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Hansen K, Curran T, Reynolds L, Shafer K, Gauvreau K, Gauthier N. Combined Exercise and Mindset Training During a Pediatric Cardiac Fitness and Rehabilitation Program Benefits Youth with a Range of Congenital Heart Disease. Pediatr Cardiol 2024:10.1007/s00246-024-03560-3. [PMID: 38981972 DOI: 10.1007/s00246-024-03560-3] [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: 03/19/2024] [Accepted: 06/18/2024] [Indexed: 07/11/2024]
Abstract
Pediatric cardiac fitness and rehabilitation programs vary widely in structure and content. The Cardiac Fitness Program (CFP) is built on traditional training pillars of aerobic, strength, and flexibility, and adds a fourth, training a positive mindset. This study assesses whether the systematic and comprehensive framework of the CFP results in broad benefits for a range of patients with congenital heart disease (CHD). Data from participants between 01/2017 and 12/2022 were analyzed. Pre- and post-CFP cardiopulmonary exercise test parameters, strength and flexibility metrics, and mindset survey results were compared overall, and by sex, age, diagnosis, and hemodynamic level. Of 62 participants (median age 15.5 years, range 8 to 23, 50% female), 3% had simple, 37% complex, 24% single ventricle CHD, and 35% arrhythmia, cardiomyopathy, or transplant. Significant improvements were noted in aerobic fitness (mean 9 ± 15% increase in % predicted peak oxygen consumption, p < 0.001). Strength metrics significantly improved (each p < 0.001), as did flexibility (p < 0.001). Patient-reported positive mindset scores did not improve significantly (mean increase 1.8 ± 5.1, p = 0.10, n = 25), whereas parents reported significant improvements (5.9 ± 10.4, p = 0.02, n = 20). Improvements were not significantly different by sex, age, diagnosis, or hemodynamic level. Comprehensive training across four pillars of fitness yields significant improvements in aerobic fitness, strength, flexibility, and parent-reported mindset scores for pediatric CHD patients, regardless of patient characteristics, diagnosis type, or severity of hemodynamic limitation. Further study is warranted into optimal standardization of training and whether a comprehensive approach amplifies individual pillars to create more than the sum of its parts.
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Affiliation(s)
- Katherine Hansen
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA.
| | - Tracy Curran
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Lindsey Reynolds
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Keri Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | | | - Naomi Gauthier
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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2
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Spence C, Khoo N, Mackie A, Conway J, Rowland S, Foshaug R, Boulanger P, Spence JC, Stickland MK, Khoury M. Exploring the Promise of Telemedicine Exercise Interventions in Children and Adolescents With Congenital Heart Disease. Can J Cardiol 2023; 39:S346-S358. [PMID: 37657493 DOI: 10.1016/j.cjca.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023] Open
Abstract
Youth with congenital heart disease (CHD) have reduced exercise capacity via various physical and psychosocial mechanisms. In addition to limited physiologic exercise capacity, these patients experience lower levels of physical activity, physical activity self-efficacy, health-related quality of life, and endothelial function. The study of exercise interventions and cardiac rehabilitation programs in pediatric CHD populations remains limited, particularly home-based interventions that incorporate real-time physiologic monitoring. Home-based interventions provide improved access and convenience to patients. This is principally important for patients from geographically disperse regions who receive their care at centralized subspecialty centres, as is the case for Canadian pediatric cardiac care. These programs, however, have traditionally not permitted the supervision of safety, technique, and adherence that are afforded by hospital/facility-based programs. As such, telemedicine is an important evolving area that combines the benefits of traditional home and facility-based cardiac rehabilitation. An additional key area lacking study surrounds the types of exercise interventions in youth with CHD. To date, interventions have often centred around moderate-intensity continuous exercise. High-intensity interval training might offer superior cardiorespiratory advantages but remains understudied in the CHD population. In this review, we highlight the existing evidence basis for exercise interventions in youth with CHD, explore the promise of incorporating telemedicine home-based solutions, and highlight key knowledge gaps. To address identified knowledge gaps, we are undertaking a 12-week randomized crossover trial of a home-based telemedicine high-intensity interval training intervention in youth with repaired moderate-severe CHD using a video game-linked cycle ergometer (known as the MedBIKE; https://spaces.facsci.ualberta.ca/ahci/projects/medical-projects/remote-rehab-bike-projects).
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Affiliation(s)
- Christopher Spence
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nee Khoo
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Mackie
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samira Rowland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rae Foshaug
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Boulanger
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - John C Spence
- Sedentary Living Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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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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Fox KR, Neville SP, Grant VR, Vannatta K, Jackson JL. Ambivalence is associated with decreased physical activity and cardiorespiratory fitness among adolescents with critical congenital heart disease. Heart Lung 2023; 58:198-203. [PMID: 36587561 PMCID: PMC9992114 DOI: 10.1016/j.hrtlng.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescents with congenital heart disease (CHD) are insufficiently physically active. Given that increasing physical activity may reduce their cardiovascular risk, it is important to identify correlates of this behavior. Perceived benefits of and barriers to physical activity are associated with physical activity engagement. Existing research has only considered these constructs separately. This population may be ambivalent toward physical activity (i.e., perceive both strong benefits and barriers). The association of ambivalence and physical activity related outcomes is unknown among this at-risk population. OBJECTIVE Determine the association of ambivalence and sedentary behavior, moderate-to-vigorous physical activity (MVPA), and cardiorespiratory fitness (VO2Peak) among adolescents with CHD. METHODS The present study is an analysis of data from an eligibility assessment for a randomized clinical trial of an intervention to promote MVPA among adolescents aged 15 to 18 years with moderate or complex CHD. Participants (N = 84) completed a survey assessing perceived benefits and barriers from which ambivalence toward physical activity was calculated, an exercise stress test to measure VO2Peak, and wore an accelerometer for one week to determine their engagement in sedentary behavior and MVPA. Linear regression analyses determined associations between ambivalence and physical activity related outcomes. RESULTS: Greater ambivalence toward physical activity was associated with increased sedentary behavior, decreased MVPA, and reduced VO2Peak, adjusting for demographic and clinical covariates. CONCLUSIONS Ambivalence is associated with objectively measured physical activity (sedentary behavior, MVPA) and a biomarker of cardiovascular health (VO2Peak). Screening for ambivalence may help clinicians identify those most likely to benefit from physical activity-related education.
