational attainment while sports participation was more frequent among participants who were younger, male, married, employed/students, with higher educational attainment, less complex anatomical defects and better functional status. Conclusions Health behaviour rates vary by country. Predictors of health behaviours may reflect larger geographic trends. Our findings have implications for the development and implementation of programmes for the assessment and promotion of optimal health behaviours in adults with congenital heart disease.
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Affiliation(s)
- Christina E Holbein
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, USA
| | - James Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Gruschen R Veldtman
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Saudi Arabia
| | - Silke Apers
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven - University of Leuven, Belgium
- UNIBS, University of the Free State, South Africa
| | - Adrienne H Kovacs
- Peter Munk Cardiac Center, University of Toronto, Canada
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | - Corina Thomet
- Center for Congenital Heart Disease, Inselspital - Bern University Hospital, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Belgium
| | - Junko Enomoto
- Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Japan
| | - Maayke A Sluman
- Coronel Institute of Occupational Health, University of Amsterdam, the Netherlands
- Department of Cardiology, Jeroen Bosch Hospital, the Netherlands
| | - Chun-Wei Lu
- Adult Congenital Heart Center, National Taiwan University Children’s Hospital
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children’s Hospital, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Université de Montréal, Canada
| | - Stephen C Cook
- Adult Congenital Heart Disease Center, Helen DeVos Children’s Hospital, USA
| | | | - Luis Alday
- Division of Cardiology, Hospital de Niños, Argentina
| | - Katrine Eriksen
- Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Norway
| | - Mikael Dellborg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Sweden
- Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Malin Berghammer
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
- Department of Health Sciences, University West, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children’s Hospital, Canada
| | | | | | - Alexandra Soufi
- Department of Congenital Heart Disease, Louis Pradel Hospital, France
| | - Susan M Fernandes
- Adult Congenital Heart Program at Stanford, Lucile Packard Children’s Hospital and Stanford Health Care, USA
| | - Kamila White
- Adult Congenital Heart Disease Center, Washington University, USA
- Barnes Jewish Heart and Vascular Center, University of Missouri, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center, University of Nebraska Medical Center, USA
- Taussig Heart Center, Johns Hopkins School of Medicine, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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Athlete Cardiovascular Concerns in the Training Room: What Do I Do If…? Clin Sports Med 2019; 38:483-496. [PMID: 31472761 DOI: 10.1016/j.csm.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac disease can present in the training room through three portals: the preparticipation history and physical may identify concerns, the athlete may present with symptoms, or screening modalities may demonstrate abnormal findings. Training-related cardiovascular remodeling can mimic real disease, therefore providers must be able to separate the two. Sports medicine providers must be knowledgeable in how these present and how to care for these concerns to ensure proper care and avoid unnecessary restrictions of athletes. This article discusses 10 common cardiac concerns that can arise in the training room.
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Buber J, Shafer K. Cardiopulmonary exercise testing and sports participation in adults with congenital heart disease. Heart 2019; 105:1670-1679. [PMID: 31273028 DOI: 10.1136/heartjnl-2018-313928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/29/2019] [Accepted: 05/27/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jonathan Buber
- Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Keri Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Cardiology, Brigham and Women's Hospital, Boston, MA, United Startes of America
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van Dissel AC, Blok IM, Hooglugt JLQ, de Haan FH, Jørstad HT, Mulder BJ, Bouma BJ, Winter MM. Safety and effectiveness of home-based, self-selected exercise training in symptomatic adults with congenital heart disease: A prospective, randomised, controlled trial. Int J Cardiol 2019; 278:59-64. [DOI: 10.1016/j.ijcard.2018.12.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/20/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease. Clin J Sport Med 2018; 28:540-560. [PMID: 28742603 DOI: 10.1097/jsm.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk-benefit ratio of sport participation versus restriction. DATA SOURCE A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria. MAIN RESULTS Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated. CONCLUSIONS Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.
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15
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Cardiac Rehabilitation for Adults With Congenital Heart Disease: Physical and Psychosocial Considerations. Can J Cardiol 2018; 34:S270-S277. [DOI: 10.1016/j.cjca.2018.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
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Novaković M, Prokšelj K, Rajkovič U, Vižintin Cuderman T, Janša Trontelj K, Fras Z, Jug B. Exercise training in adults with repaired tetralogy of Fallot: A randomized controlled pilot study of continuous versus interval training. Int J Cardiol 2018; 255:37-44. [DOI: 10.1016/j.ijcard.2017.12.105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/28/2017] [Accepted: 12/27/2017] [Indexed: 01/28/2023]
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Powell A. Exercise in congenital heart disease: A contemporary review of the literature. HEART AND MIND 2018. [DOI: 10.4103/hm.hm_38_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Ávila P, Chaix MA, Mondésert B, Khairy P. Sudden Cardiac Death in Adult Congenital Heart Disease. Card Electrophysiol Clin 2017; 9:225-234. [PMID: 28457237 DOI: 10.1016/j.ccep.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sudden death of presumed arrhythmic etiology is a leading cause of mortality in adults with congenital heart disease. Anticipated benefits of the implantable cardioverter-defibrillator (ICD) must be weighed against high complication rates. Without robust evidence from randomized trials, caregivers face difficult decisions in selecting appropriate candidates. Although secondary prevention indications are often clear-cut, risk stratification for primary prevention ICDs is more challenging. Factors associated with sudden death in patients with tetralogy of Fallot are reasonably consistent across studies. In contrast, identification of high-risk patients with systemic right ventricles or univentricular hearts remains controversial.
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Affiliation(s)
- Pablo Ávila
- Department of Cardiology, Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Marie-A Chaix
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street East, Montreal H1T 1C8, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street East, Montreal H1T 1C8, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street East, Montreal H1T 1C8, Canada.
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Cardiovascular autonomic dysfunction and carotid stiffness in adults with repaired tetralogy of Fallot. Clin Auton Res 2017; 27:185-192. [DOI: 10.1007/s10286-017-0411-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
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Exercise and Congenital Heart Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1000:95-101. [DOI: 10.1007/978-981-10-4304-8_7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Ávila P, Marcotte F, Dore A, Mercier LA, Shohoudi A, Mongeon FP, Mondésert B, Proietti A, Ibrahim R, Asgar A, Poirier N, Khairy P. The impact of exercise on ventricular arrhythmias in adults with tetralogy of Fallot. Int J Cardiol 2016; 219:218-24. [DOI: 10.1016/j.ijcard.2016.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/12/2016] [Indexed: 12/19/2022]
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Sless R, Stern NJ. Transposition of exercise protocols: cardiovascular response to exercise in patients with transposition of the great arteries. J Physiol 2016; 593:4081-2. [PMID: 26372835 DOI: 10.1113/jp271049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/22/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- R Sless
- Department of Exercise Science, University of Toronto, Toronto, Ontario, Canada
| | - N J Stern
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Diller GP, Baumgartner H. Sudden cardiac death during exercise in patients with congenital heart disease: the exercise paradox and the challenge of appropriate counselling. Eur Heart J 2015; 37:627-9. [DOI: 10.1093/eurheartj/ehv523] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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