Changes in perceived health of children with congenital heart disease after attending a special sports camp

The Effects of Cardiac Implantable Electronic Device Personal Protective Equipment Use in Patients with Pediatric and Adult Congenital Heart Disease

Pediatric and adult congenital heart disease (ACHD) patients encounter physical and emotional barriers. Cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardiac defibrillators (ICD) often compound these issues. Patient fear associated with damaging the CIED system can lead to avoidance of physical activity and reduced quality of life (QOL). CIED personal protective equipment (PPE) is a potential treatment for decreasing this fear. We sought to determine the effects of CIED PPE use in the pediatric and ACHD population. Patients 5 years or older with a CIED at a single pediatric and ACHD heart rhythm center received a CIED protector and customized athletic shirt. QOL was assessed using the PedsQL TM 4.0 SF15 prior to and after 6-12 months. Of the 77 patients enrolled, 26 completed repeat assessment. The mean age at enrollment was 15.6 years (range 5-36) with a mean device age of 2.2 years (< 1-10 years). Pacemakers were present in 77% and 23% had ICDs. The PPE was used in 92% with no PPE malfunction. Fear associated with physical activity was reduced, z = - 4, p < 0.001, with a large effect size (r = 0.55). There was a trend toward increased physical activity. Total QOL scores improved, z = - 2.771, P < 0.05, with a medium effect size (r = 0.4). This first study of CIED PPE in children shows that providing CIED PPE to pediatric and ACHD patients may decrease their fear of damaging their device system, increasing physical activity levels, and improving quality of life.

Exploring the Promise of Telemedicine Exercise Interventions in Children and Adolescents With Congenital Heart Disease

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).

"Like Any Other Camp": Experiences and lessons learned from an integrated day camp for children with heart disease

PURPOSE

Summer camps for children living with heart disease can have a profound impact on well-being. However, specialized camps often require extensive resources (i.e., 24-h medical staff supervision) and may be located in far remote settings. Integrating children with heart disease into mainstream day camps may address these barriers. The purpose of this study is to describe the experience of attending an integrated day camp from the perspectives of children with heart disease and their parents.

DESIGN AND METHODS

This study used a qualitative descriptive design. Among 25 eligible families, 9 participated in interviews which were held 3 months to 2 years after attending an integrated camp (mean age of children at camp was 7.3 ± 2.25 years). Interviews were audio-recorded and transcribed verbatim for an inductive thematic analysis.

RESULTS

Many parents chose the integrated camp as their child's first summer camp experience, citing trust in the local division of Cardiology's approval of the camp activities as an important reason for enrolling. All participants agreed the integrated camp was a valued opportunity which should continue, although not all described positive camp experiences. Participants' descriptions of the integrated camp were organized into two main themes: 1) overall expectations of the camp and 2) important opportunities afforded by the camp experience. Partaking in a typical camp experience, connecting to local children with heart disease, adequate safety precautions and activity adaptations were specific expectations held by participants. Important opportunities included greater independence and confidence, navigating disclosure of their diagnosis to peers on their own terms, and more diverse social connections. Improving communication with parents to ensure expectations match camp objectives would have enhanced the experience.

PRACTICE IMPLICATIONS

Practitioners looking for an alternative to specialized camps for their patients with heart disease may use these results to guide the design and promotion of an integrated camp.

Neurodevelopmental and psychosocial interventions for individuals with CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative

In 2018, the Neurodevelopmental and Psychosocial Interventions Working Group of the Cardiac Neurodevelopmental Outcome Collaborative convened through support from an R13 grant from the National Heart, Lung, and Blood Institute to survey the state of neurodevelopmental and psychosocial intervention research in CHD and to propose a slate of critical questions and investigations required to improve outcomes for this growing population of survivors and their families. Prior research, although limited, suggests that individualised developmental care interventions delivered early in life are beneficial for improving a range of outcomes including feeding, motor and cognitive development, and physiological regulation. Interventions to address self-regulatory, cognitive, and social-emotional challenges have shown promise in other medical populations, yet their applicability and effectiveness for use in individuals with CHD have not been examined. To move this field of research forward, we must strive to better understand the impact of neurodevelopmental and psychosocial intervention within the CHD population including adapting existing interventions for individuals with CHD. We must examine the ways in which dedicated cardiac neurodevelopmental follow-up programmes bolster resilience and support children and families through the myriad transitions inherent to the experience of living with CHD. And, we must ensure that interventions are person-/family-centred, inclusive of individuals from diverse cultural backgrounds as well as those with genetic/medical comorbidities, and proactive in their efforts to include individuals who are at highest risk but who may be traditionally less likely to participate in intervention trials.