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Affiliation(s)
- Kristen R Fox
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205.
| | - Steven P Neville
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205
| | - Victoria R Grant
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH, USA 43210
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Near East Office Building, 3rd Floor, 431 S. 18th St., Columbus, OH, USA 43205; Department of Pediatrics, The Ohio State University, 370 W. 9th Ave., Columbus, OH, USA 43210
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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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Souilla L, Avesani M, Boisson A, Requirand A, Matecki S, Vincenti M, Werner O, De La Villeon G, Pommier V, Pasquie JL, Guillaumont S, Amedro P. Cardiorespiratory fitness, muscle fitness, and physical activity in children with long QT syndrome: A prospective controlled study. Front Cardiovasc Med 2023; 9:1081106. [PMID: 36712265 PMCID: PMC9874118 DOI: 10.3389/fcvm.2022.1081106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background In children with congenital long QT syndrome (LQTS), the risk of arrhythmic events during exercise commonly makes it difficult to balance exercise restrictions versus promotion of physical activity. Nevertheless, in children with LQTS, cardiorespiratory fitness, muscle fitness, and physical activity, have been scarcely explored. Materials and methods In this prospective, controlled, cross-sectional study, 20 children with LQTS (12.7 ± 3.7 years old) and 20 healthy controls (11.9 ± 2.4 years old) were enrolled. All participants underwent a cardiopulmonary exercise test, a muscular architecture ultrasound assessment, (cross-sectional area on right rectus femoris and pennation angle), a handgrip muscular strength evaluation, and a standing long broad jump test. The level of physical activity was determined using with a waist-worn tri-axial accelerometer (Actigraph GT3X). Results Peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT) were lower in children with LQTS than in healthy controls (33.9 ± 6.2 mL/Kg/min vs. 40.1 ± 6.6 mL/Kg/min, P = 0.010; 23.8 ± 5.1 mL/Kg/min vs. 28.8 ± 5.5 mL/Kg/min, P = 0.007, respectively). Children with LQTS had lower standing long broad jump distance (119.5 ± 33.2 cm vs. 147.3 ± 36.1 cm, P = 0.02) and pennation angle (12.2 ± 2.4° vs. 14.3 ± 2.8°, P = 0.02). No differences in terms of moderate-to-vigorous physical activity were observed (36.9 ± 12.9 min/day vs. 41.5 ± 18.7 min/day, P = 0.66), but nearly all children were below the WHO guidelines. Conclusion Despite similar physical activity level, cardiorespiratory fitness and muscle fitness in children with LQTS were lower than in healthy controls. The origin of this limitation seemed to be multifactorial, involving beta-blocker induced chronotropic limitation, physical and muscle deconditioning. Cardiovascular rehabilitation could be of interest in children with LQTS with significant physical limitation.
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Affiliation(s)
- Luc Souilla
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Martina Avesani
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Pessac, France
| | - Aymeric Boisson
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
| | - Anne Requirand
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Stefan Matecki
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
- Department of Physiology, University Hospital of Montpellier, Montpellier, France
| | - Marie Vincenti
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Oscar Werner
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Victor Pommier
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Jean-Luc Pasquie
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- PhyMedExp, Univ Montpellier, INSERM, French National Centre for Scientific Research (CNRS), Montpellier, France
| | - Sophie Guillaumont
- Department of Paediatric and Congenital Cardiology, M3C Regional Reference Centre, University Hospital, Montpellier, France
- Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Pessac, France
- Inserm, U1045, Institut Hospitalo-Universitaire (IHU) Liryc, Bordeaux Cardio-Thoracic Research Centre, Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France
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Prescription medication use after congenital heart surgery. Cardiol Young 2022; 32:1786-1793. [PMID: 34986916 DOI: 10.1017/s1047951121005060] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. METHODS Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. RESULTS Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7-2.1; severe hazard ratio 6.5, 95% confidence interval 5.3-8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8-3.7; severe hazard ratio 38.8, 95% CI 27.5-54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. CONCLUSIONS The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.
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Colombo JN, Sawda CN, White SC. Cardiac Concerns in the Pediatric Athlete. Clin Sports Med 2022; 41:529-548. [PMID: 35710276 DOI: 10.1016/j.csm.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease remains the number one cause of death in Americans. It is no secret that exercise mitigates this risk. Exercise and regular physical activity are beneficial for physical health including aerobic conditioning, endurance, strength, mental health, and overall improved quality of life. Unfortunately, today many children and adolescents are sedentary, lacking the recommended daily amount of physical activity, leading to higher rates of obesity, cardiovascular disease, stroke, diabetes, anxiety, and depression. Given this rising concern, the World Health Organization launched a 12-year plan to improve physical activity in children and adolescents by reducing the inactivity rate by 15% in the world. How does this apply to children and adolescents with acquired or congenital heart disease?.
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Affiliation(s)
- Jamie N Colombo
- Department of Pediatrics, Division of Cardiology, Washington University School of Medicine/St. Louis Children's Hospital, 1 Childrens Place, St. Louis, MO 63110, USA
| | - Christine N Sawda
- Department of Pediatrics, Division of Cardiology, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Shelby C White
- Department of Pediatrics, Division of Cardiology, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA.
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9
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Boisson A, De La Villeon G, Huguet H, Abassi H, Pasquie JL, Lavastre K, Matecki S, Guillaumont S, Requirand A, Calderon J, Amedro P. Physical activity and aerobic fitness in children with inherited cardiac diseases. Arch Cardiovasc Dis 2021; 114:727-736. [PMID: 34756533 DOI: 10.1016/j.acvd.2021.07.004] [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: 03/04/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Because of sports and exercise restrictions, children with inherited cardiac disease are at risk of physical deconditioning. Guidelines on sports participation in cardiovascular disease have become less restrictive over time, but their real-life application and behavioural impact have seldom been evaluated in children. AIMS We aimed to evaluate adherence to the 2020 European Society of Cardiology guidelines on sports and exercise in children with inherited cardiac arrhythmia and inherited cardiomyopathy; we also sought to evaluate their aerobic fitness, and the behavioural impact of inherited cardiac diseases on physical activity in children. METHODS Children aged 6-18 years with inherited cardiomyopathy or inherited cardiac arrhythmia were eligible for this cross-sectional study. Clinical, demographic and qualitative data were analysed. RESULTS A total of 32 children were included in the study (mean age 12.7±3.5 years). Most children (81.3%) complied with the 2020 European Society of Cardiology guidelines; they were physically active and had good overall aerobic fitness, with a mean peak oxygen uptake (VO2) value of 36.5±8.0mL/kg/min (84.0±17.2% of theoretical value). As a result of personal or parental behaviour, some children at risk of sudden cardiac death did not comply with the recommended upper limit of physical activity intensity, whereas others at low risk did not comply with the lower limit. CONCLUSION Most children with inherited cardiac arrhythmia or inherited cardiomyopathy complied with current 2020 European Society of Cardiology guidelines on sports cardiology and exercise in cardiovascular disease.
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Affiliation(s)
- Aymeric Boisson
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, 34250 Palavas-Les-Flots, France
| | - Helena Huguet
- Clinical Research and Epidemiology Unit, CHU de Montpellier, University of Montpellier, 34295 Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Inserm, PhyMedExp, CNRS, University of Montpellier, 34295 Montpellier, France
| | - Jean-Luc Pasquie
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Inserm, PhyMedExp, CNRS, University of Montpellier, 34295 Montpellier, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France
| | - Stefan Matecki
- Inserm, PhyMedExp, CNRS, University of Montpellier, 34295 Montpellier, France; Department of Physiology, CHU de Montpellier, 34295 Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, 34250 Palavas-Les-Flots, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France
| | - Johanna Calderon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Inserm, PhyMedExp, CNRS, University of Montpellier, 34295 Montpellier, France
| | - Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, 33604 Pessac, France; Inserm, U1045, IHU Liryc, Bordeaux Cardio-Thoracic Research Centre, Electrophysiology and Heart Modelling Institute, University of Bordeaux, Fondation Bordeaux Université, 33604 Pessac, France.
