Recreational and sports recommendations for the child with heart disease

Positive mindset and exercise capacity in school-aged children and adolescents with congenital heart disease

Introduction

Patients with congenital heart disease (CHD) have variable degrees of peak oxygen consumption (VO₂) that can be improved with supervised fitness training. The ability to exercise is affected by anatomy, hemodynamics, and motivation. Motivation is in part related to mindset, or personal attitudes and beliefs, and a more positive mindset around exercise has been associated with better outcomes. It is unknown whether variations in measured peak VO₂ in patients with CHD are related to having a positive mindset.

Methods

Patient's ages 8-17 years with CHD were administered quality of life and physical activity questionnaires at the time of their routine cardiopulmonary exercise test. Those with severe hemodynamic burden were excluded. Patients were grouped based on disease classification. Mindset was evaluated via validated questionnaires including a PROMIS Meaning and Purpose (MaP) survey and an Anxiety survey. Pearson correlation coefficients were calculated to estimate the magnitude of the association between percent predicted peak oxygen consumption (pppVO₂) and questionnaire scores overall and within CHD subgroups.

Results

Eighty-five patients participated; median age was 14.7 years, 53% were female, 66% had complex CHD, 20% had simple CHD, and 14% had single ventricle heart disease. Mean MaP scores were significantly lower in all CHD groups compared to population norms (p < 0.001). As a group, MaP scores were positively associated with the amount of reported physical activity (p = 0.017). In patients with simple CHD, MaP scores were positively associated with pppVO₂ (p = 0.015). The association was even stronger for MaP:Anxiety, with worse ratios associated with lower pppVO₂ (p = 0.005). Patients with complex and single ventricle CHD did not show a similar association.

Conclusions

Patients with CHD, regardless of severity, had lower meaning and purpose scores than the general population, and these scores were associated with amount of reported physical activity. In the simple CHD subset, having a more positive mindset was associated with higher peak VO₂ and a more negative mindset with lower peak VO₂. This relationship was not seen with more significant CHD. While underlying CHD diagnoses are not modifiable, mindset and peak VO₂ are, and consideration should be given to measuring both as each may be a target for intervention.

Physical activity assessments in children with congenital heart disease: A systematic review

AIM

To describe the physical activity (PA) of children with congenital heart disease (CHD) according to different assessment methods and compare their results with the World Health Organization (WHO) recommendations.

METHODS

A systematic review was conducted using five databases. We included cross-sectional, longitudinal, observational studies and clinical trials in a paediatric population with CHD. In publications with indirect measurement, the score in each dimension was considered. Similarly, moderate-to-vigorous PA (MVPA) was considered as the main outcome in articles with direct measurement.

RESULTS

A total of 1103 articles were found, and 16 primary articles were considered. Eight articles evaluated PA with indirect methods, six with direct methods and two used both methods, representing 1649 subjects evaluated. It was found that 46% of children with CHD do not exceed WHO recommendations for MVPA, with no differences depending on the severity of CHD.

CONCLUSION

There are a variety of ways to measure PA in children with CHD. In the articles that objectively evaluated PA, the most measured outcome was the MVPA, which shows that the MVPA time was shorter in about half of the children with CHD than what is recommended by WHO.

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

The purpose of this study was to examine among young patients with congenital heart malformation (CHM) the concordance between a cardiologist's definition of the severity of malformation and recommendations regarding physical activity and the patients' perceptions of their condition. Subjects included male (n = 55) and female (n = 45) adolescents aged between 12 and 18 years who have trivial (38%), mild (21%), or moderate (41%) CHM. Thirty-one percent of the patients rated their CHM as less severe whereas 15% rated their CHM as more severe than the cardiologist's definition. Although most patients engaged in physical activity appropriate for their condition, a noteworthy percentage engaged in activities more intense than those recommended by the patient's personal cardiologist.

Cardiac risk factors and participation guidelines for youth sports

Accurate assessment of the cardiac system in pediatric and adolescent youth is important. The hemodynamic demands associated with exercise, training, and sport participation are usually positive and beneficial; however, when an underlying cardiac problem exists, it is imperative that such cardiac problems be identified. Safe sport-related cardiac participation guidelines should be provided for young athletes and their families and coaches. This chapter provides a physician perspective on the recognition and current cardiac management considerations for young athletes participating in both static and dynamic types of sports. The most recent guidelines for hypertension in youth are also provided.

Health care issues facing adolescents with congenital heart disease

The number of children with congenital heart disease surviving beyond adolescence is rapidly increasing. Consequently, pediatric health providers not only have to address medical issues associated with the cardiac condition but must begin to develop programs that assist adolescents and their families in dealing with special health care needs for the young patient to successfully move into the adult world. Transitional health-related issues facing the adolescent with congenital heart disease including medical follow-up, insurability, employability, sexuality, and reproduction are described. Discussion about advising and counseling both patient and parents is included.

