Daily physical activity and perception of condition severity among male and female adolescents with congenital heart malformation

A survey of exercise advice and recommendations in United Kingdom paediatric cardiac clinics

BACKGROUND

Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics.

METHODS

A three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice.

RESULTS

There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity.

CONCLUSION

Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.

Social-cognitive determinants of exercise behaviour among adolescents with mild congenital heart disease

BACKGROUND

Nowadays, most adolescents with mild congenital heart disease (CHD) undergo medical or surgical correction in early childhood for their congenital anomalies. There is a need to examine the determinants of exercise behaviour among adolescents (CHD) who are able to exercise.

AIMS

The aims of this study were to examine determinants of exercise among adolescents with mild CHD, including personal beliefs about exercise, interpersonal influences on exercise, and availability of physical environments for exercise, based on social-cognitive theory.

METHOD

A repeated-measures study was conducted at three medical centres in Taiwan. All participants, 126 adolescents with CHD aged 12 to 18 years, had a cardiologist's recommendation of exercise with no limits or limits only on vigorous exercise. Self-administered questionnaires were completed during a summer vacation and again in the fall semester of school along with a 7-day exercise log. The data were analysed using structured equation modelling.

RESULTS

The effect of interpersonal influences on total exercise and moderate-to-vigorous exercise was mediated by personal exercise beliefs. Peer influences had significant effects on moderate-to-vigorous exercise through the mediator of perceived exercise self-efficacy. There was no significant difference in the determinants of exercise behaviour during two periods. Personal exercise beliefs, particularly perceived exercise self-efficacy, played the most important role in determining the performance of moderate-to-vigorous exercise.

CONCLUSIONS

The social-cognitive determinants may serve as a clinical reference for promoting exercise among adolescents with mild CHD.

Self-efficacy and physical activity in children with congenital heart disease: is there a relationship?

PURPOSE

This study examined the relationship between self-efficacy and physical activity in 10- to 14-year-old children with congenital heart disease.

DESIGN AND METHODS

Cross-sectional study using self-report instruments.

RESULTS

In 84 participants, self-efficacy scores were similar to those published for healthy adolescents, 30.8 as compared with 29.4. Physical activity participation as prescribed by the Centers for Disease Control and Prevention was low (38%). Self-efficacy scores were moderately correlated with physical activity participation (r = .47; p < .001).

PRACTICE IMPLICATIONS

Interventions are needed to increase physical activity in this high-risk group. Interventions that focus on self-efficacy may be particularly helpful given the link between self-efficacy and physical activity.

Exercise capacity and participation of children with a ventricular septal defect

Existing data on exercise performance in children with a ventricular septal defect (VSD) are scarce and inconclusive. We aimed to elucidate whether and why exercise capacity and physical activity level are decreased in children with VSD. Children 9 to 17 years of age with a surgically (operated, n = 13) or conservatively (unoperated, n = 14) managed VSD were compared with healthy peers (controls, n = 15) regarding (1) anthropometric and spirometric measurements; (2) cycle ergometric performance in terms of peak oxygen uptake, peak heart rate, and peak workload; and (3) mean daily energy expenditure. All subjects completed a questionnaire on physical activity participation, overprotection, and self-perceived fitness and health. Anthropometric variables were comparable among groups, whereas lung function at rest was mildly decreased in the 2 VSD subgroups. Exercise testing succeeded in all 42 subjects; valid results were obtained in 39. Weight- and body fat-adjusted peak oxygen uptake, peak workload, and energy expenditure were not significantly different among groups. Peak heart rate emerged as significantly lower in operated subjects, which was not attributable to poorer effort. Physical fitness and general health were rated comparably among groups, whereas participation in sports was markedly lower in children with VSD. Discouragement from engaging in (strenuous) exercise occurred equally infrequently in children with VSD and controls. In conclusion, children with patent or surgically closed VSDs have a normal exercise capacity, despite a mild chronotropic limitation in the latter. Previous cardiac surgery did not influence these children's exercise performance. These children consider themselves healthy, they exhibit a normal habitual physical activity level, and they are not withheld from (strenuous) exercise.

Health-promoting behavior of adolescents with congenital heart disease

PURPOSE

To evaluate and compare the health-promoting behavior of adolescents with congenital heart disease (CHD) to that of adolescents without CHD.

METHODS

Cross-sectional data were collected from pediatric cardiology outpatient departments at two medical centers in Taiwan. A total of 1209 adolescents, including 316 with various forms of CHD and 893 without CHD, completed the Adolescent Health Promotion (AHP) scale. Of those with CHD, 162 were female, and 12-18 years old. The scores of adolescents with CHD were compared with published normative adolescent data.

RESULTS

No significant differences were found between those adolescents with CHD and those without in terms of dimensions of the AHP, which consisted of nutrition, social support, health responsibility, life appreciation, exercise, stress management, and overall health-promoting behavior. The three highest and lowest mean scores of scale items between these two groups were identified. Factors among adolescents with CHD, such as age, gender, parental educational level, and cardiac function were significantly associated with at least one dimension of the AHP. Such significant associations were not indicated when comparing body mass index, medical diagnoses, and whether they had undergone heart surgery.

CONCLUSIONS

Adolescents with CHD practice health-promoting behavior similar to that of their counterparts without CHD. Health-promotion counseling for adolescents with CHD should be encouraged to improve lifestyle habits, especially to ensure that they engage in adequate and vigorous exercise and practice good dental hygiene.