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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: 4] [Impact Index Per Article: 1.3] [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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Fernández-Portero C, Alarcón D, Gallardo-Flores A, Amián JG, Sánchez-Medina JA. Effectiveness of a Mindfulness-Based Intervention Program for Women Family Caregivers of Older Adults. Healthcare (Basel) 2021; 9:healthcare9091216. [PMID: 34574990 PMCID: PMC8465928 DOI: 10.3390/healthcare9091216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The objective of this study was to analyze the effectiveness of a mindfulness-based intervention program for the promotion of well-being and health in family caregivers. METHODS The participants were 111 family women caregivers aged between 33 and 75 years old. This was a double-blinded randomized controlled trial. The mindfulness intervention program lasted 12 weeks. The experimental group underwent mindfulness and acceptance-based interventions (MABIs). The control group performed physical activity training. RESULTS A cross-lagged panel analysis was computed with the two waves of health, well-being, burden and resilience and age in years and intervention as predictors. The cross-lagged path model fit well χ2 (8) = 7.179, p = 0.51, root mean square error of approximation (RMSEA) = 0.00, comparative fit index (CFI) = 1.00, standardized root mean square residual (SRMR) = 0.05. The mindfulness intervention program was a significant predictor accounting for decreasing health problems (β = -0.292, p < 0.01) and burden (β = -0.190, p < 0.01) and increasing well-being (β = 0.107, p < 0.05) at post-test. CONCLUSIONS Mindfulness-based intervention programs are effective in coping with the burden of family caregivers and, in turn, in promoting resilience, well-being and health among caregivers. Our findings encourage clinical uses of mindfulness interventions to promote health.
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Affiliation(s)
- Cristina Fernández-Portero
- Deparment of Social Antropology, Psychology and Public Health, Pablo de Olavide University, 41013 Sevilla, Spain; (C.F.-P.); (J.G.A.); (J.A.S.-M.)
| | - David Alarcón
- Deparment of Social Antropology, Psychology and Public Health, Pablo de Olavide University, 41013 Sevilla, Spain; (C.F.-P.); (J.G.A.); (J.A.S.-M.)
- Correspondence: ; Tel.: +34-95-4977-406
| | - Ana Gallardo-Flores
- Deparment of Social Work and Social Services, Pablo de Olavide University, 41013 Sevilla, Spain;
| | - Josue G. Amián
- Deparment of Social Antropology, Psychology and Public Health, Pablo de Olavide University, 41013 Sevilla, Spain; (C.F.-P.); (J.G.A.); (J.A.S.-M.)
| | - Jose A. Sánchez-Medina
- Deparment of Social Antropology, Psychology and Public Health, Pablo de Olavide University, 41013 Sevilla, Spain; (C.F.-P.); (J.G.A.); (J.A.S.-M.)
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12
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Amedro P, Werner O, Abassi H, Boisson A, Souilla L, Guillaumont S, Calderon J, Requirand A, Vincenti M, Pommier V, Matecki S, De La Villeon G, Lavastre K, Lacampagne A, Picot MC, Beyler C, Delclaux C, Dulac Y, Guitarte A, Charron P, Denjoy-Urbain I, Probst V, Baruteau AE, Chevalier P, Di Filippo S, Thambo JB, Bonnet D, Pasquie JL. Health-related quality of life and physical activity in children with inherited cardiac arrhythmia or inherited cardiomyopathy: the prospective multicentre controlled QUALIMYORYTHM study rationale, design and methods. Health Qual Life Outcomes 2021; 19:187. [PMID: 34321045 PMCID: PMC8317438 DOI: 10.1186/s12955-021-01825-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023] Open
Abstract
Background Advances in paediatric cardiology have improved the prognosis of children with inherited cardiac disorders. However, health-related quality of life (QoL) and physical activity have been scarcely analysed in children with inherited cardiac arrhythmia or inherited cardiomyopathy. Moreover, current guidelines on the eligibility of young athletes with inherited cardiac disorders for sports participation mainly rely on expert opinions and remain controversial. Methods The QUALIMYORYTHM trial is a multicentre observational controlled study. The main objective is to compare the QoL of children aged 6 to 17 years old with inherited cardiac arrhythmia (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, or arrhythmogenic right ventricular dysplasia), or inherited cardiomyopathy (hypertrophic, dilated, or restrictive cardiomyopathy), to that of age and gender-matched healthy subjects. The secondary objective is to assess their QoL according to the disease’s clinical and genetic characteristics, the level of physical activity and motivation for sports, the exercise capacity, and the socio-demographic data. Participants will wear a fitness tracker (ActiGraph GT3X accelerometer) for 2 weeks. A total of 214 children are required to observe a significant difference of 7 ± 15 points in the PedsQL, with a power of 90% and an alpha risk of 5%. Discussion After focusing on the survival in children with inherited cardiac disorders, current research is expanding to patient-reported outcomes and secondary prevention. The QUALIMYORYTHM trial intends to improve the level of evidence for future guidelines on sports eligibility in this population. Trial registration ClinicalTrials.gov Identifier: NCT04712136, registered on January 15th, 2021 (https://clinicaltrials.gov/ct2/show/NCT04712136).
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Affiliation(s)
- Pascal Amedro
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France. .,INSERM, Bordeaux Cardio-Thoracic Research Centre, U1045, University of Bordeaux, Pessac, France. .,IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France.
| | - Oscar Werner
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Aymeric Boisson
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Luc Souilla
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, Institut-Saint-Pierre, Palavas-Les-Flots, France
| | - Johanna Calderon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Anne Requirand
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Marie Vincenti
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Victor Pommier
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, Institut-Saint-Pierre, Palavas-Les-Flots, France
| | - Stefan Matecki
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, Institut-Saint-Pierre, Palavas-Les-Flots, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Alain Lacampagne
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
| | - Constance Beyler
- Paediatric Cardiology and Physiology Department, Robert Debré University Hospital, University of Paris, AP-HP, Paris, France
| | - Christophe Delclaux
- Paediatric Cardiology and Physiology Department, Robert Debré University Hospital, University of Paris, AP-HP, Paris, France
| | - Yves Dulac
- Paediatric Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse, France
| | - Aitor Guitarte
- Paediatric Cardiology Department, M3C Regional Reference Centre, Toulouse University Hospital, Toulouse, France
| | - Philippe Charron
- Department of Cardiology, National Reference Centre for Inherited Cardiomyopathy, University of Paris, AP-HP, Paris, France
| | - Isabelle Denjoy-Urbain
- Department of Cardiology, National Reference Centre for Inherited Cardiomyopathy, University of Paris, AP-HP, Paris, France
| | - Vincent Probst
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Alban-Elouen Baruteau
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, L'Institut du Thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Philippe Chevalier
- Department of Congenital Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, University of Lyon, Lyon University Hospital, Lyon, France
| | - Sylvie Di Filippo
- Department of Congenital Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, University of Lyon, Lyon University Hospital, Lyon, France
| | - Jean-Benoit Thambo
- Department of Paediatric and Adult Congenital Cardiology, M3C National Reference Centre, Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France.,INSERM, Bordeaux Cardio-Thoracic Research Centre, U1045, University of Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, Pessac, France
| | - Damien Bonnet
- Paediatric Cardiology Department, Necker-Enfants malades, M3C National Reference Centre, University of Paris, AP-HP, Paris, France
| | - Jean-Luc Pasquie
- Cardiology Department of Cardiology, Regional Reference Centre for Inherited Cardiac Arrhythmia, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
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Longmuir PE, Corey M, McCrindle BW. Interactions with Home and Health Environments Discourage Physical Activity: Reports from Children with Complex Congenital Heart Disease and Their Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4903. [PMID: 34064527 PMCID: PMC8124231 DOI: 10.3390/ijerph18094903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
Children with complex congenital heart disease are less active than recommended for optimal health, with social and physical environments important determinants. The purpose of this study was to examine the physical activity perceptions of children with complex congenital heart disease and their parents to identify social and physical environment intervention targets. A semi-structured discussion guide elicited physical activity perceptions from children (26 boys, 19 girls, 6.0-12.4 years) with complex congenital heart disease (single ventricle n = 42) and their parents during three child and three parent focus groups and 41 interviews. Interviews and focus groups were audio-recorded and transcribed verbatim for inductive thematic analysis. Children and parents identified home, peer and health environments as impacting on their children's physical activity participation. Peer environments, such as school or daycare, were supportive by providing physical activity facilities and enabling fun with peers and time outdoors. At home, parent and sibling interactions both encouraged and discouraged physical activity. The children's unique health environment fostered physical activity uncertainty, discouraging activity despite minimal or no physician recommendations to restrict physical activity. Children with complex congenital heart disease and their parents recognize the importance of physical activity and fun with friends. Physical activity uncertainty contributes to their inactive lifestyles despite minimal restrictions from health professionals. Positive clinical encouragement and health environment interventions that better support physical activity are required.