Self-efficacy and physical activity in adolescents with trivial, mild, or moderate congenital cardiac malformations

Our purpose was to examine the cognitive processes that influence involvement in physical activity among 100 adolescents, 55 boys and 45 girls, ranging in age from 12 to 18 years, with trivial, mild, or moderate forms of congenital cardiac disease. We hypothesized, first, that the severity of the congenital cardiac malformation itself has an indirect effect on self-efficacy regarding physical activity, and that the relationship between the two is mediated by the recommendations of the cardiologist and the attitude of the mother. Second, we argued that self-efficacy serves as a mediating variable between the recommendations of the cardiologist and the attitude of the mother, on the one hand, and involvement in physical activity, on the other. The results confirmed both hypotheses. In a population of adolescents with trivial to moderate congenital cardiac malformations, beliefs in self-efficacy, rather than severity of the disease, were the most influential factors in determining whether or not adolescents will engage in sports or other physical activities. We also demonstrated the importance of the role played by the recommendations of the cardiologist in determining both the attitudes of the mother and the belief in self-efficacy of the adolescents.

Use of the heart rate monitor to modulate physical activity in adolescents with congenital aortic stenosis: an innovative approach

The task of setting exercise limitations on children with aortic stenosis is fraught with difficulties. In particular, teenagers are difficult to manage because of the increasingly professional demands of adolescents sports; the rapid changes in somatic growth, which are often accompanied by an increase in the severity of aortic valve disease; and the natural tendency of teenagers to disregard advice from authoritarian sources like a medical team. This article describes our innovative approach of using a heart-rate monitor as a means of modulating physical activity in adolescents with mild to moderate aortic stenosis. This approach enabled the setting of clear, precise, observable, measureable limits on physical activity, and self-controling of an acceptable level of physical activity. This created a different negotiation between the patient, his parents, and the medical team, and eased the concern and anxiety of the mothers.

[Cardiovascular evaluation in athletic children]

Although rare, sports related sudden cardiac deaths in children and adolescents justify the search for risk factors in any child or adolescent who wishes to practice sports. Each time that history and careful clinical cardiovascular examination point to a possible cardiovascular abnormality, an electrocardiogram and an echocardiography must be performed. Exercise testing is useful to appreciate the cardiovascular tolerance, either in normal subjects or in subjects with a cardiovascular abnormality; its interpretation requires good knowledge and understanding of hemodynamic responses to exercise. Indications, risks and procedures of exercise testing are discussed with reference to exercise physiology.

Pediatric rehabilitation. 1. General principles and special considerations

This self-directed learning module addresses core concepts in the assessment of any child with disability, including physical growth and development, evolution of reflexes, and cognitive and personality development. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The rehabilitation perspective is emphasized, especially as it changes to accommodate the developing child, with a focus on specific chronic disorders such as respiratory disease, congenital heart disease, and malignancy. These types of disorders serve as a model for the management of problems that require special medical, rehabilitative, and psychosocial consideration.

Exercise after surgical repair of congenital cardiac lesions

Congenital heart defects arise in approximately 1% of all live births, independent of ethnic and geographical considerations. With the development of new surgical procedures and current technologies a large number of these heart lesions can be surgically corrected in infancy. In the majority of cases patients evaluated some 10 to 20 years after surgery are asymptomatic and can lead a normal life. Despite their satisfactory clinical outcome patients may, nevertheless, show an abnormal pattern of physiological responses when submitted to dynamic exercise. This paper reviews the scientific literature concerning the exercise capabilities and the cardiorespiratory adjustments to exercise in patients surgically corrected for 4 of the most common congenital heart lesions: isolated atrial septal defect, isolated ventricular septal defects, pulmonary stenosis and tetralogy of Fallot. The maximal exercise tolerance of postoperative congenital heart defect patients may usually be related to: (a) the age of the patients at the time of surgery; (b) the severity of the lesions remaining after surgery; and (c) the age of the patients at the time of investigation. Although normal maximal exercise capabilities may be found in a good number of patients operated for either of the 4 lesions considered, this does not imply normal exercise haemodynamics. A general observation made in these 4 groups of patients is that of a subnormal exercise cardiac output which may or may not be fully compensated by an increase in peripheral oxygen extraction. The limitation in exercising cardiac output may, in turn, be attributed to either a subnormal stroke volume or a limitation in the chronotropic response to exercise or a combination of both factors. Residual pulmonary stenosis, increased pulmonary vascular resistance, increased myocardial stiffness are all factors that may contribute to the cardiac output limitation. A thorough explanation of underlying causes for the abnormal haemodynamic response to exercise, however, still remains to be provided.

Sudden nontraumatic death in adolescence. Deaths at school

Sudden and unexpected nontraumatic death of adolescents in a school setting was studied in a defined population. All deaths of Allegheny County, Pennsylvania, residents between 12 and 21 years of age for a nine-year period were reviewed. One hundred twenty-four sudden, nontraumatic events were identified. Fourteen events (11.3%) were school related, of which seven were associated with physical exertion. Of the four events occurring during organized school sports, no subject had a condition that would have been easily detectable by preathletic screening. Further evaluation of preventive measures, such as identification and treatment of individuals at high risk for sudden death, and improved cardiopulmonary resuscitation by trained personnel, is recommended.