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Affiliation(s)
- Patricia E. Longmuir
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Mary Corey
- Child Health Evaluative Sciences, The Hospital for Sick Children and Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5G 1X8, Canada;
| | - Brian W. McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1X8, Canada
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14
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Perceptions of Healthy Lifestyles Among Children With Complex Heart Disease and Their Caregivers. CJC Open 2021; 3:854-863. [PMID: 34401692 PMCID: PMC8347848 DOI: 10.1016/j.cjco.2021.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Children with complex heart problems may be at higher risk for sedentary lifestyle morbidities than their healthy peers. This project examined perceptions, barriers, and supports that influence healthy active lifestyles among children with complex heart problems and their caregivers, to enable effective health and quality-of-life interventions. Methods Inductive thematic analysis was conducted of semi-structured guided discussions from 6 focus groups (young child [n = 2]; older child [n = 4]; parents of young child [n = 4]; parents of older child [n = 4]; pediatric cardiologist [n = 5]; pediatric cardiac nurse [n = 5]) and individual interviews with 7 parents, 5 parent/child dyads, 2 adults with complex heart problems, 6 pediatric cardiologists, 3 pediatric cardiac nurses, 4 pediatric cardiology mental health professionals, and 14 recreation professionals. Results Four interrelated themes were identified: (i) "It takes a village"—coordinated and collaborative interdisciplinary support; (ii) clear healthy lifestyle communication among children, families, and professionals is critically important; (iii) Ccreating supportive environments by building professional expertise; (iv) inspiring healthy lifestyles in the children’s own environments. All groups identified a need to improve knowledge about childhood heart conditions among education and recreation professionals and to encourage effective communication between healthcare professionals and families. Participants indicated that these changes would support families, educators, and recreation professionals in engaging children with heart problems in healthy lifestyles in home, school, and community settings. Conclusions Important healthy lifestyle barriers were identified within individuals and in their interactions. There is a profound need to enhance knowledge of childhood heart conditions and improve interactions among key stakeholders—children and families, educators, and recreation and healthcare professionals.
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Health-related quality of life correlates with time in therapeutic range in children on anticoagulants with International Normalised Ratio self-monitoring. Arch Cardiovasc Dis 2020; 113:811-820. [PMID: 33069639 DOI: 10.1016/j.acvd.2020.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Managing oral anticoagulant therapy with vitamin K antagonists remains challenging in paediatric medicine. AIMS This study aimed to assess the correlation between time in therapeutic range and quality of life in children participating in a non-selective International Normalised Ratio self-monitoring and vitamin K antagonist education programme. METHODS Children aged from 2 to 18 years and receiving vitamin K antagonist therapy were eligible for this prospective multicentre study. Clinical and demographic data were collected. Health-related quality of life was assessed using the PedsQL™ 4.0 questionnaire. Correlations between quality of life scores and time in therapeutic range were measured. RESULTS A total of 121 children were included in the study (mean age 9.6±4.9 years). Cardiac conditions were the predominant indication for vitamin K antagonists. The mean time in therapeutic range was 0.78±0.15 overall, and 0.76±0.24 over the 3-month period before quality of life assessment. The mean total quality of life score was 76.2±18 in self reports, 71.4±22 in mother reports and 73.5±19 in father reports. The time in therapeutic range correlated with the total quality of life scores in self reports (r=0.22; P=0.04), mother reports (r=0.23; P=0.02) and father reports (r=0.28; P=0.02). The time in therapeutic range predominantly correlated with school functioning in self reports (r=0.38; P=0.002) and mother reports (r=0.40; P<0.001), and with physical functioning in father reports (r=0.28; P=0.03). CONCLUSIONS Time in therapeutic range correlated with quality of life in children participating in a non-selective International Normalised Ratio self-monitoring and vitamin K antagonist education programme. Regular assessment of quality of life in patient education programmes contributes towards understanding the concerns and needs of patients.
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Cardiac rehabilitation in the paediatric Fontan population: development of a home-based high-intensity interval training programme. Cardiol Young 2020; 30:1409-1416. [PMID: 32716280 DOI: 10.1017/s1047951120002097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology. METHODS The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology. RESULTS There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total. CONCLUSION The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.
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Physical Activity Promotion in Pediatric Congenital Heart Disease: Are We Running Late? Can J Cardiol 2020; 36:1406-1416. [DOI: 10.1016/j.cjca.2020.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
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Marques A, Gouveia B. Physical Activity Knowledge and Levels among Children with Congenital Heart Disease. Arq Bras Cardiol 2020; 114:793-794. [PMID: 32491071 PMCID: PMC8386996 DOI: 10.36660/abc.20200286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa - Portugal.,ISAMB, Faculdade de Medicina, Universidade de Lisboa, Lisboa - Portugal
| | - Bruna Gouveia
- Instituto de Administração da Saúde, IP-RAM, Ilha da Madeira - Portugal.,Interactive Technologies Institute, LARSyS, Lisboa - Portugal
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Impact of Sophrology on cardiopulmonary fitness in teenagers and young adults with a congenital heart disease: The SOPHROCARE study rationale, design and methods. IJC HEART & VASCULATURE 2020; 27:100489. [PMID: 32154361 PMCID: PMC7057190 DOI: 10.1016/j.ijcha.2020.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/21/2022]
Abstract
Background Recent advances in the field of congenital heart disease (CHD) have significantly improved the overall prognosis. Now more attention is being given to health-related quality of life (HRQoL) and promotion of physical activity. Non-invasive relaxation therapy may be effective in cardiac patients concerned with exercise-induced dyspnoea. The SOPHROCARE randomised trial aims to assess the impact of Caycedian Sophrology on cardiopulmonary fitness in adolescents and young adults with CHD. Methods The SOPHROCARE trial is a nationwide, multicentre, randomised, controlled study in CHD patients aged from 13 to 25 years old. Patients will be randomised into 2 groups (8 Sophrology group sessions vs. no intervention). The primary outcome is the change in percent predicted maximum oxygen uptake (VO2max) between baseline and 12-month follow-up. A total of 94 patients in each group is required to observe a significant increase of 10% in VO2max with a power of 80% and an alpha risk of 5%. The secondary outcomes are: clinical outcomes, cardiopulmonary exercise test parameters (VE/VCO2 slope, ventilatory anaerobic threshold, oxygen pulse, respiratory response to hypercapnia), health-related quality of life score (PedsQL), physical and psychological status. Conclusion After focusing on the survival in CHD, current research is opening on secondary prevention and patient-related outcomes. We sought to assess in the SOPHROCARE trial, if a Sophrology program, could improve exercise capacity and quality of life in youth with CHD. Trial registration Clinicaltrials.gov (NCT03999320).
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Chen YJ, Wang JK, Liu CY, Yang CY, Chiang YT, Chen CW. Healthcare needs and Quality of Life in Youths with Congenital Heart Disease: Health-Promoting Behaviors as a Mediator. J Pediatr Nurs 2020; 50:e113-e118. [PMID: 30928310 DOI: 10.1016/j.pedn.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to examine the relationship between healthcare needs, health-promoting behaviors and quality of life (QoL) of youths with congenital heart disease (CHD), and to determine whether health-promoting behaviors were a mediating variable. DESIGN AND METHODS This cross-sectional descriptive study was conducted recruiting 205 youths aged 15 to 24 with either ventricular septal defect (VSD) or tetralogy of Fallot (TOF). A self-reported questionnaire was used to collect demographic information; furthermore, the thickness of the triceps skinfold was measured. The Healthcare Needs Scale for Youth with CHD, Adolescent Health Promotion-short form scale, and World Health Organization QoL-BREF scale were administered, and Pearson's correlation, multiple regressions, and the Sobel test were conducted. RESULTS The triceps skinfold of participants with VSD was significantly thicker than that of participants with TOF (p < 0.05). Healthcare needs, health-promoting behaviors, and QoL were positively correlated. The overall health-promoting behaviors served as a partial mediator between overall healthcare needs and QoL, accounting for 40.1% of the total variation. CONCLUSIONS The study illustrates that health-promoting behaviors have an impact on healthcare needs and QoL of youths with CHD. The development of tailored health consulting interventions to fulfill healthcare needs is required to improve physical and psychosocial wellness among youths with CHD. PRACTICE IMPLICATIONS Targeting individual and public health strategies for enhancing health-promoting behaviors should be integrated in CHD care planning.
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Affiliation(s)
- Yan-Ju Chen
- Department of Nursing, KK Women's and Children's Hospital, Singapore
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chiu-Yueh Yang
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | | | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
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Werner O, Abassi H, Lavastre K, Guillaumont S, Picot MC, Serrand C, Dulac Y, Souletie N, Acar P, Bredy C, Amedro P. Factors influencing the participation of adolescents and young adults with a congenital heart disease in a transition education program: A prospective multicentre controlled study. PATIENT EDUCATION AND COUNSELING 2019; 102:2223-2230. [PMID: 31262673 DOI: 10.1016/j.pec.2019.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/20/2019] [Accepted: 06/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Transition education programs dedicated to adolescents and young adults with congenital heart disease (CHD) aim to facilitate transfer to adult cardiology and bring more autonomy to teenagers. This prospective controlled multicentre study analysed the factors influencing the participation in a transition education program. METHODS CHD patients aged 13-25 y were offered to participate in the transition program. A multiple linear regression identified the explanatory factors for participation in the program. RESULTS A total of 123 patients (mean age 19.6 ± 3.4 y) were included in the study, with 57 participants and 66 non-participants. Both groups showed similar socio-demographic and quality of life characteristics, low level of physical activity with muscular deconditioning and high exposure to risk behaviours (71% patients with ≥1 risk factor). Patients with complex CHD (OR = 4.1, P = 0.03), poor disease knowledge (OR = 0.3, P = 0.02), risk behaviours (body piercing, OR = 5.53, P = 0.01; alcohol, OR = 3.12, P = 0.06), and aged <20 y (OR = 0.29, P = 0.03), were more likely to join the program. CONCLUSION Many risk factors influencing the participation of adolescents and young adults with CHD in transition education programs are controllable. PRACTICE IMPLICATION Further randomized studies are necessary to evaluate the impact of transition education program on quality of life, successful transfer to adult centre and, ultimately, prognosis.
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Affiliation(s)
- Oscar Werner
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; Centre for Studies and Research on Health Services and Quality of Life, EA3279, Public Health Department, Aix-Marseille University, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France; Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, France
| | - Chris Serrand
- Epidemiology and Clinical Research Department, University Hospital, Montpellier, France
| | - Yves Dulac
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Nathalie Souletie
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Philippe Acar
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Toulouse University Hospital, Toulouse, France
| | - Charlene Bredy
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France; Centre for Studies and Research on Health Services and Quality of Life, EA3279, Public Health Department, Aix-Marseille University, France; PhyMedExp, University of Montpellier, INSERM, CNRS, France.
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22
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Andonian C, Langer F, Beckmann J, Bischoff G, Ewert P, Freilinger S, Kaemmerer H, Oberhoffer R, Pieper L, Neidenbach RC. Overweight and obesity: an emerging problem in patients with congenital heart disease. Cardiovasc Diagn Ther 2019; 9:S360-S368. [PMID: 31737542 PMCID: PMC6837933 DOI: 10.21037/cdt.2019.02.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
Due to technological and medical advances the population of adults with congenital heart disease (ACHD) is constantly growing. Worldwide, congenital heart disease (CHD) affects 1.35-1.5 million children each year and the number of ACHD meanwhile exceeds the number of CHD children. It has been found that a substantial number of ACHD present problematic health behaviors, such as physical inactivity and bad nutritional habits. Recent studies document alarming rates of overweight and obesity among CHD patients which may consequently lead to further health complications in this population. The present article focuses on the distinct psychosocial effects resulting from the diagnosis of CHD and their impact on developing disordered eating patterns and excess weight. It seeks to identify unique risk factors and relevant explanations associated with the increasing prevalence of obesity among CHD patients. This review suggests a vital need to establish clinical guidelines for nutrition and weight management in this patient population as part of a holistic treatment approach.
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Affiliation(s)
- Caroline Andonian
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Technical University Munich, Munich, Germany
- Sigmund Freud University, Vienna, Austria
| | - Fabian Langer
- Department of Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder, Munich, Germany
| | - Jürgen Beckmann
- Technical University Munich, Munich, Germany
- University of Queensland, Brisbane, Australia
| | - Gert Bischoff
- Department of Clinical Nutrition and Preventive Medicine, Hospital Barmherzige Brüder, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Sebastian Freilinger
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Rhoia Clara Neidenbach
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
- Technical University Munich, Munich, Germany
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23
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Shustak RJ, Cohen MS. What influences outcomes in pediatric and congenital cardiovascular disease?: A healthy lifestyle; obesity and overweight. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Kim HJ, Jae SY, Choo J, Yoon JK, Kim S, Königstein K, Schmidt‐Trucksäss A, Franklin BA. Mediating effects of exercise capacity on the association between physical activity and health‐related quality of life among adolescents with complex congenital heart disease. Am J Hum Biol 2019; 31:e23297. [DOI: 10.1002/ajhb.23297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 05/08/2019] [Accepted: 06/28/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hyun Jeong Kim
- Department of Sport ScienceUniversity of Seoul Seoul South Korea
- Department of PediatricsSejong General Hospital Bucheon South Korea
| | - Sae Young Jae
- Department of Sport ScienceUniversity of Seoul Seoul South Korea
| | - Jina Choo
- College of NursingKorea University Seoul South Korea
| | - Ja Kyoung Yoon
- Department of PediatricsSejong General Hospital Bucheon South Korea
| | - Seong‐Ho Kim
- Department of PediatricsSejong General Hospital Bucheon South Korea
| | - Karsten Königstein
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and HealthUniversity of Basel Basel Switzerland
| | - Arno Schmidt‐Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and HealthUniversity of Basel Basel Switzerland
| | - Barry A. Franklin
- Preventive Cardiology and Cardiac RehabilitationWilliam Beaumont Hospital Royal Oak Michigan
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25
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Amedro P, Gavotto A, Legendre A, Lavastre K, Bredy C, De La Villeon G, Matecki S, Vandenberghe D, Ladeveze M, Bajolle F, Bosser G, Bouvaist H, Brosset P, Cohen L, Cohen S, Corone S, Dauphin C, Dulac Y, Hascoet S, Iriart X, Ladouceur M, Mace L, Neagu OA, Ovaert C, Picot MC, Poirette L, Sidney F, Soullier C, Thambo JB, Combes N, Bonnet D, Guillaumont S. Impact of a centre and home-based cardiac rehabilitation program on the quality of life of teenagers and young adults with congenital heart disease: The QUALI-REHAB study rationale, design and methods. Int J Cardiol 2019; 283:112-118. [DOI: 10.1016/j.ijcard.2018.12.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
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26
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Fuertes Moure A, Meyer M, Häcker AL, Reiner B, Brudy L, Oberhoffer R, Ewert P, Müller J. Health-Related Physical Fitness and Quality of Life in Children and Adolescents With Isolated Left-to-Right Shunt. Front Pediatr 2019; 7:488. [PMID: 31824901 PMCID: PMC6882769 DOI: 10.3389/fped.2019.00488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/06/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: Atrial (ASD) and ventricular septal defects (VSD) represent the most common congenital heart defects (CHD) and are considered simple and curable. This study investigates long-term functional outcomes in children with such defects. Patients and Methods : We examined 147 patients (74 girls, 12.1 ± 3.5 years) with isolated shunts (ASD: 54%, VSD: 46%) for their Health-Related Physical Fitness (HRPF) and Health-Related Quality of Life (HRQoL). Native condition was present in 58 patients, interventional closure of the defect was performed in 42 and surgical closure in 47. For comparison, a healthy control group (CG) of 1,724 children (48.9% girls, 12.8 ± 2.8 years) was recruited within two recent school projects. Results: After adjustment for age and sex, children with ASD and VSD presented lower HRPF (z-score healthy peers: 0.02 ± 0.73, ASD: -0.41 ± 0.73, p < 0.001; VSD: -0.61 ± 0.73, p < 0.001) then healthy peers. Transferred into percentiles, VSD were on the 26th and ASD on the 34th percentile of the healthy peers. HRQoL did not differ between peers and CHD with isolated shunts (healthy peers: 76.1 ± 9.7, ASD: 76.2 ± 9.9, p = 0.999; VSD: 78.7 ± 9.7, p = 0.316). Regarding the surgical history of the shunts (native, percutaneously treated, surgically treated), there were also no difference in-between these three states, nor differed HRPF and HRQoL in-between gender. Conclusions: Children with ASD or VSD have impaired HRPF but normal HRQoL. Early childhood sports promotion could be a good measure to counteract these restrictions in HRPF at an early stage.
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Affiliation(s)
| | - Michael Meyer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Anna-Luisa Häcker
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Barbara Reiner
- Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Leon Brudy
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Jan Müller
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Technical University Munich, Munich, Germany.,Institute of Preventive Pediatrics, Technical University Munich, Munich, Germany
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27
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Longmuir PE, Jackson J, Ertel E, Bhatt M, Doja A, Duffy C, Gardin L, Jurencak R, Katz SL, Lai L, Lamontagne C, Lee S, Lougheed J, McCormick A, McMillan H, Pohl D, Roth J, Theoret-Douglas C, Watanabe Duffy K, Wong D, Zemek R. Sensitivity, specificity, and reliability of the Get Active Questionnaire for identifying children with medically necessary special considerations for physical activity. Appl Physiol Nutr Metab 2018; 44:736-743. [PMID: 30500268 DOI: 10.1139/apnm-2018-0314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Physical activity is promoted for optimal health but may carry risks for children who require medically necessary activity restrictions. The sensitivity, specificity, and reliability of the Get Active Questionnaire (GAQ) for identifying children needing special considerations during physical activity was evaluated among parents of 207 children aged 3 to 14 years (97 (47%) female, mean age of 8.4 ± 3.7 years). GAQ responses were compared with reports obtained directly from the treating physician (n = 192/207) and information in the medical chart (clinic notes/physician letter, n = 111/207). Parent GAQ responses (either "No to all questions" or "Yes to 1 or more questions") agreed with physician (κ = 0.16, p = 0.003) and medical record (κ = 0.15, p = 0.003) reports regarding the need for special consideration during physical activity (Yes/No). Sensitivity was 71% (20/28) and specificity was 59% (96/164), with few false-negative responses. The GAQ was most effective for rheumatology and cardiology patients. False positives were 29% to 46%, except among chronic pain (80%) and rehabilitation (75%) patients. Test-retest reliability was moderate (Cronbach's α = 0.70) among 57 parents who repeated the GAQ 1 week later. The GAQ effectively identified children not requiring physical activity restrictions and those with medical conditions similar to those of concern among adults. Additional questions from a qualified exercise professional, as recommended for a "Yes" response on the GAQ, should reduce the false-positive burden. Indicating the timeframe of reference for each question and including an option to describe other special considerations (e.g., medication, supervision) are recommended.
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Affiliation(s)
- Patricia E Longmuir
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Julia Jackson
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Emily Ertel
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Maala Bhatt
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Asif Doja
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Ciarán Duffy
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Letizia Gardin
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Roman Jurencak
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Sherri Lynne Katz
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Lillian Lai
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Christine Lamontagne
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Suzie Lee
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Jane Lougheed
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Anna McCormick
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Hugh McMillan
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Daniela Pohl
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Johannes Roth
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Carol Theoret-Douglas
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Karen Watanabe Duffy
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Derek Wong
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Roger Zemek
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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Amedro P, Guillaumont S, Bredy C, Matecki S, Gavotto A. Atrial septal defect and exercise capacity: value of cardio-pulmonary exercise test in assessment and follow-up. J Thorac Dis 2018; 10:S2864-S2873. [PMID: 30305946 DOI: 10.21037/jtd.2017.11.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly four decades ago, the World Health Organization stated that functional capacity explorations best reflected the impact of a chronic disease on quality of life. Today, cardio-pulmonary exercise test (CPET) is recommended in the follow-up of patients with congenital heart diseases (CHDs). Indeed, the maximum oxygen uptake (VO2max) and the ventilatory efficiency (VE/VCO2 slope) correlate with both the prognosis and the quality of life in this population. Atrial septal defects (ASDs) represent the second most frequent CHD and are usually considered as simple CHDs. However, the exercise capacity of ASD patients may be impaired. Therefore, the CPET provides important information in assessment and follow-up of patients with ASDs, for both children and adults. Exercise capacity of patients with unrepaired ASDs depends on the importance of the shunt, the right ventricular (RV) function and volume overload, the level of pulmonary arterial pressure, and the occurrence of arrhythmias. For repaired ASDs, exercise capacity also depends on the delay before closure and the type of procedure (catheter or surgery). In most cases, the exercise capacity is nearly normal and CPET contributes to promote sports participation. In addition, a regular CPET follow-up is necessary to evaluate the occurrence, severity and physiological mechanisms of comorbidities, i.e., heart failure, pulmonary hypertension and arrhythmia. Furthermore, CPET follow-up in patients with ASDs may detect early onset of muscular deconditioning, for which cardiac rehabilitation may be considered.
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Affiliation(s)
- Pascal Amedro
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Charlene Bredy
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Stefan Matecki
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France.,Functional Exploration Laboratory, Physiology Department, University Hospital, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Adult Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
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29
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Amedro P, Gavotto A, Guillaumont S, Bertet H, Vincenti M, De La Villeon G, Bredy C, Acar P, Ovaert C, Picot MC, Matecki S. Cardiopulmonary fitness in children with congenital heart diseases versus healthy children. Heart 2017; 104:1026-1036. [DOI: 10.1136/heartjnl-2017-312339] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023] Open
Abstract
ObjectiveWe aimed to compare the cardiopulmonary fitness of children with congenital heart diseases (CHD) with that of age-adjusted and gender-adjusted controls. We also intended to identify clinical characteristics associated with maximum oxygen uptake (VO2max) in this population.Methods and resultsWe included in a cross-sectional multicentre study a total of 798 children (496 CHD and 302 controls) who underwent a complete cardiopulmonary exercise test (CPET). The association of clinical characteristics with VO2max was studied using a multivariate analysis. Mean VO2max in the CHD group and control represented 93%±20% and 107%±17% of predicted values, respectively. VO2max was significantly lower in the CHD group, overall (37.8±0.3vs 42.6±0.4 mL/kg/min, P<0.0001) and for each group (P<0.05). The mean VO2max decline per year was significantly higher in CHD than in the controls overall (−0.84±0.10 vs −0.19±0.14 mL/kg/min/year, P<0.01), for boys (−0.72±0.14vs 0.11±0.19 mL/kg/min/year, P<0.01) and for girls (−1.00±0.13 vs −0.55±0.21 mL/kg/min/year, P=0.05). VO2max was associated with body mass index, ventilatory anaerobic threshold, female gender, restrictive ventilatory disorder, right ventricle systolic hypertension, tricuspid regurgitation, the number of cardiac catheter or surgery procedures, and the presence of a genetic anomaly.ConclusionsAlthough the magnitude of the difference was not large, VO2max among children with CHD was significantly lower than in normal children. We suggest performing CPET in routine follow-up of these patients.Trial registration numberClinicalTrials.gov NCT01202916; Post-results.
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30
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Sigler BE. Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study. JMIR Mhealth Uhealth 2017; 5:e36. [PMID: 28325711 PMCID: PMC5380813 DOI: 10.2196/mhealth.5892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/07/2016] [Accepted: 01/30/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting. OBJECTIVE The aim of our study was to investigate care coordinators' perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI). METHODS Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement. RESULTS The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients' agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship. CONCLUSIONS Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations.
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Affiliation(s)
- Brittany Erika Sigler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States.,Wellpass (formerly Sense Health), New York, NY, United States
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The Influence of Exercise Training on Quality of Life and Psychosocial Functioning in Children with Congenital Heart Disease:A Review of Intervention Studies. Sports (Basel) 2017; 5:sports5010013. [PMID: 29910373 PMCID: PMC5969012 DOI: 10.3390/sports5010013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/08/2017] [Indexed: 11/22/2022] Open
Abstract
Children and adolescents operated upon for congenital heart disease may show reduced exercise capacity and physical activity, associated with lowered quality of life. This review presents intervention studies on the influence of an exercise program on quality of life and psychosocial functioning in children with severe congenital heart disease. Participation in an exercise program among young people with complex congenital heart disease seemed to have positive effects on quality of life and passive leisure time spent. However, more effects of the exercise programs may have been expected. For future research it is important to critically evaluate the content of the exercise programs.
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Jacobsen RM, Ginde S, Mussatto K, Neubauer J, Earing M, Danduran M. Can a Home-based Cardiac Physical Activity Program Improve the Physical Function Quality of Life in Children with Fontan Circulation? CONGENIT HEART DIS 2016; 11:175-82. [DOI: 10.1111/chd.12330] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Roni M. Jacobsen
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
| | - Salil Ginde
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - Kathleen Mussatto
- Division of Pediatric Cardiology, Department of Pediatrics; Children's Hospital of Wisconsin; Milwaukee Wis USA
| | - Jennifer Neubauer
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
| | - Michael Earing
- Division of Pediatric Cardiology; Department of Pediatrics, Medical College of Wisconsin; Milwaukee Wis USA
- Division of Cardiovascular Medicine, Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wis USA
| | - Michael Danduran
- Division of Pediatric Cardiology, Department of Pediatrics; Children's Hospital of Wisconsin; Milwaukee Wis USA
- Program in Exercise Science, College of Health Sciences, Marquette University; Milwaukee Wis USA
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Amedro P, Picot M, Moniotte S, Dorka R, Bertet H, Guillaumont S, Barrea C, Vincenti M, De La Villeon G, Bredy C, Soulatges C, Voisin M, Matecki S, Auquier P. Correlation between cardio-pulmonary exercise test variables and health-related quality of life among children with congenital heart diseases. Int J Cardiol 2016; 203:1052-60. [DOI: 10.1016/j.ijcard.2015.11.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 11/25/2022]
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Quality of Life of Children with Congenital Heart Diseases: A Multicenter Controlled Cross-Sectional Study. Pediatr Cardiol 2015; 36:1588-601. [PMID: 26024647 DOI: 10.1007/s00246-015-1201-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/06/2015] [Indexed: 12/17/2022]
Abstract
To assess the health-related quality of life (QoL) in children with congenital heart diseases (CHD) with a validated questionnaire in comparison with control children. We prospectively recruited 282 children with CHD aged from 8 to 18 years in two tertiary care centers (France and Belgium) and 180 same-age controls in randomly selected French schools. Children's QoL was self-reported with the KIDSCREEN-52 questionnaire and reported by parents with the KIDSCREEN-27. QoL scores of each dimension were compared between CHD and controls and between the classes of disease severity. Both centers were comparable for most demographic and clinical data. Age- and gender-adjusted self-reported QoL scores were lower in CHD children than in controls for physical well-being (mean ± SEM 45.97 ± 0.57 vs 50.16 ± 0.71, p < 0.0001), financial resources (45.72 ± 0.70 vs 48.85 ± 0.87, p = 0.01), peers/social support (48.01 ± 0.72 vs 51.02 ± 0.88, p = 0.01), and autonomy in the multivariate analysis (47.63 ± 0.69 vs 49.28 ± 0.85, p = 0.04). Parents-reported scores were lower in CHD children for physical (p < 0.0001), psychological well-being (p = 0.04), peers/social support (p < 0.0001), and school environment (p < 0.0001) dimensions. Similarly, the disease severity had an impact on physical well-being (p < 0.001), financial resources (p = 0.05), and peers/social support (p = 0.01) for self-reported dimensions, and on physical well-being (p < 0.001), psychological well-being (p < 0.01), peers/social support (p < 0.001), and school environment (p < 0.001) for parents-reported dimensions. However, in multivariate analysis on self-reported QoL, disease severity was significantly associated with the self-perception dimension only. Self-reported QoL of CHD children was similar to that of same-age healthy children in seven of 10 dimensions, but parents-reported QoL was impaired in four of five dimensions.
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Duppen N, Kapusta L, de Rijke YB, Snoeren M, Kuipers IM, Koopman LP, Blank AC, Blom NA, Dulfer K, Utens EMWJ, Hopman MTE, Helbing WA. The effect of exercise training on cardiac remodelling in children and young adults with corrected tetralogy of Fallot or Fontan circulation: a randomized controlled trial. Int J Cardiol 2014; 179:97-104. [PMID: 25464424 DOI: 10.1016/j.ijcard.2014.10.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/13/2014] [Accepted: 10/18/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Exercise can improve physical fitness in children and adults with congenital heart disease. We hypothesized that exercise training would not lead to adverse cardiac remodelling in this population. METHODS AND RESULTS This multi-centre randomized controlled trial included children and young adults (10 to 25 years) with either corrected tetralogy of Fallot or Fontan circulation. The exercise-group was enrolled in a 12 week standardized aerobic dynamic exercise training program. The control-group continued their life-style and received care as usual. Both groups underwent cardiopulmonary exercise testing, cardiac magnetic resonance imaging (MRI), echocardiography and neurohormonal assessment, within 2 weeks before and 2 weeks after the intervention period. Fifty-six patients were randomized to the exercise-group and 37 to the control-group. We assessed changes between the pre- and the post-intervention period for the exercise group compared to the changes in the control-group. Peak load increased significantly in the exercise-group compared to the control-group (exercise-group 6.9 ± 11.8 W; control-group 0.8 ± 13.9 W; p=0.047). There were no adverse events linked to the study. Ventricular systolic parameters, cardiac dimensions and neurohormonal markers during follow-up did not change in patients allocated to the exercise-group and control-group. Although there were some isolated minor changes in inflow parameters, there was no consistent pattern of changes, indicating a lack of true change in the diastolic function. CONCLUSION We demonstrated that no clinically relevant adverse cardiac remodelling occurred after 12 weeks of exercise training in patients with either corrected tetralogy of Fallot or Fontan circulation. CLINICAL TRIAL REGISTRATION www.trialregister.nl, identification NTR2731.
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Affiliation(s)
- N Duppen
- Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands; Departments of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - L Kapusta
- Department of Paediatric Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Paediatrics, Paediatric Cardiology unit, Tel-Aviv Sourasky Medical Centre, Tel Aviv University, Israel
| | - Y B de Rijke
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - M Snoeren
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I M Kuipers
- Department of Paediatric Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - L P Koopman
- Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands
| | - A C Blank
- Department of Paediatric Cardiology, University MC Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - N A Blom
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Dulfer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M T E Hopman
- Department of Integrative Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - W A Helbing
- Department of Paediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital Rotterdam, The Netherlands; Departments of Radiology, Erasmus MC, Rotterdam, The Netherlands.
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Barbiero SM, D'Azevedo Sica C, Schuh DS, Cesa CC, de Oliveira Petkowicz R, Pellanda LC. Overweight and obesity in children with congenital heart disease: combination of risks for the future? BMC Pediatr 2014; 14:271. [PMID: 25323400 PMCID: PMC4287310 DOI: 10.1186/1471-2431-14-271] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 08/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Children who have unhealthy lifestyles are predisposed to develop hypertension, dyslipidemia and other complications. The epidemic of obesity is also affecting children with congenital heart disease. The aim of this study is to estimate the prevalence of obesity and describe associated risk factors, including family history in children with congenital heart disease. Methods A cross-sectional study with 316 children and adolescents with congenital heart disease seen in an outpatient clinic of a reference hospital. Collected sociodemographic data included family history of chronic disease, dietary habits, laboratory tests (total cholesterol, HDL and LDL/cholesterol, triglycerides, fasting glucose, CRP, hematocrit and hemoglobin), and anthropometric assessment. Anthropometric data of the caregivers was self-reported. Results The prevalence of excess weight was 26.9%. Altered levels of total cholesterol were observed in 46.9%, of HDL in 32.7%, LDL in 23.6% and of triglycerides levels in 20.0%. A higher frequency of family history of obesity (42.6%; p = 0.001), dyslipidemia (48.1%; p = <0.001), diabetes (47.4%; p = 0.002), hypertension (39.2%; p = 0.006) and ischemic disease (43.7%; p = 0.023), as well as significantly higher values of triglycerides (p = 0.017), glycemia (p = 0.004) and C-reactive protein (p = 0.002) were observed among patients with excess weight. Conclusion The presence of modifiable risk factors and the variables associated to excess weight in this population was similar to that described in the literature for children without congenital disease. As these children already present the risks associated to heart disease, it is particularly important to promote a healthy lifestyle in this group.
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Affiliation(s)
| | | | | | | | | | - Lucia Campos Pellanda
- Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, Brazil.
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Bertoletti J, Marx GC, Hattge Júnior SP, Pellanda LC. Quality of life and congenital heart disease in childhood and adolescence. Arq Bras Cardiol 2013; 102:192-8. [PMID: 24676375 PMCID: PMC3987336 DOI: 10.5935/abc.20130244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/26/2013] [Indexed: 01/09/2023] Open
Abstract
Advances in cardiac surgery techniques and early diagnosis have enabled the increased
survival of individuals with congenital heart disease. The investigation of the
quality of life in children and adolescents with congenital heart disease provides
complementary information to clinical data that can assist in decision making on the
part of health professionals. Although many studies have been conducted to
investigate the quality of life of children and adolescents with congenital heart
disease, the results prove to be contradictory; while some studies show that
congenital heart disease can impact the quality of life, others describe a better
perception of quality of life among children and adolescents who suffer from the
disease when compared with healthy control subjects. The purpose of this study is to
review the literature on the assessment of health related quality of life in children
and adolescents with congenital heart disease, in order to systematize the existing
knowledge on this topic today. It is observed that research seeks to investigate
aspects of personality in cardiac patients, their coping strategies used and
perceived social support, aiming at better understanding the association of these
variables with the level of quality of life in this population.
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Affiliation(s)
- Juliana Bertoletti
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Porto Alegre, RS, Brasil
| | | | | | - Lucia Campos Pellanda
- Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Porto Alegre, RS, Brasil
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Sims-Gould J, Miran-Khan K, Haggis C, Liu-Ambrose T. Timing, Experience, Benefits, and Barriers: Older Women's Uptake and Adherence to an Exercise Program. ACTIVITIES ADAPTATION & AGING 2012. [DOI: 10.1080/01924788.2012.729188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McCusker CG, Doherty NN, Molloy B, Rooney N, Mulholland C, Sands A, Craig B, Stewart M, Casey F. A Randomized Controlled Trial of Interventions to Promote Adjustment in Children With Congenital Heart Disease Entering School and Their Families. J Pediatr Psychol 2012; 37:1089-103. [DOI: 10.1093/jpepsy/jss092] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nelson PA, Kirk SA, Caress AL, Glenny AM. Parents' emotional and social experiences of caring for a child through cleft treatment. QUALITATIVE HEALTH RESEARCH 2012; 22:346-359. [PMID: 21890716 DOI: 10.1177/1049732311421178] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Little is known about the experiences of parents caring for a child through long-term treatment for cleft lip and/or cleft palate. We conducted in-depth interviews with 35 parents with children between the ages of 20 weeks and 21 years to explore experiences across the treatment program. We analyzed the data using a constructivist grounded theory approach and present in detail in this article one subcategory from the analysis: managing emotions. Throughout childhood and adolescence, parents experienced conflicting emotions about their child's impairment, uncertainty about cleft treatment, and stigmatizing attitudes. Although parents attempted to manage emotional tensions by pursuing cleft treatments, the interventions could themselves be a source of conflict for them. We suggest that routine assessment of parents' emotional and social well-being should be included in cleft treatment programs, and access to psychosocial support made available.
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