Impact of a Residential Summer Camp Experience on Children With Sickle Cell Disease

Background: Sickle cell disease (SCD) has a significant psychosocial impact on affected children. Summer camp has been shown to improve psychological and physical states for children with diabetes and cancer. However, opportunities to attend camp for children with SCD are limited, as many are from low-income families, and many camps are not equipped to care for children with medical complexities. To our knowledge, no literature evaluates how camp can positively affect emotional functioning, social functioning, self-esteem, and physical activity levels in children with SCD. Methods: Children with SCD attending a residential summer camp during 2019 were identified. Participants completed a modified version of the Pediatric Camp Outcome Measure, a validated 29-item questionnaire that evaluates self-esteem, emotional function, social function, and physical activity. Four additional questions related to SCD were included. Results: Nine campers enrolled in the study. Questionnaire results showed a total score of 113.7 (maximum score135, range 84-129), with a self-esteem subscale score of 22.1 (maximum score 25, range 20-25), an emotional subscale score of 32.1 (maximum score 40, range 25-39), a social subscale score of 38.9 (maximum score 45, range 24-45), and a physical activity subscale score of 20.6 (maximum score 25, range 19-25). All campers indicated that they would return to camp. Conclusion: Attending summer camp has a beneficial impact on emotional function, social function, self-esteem, and physical activity. Mean questionnaire scores from children with cardiac disease and cancer are similar to those of children with SCD. Increased funding should be awarded to sickle cell camps to allow for more children to have this beneficial experience.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Identifying elements for a comprehensive paediatric cardiac rehabilitation programme

INTRODUCTION

The aim of this study was to identify relevant content among four important domains for the development and structure of a paediatric cardiac rehabilitation curriculum for young patients with congenital heart disease using a consensus approach.

METHODS

A three-round e-Delphi study among congenital heart disease and paediatric exercise physiology experts was conducted. Round 1, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a paediatric cardiac rehabilitation programme. Round 2, experts were asked to re-rate the same items after feedback and summary data were provided from round 1. Round 3, the same experts were asked to re-rate items that did not reach consensus from round 2.

RESULTS

Forty-seven experts were contacted via e-mail to participate on the Delphi panel, 37 consented, 35 completed round 1, 29 completed round 2, and 28 completed the final round. After round 2, consensus was reached in 55 of 60 (92%) questionnaire items across four domains: exercise training, education, outcome metrics, and self-confidence.

CONCLUSION

This study established consensus towards programme structure, exercise training principles, educational content, patient outcome measures, and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a paediatric cardiac rehabilitation curriculum to be used and tested by exercise physiologists, paediatric and adult congenital cardiologists, and other healthcare team members for optimising the health and wellness of paediatric patients with congenital heart disease.

Physical activity levels and self-efficacy of Greek children with congenital heart disease compared to their healthy peers

OBJECTIVE

It remains a challenge for children with congenital heart disease (CHD) to develop healthy lifestyle behaviors. This study investigates the interrelationship of physical activity and self-efficacy levels in Greek children with corrected CHD and compares them with those of healthy controls.

METHODS

A prospective cross-sectional study of 76 patients with operated CHD and 78 healthy volunteers (n = 154) was conducted. The Self Efficacy Scale and Previous Day Physical Activity Recall self-reporting questionnaires were used to assess self-efficacy and physical activity, respectively. Calculated metabolic equivalent of task (MET) provided an indication of participation in moderate and vigorous physical activities.

RESULTS

Mean physical self-efficacy in children with CHD was 29.01 ± 7.28, while that in healthy volunteers was 29.04 ± 6.60 (p = 0.076). Average physical activity levels-METs in children with CHD (2.38 ± 0.85) were significantly lower than those in controls (3.1 ± 0.95). Physical self-efficacy and physical activity were positively correlated (r = 0.515, p = 0.001), thus indicating that children with higher self-efficacy engaged in more vigorous physical activities. In children with CHD, self-efficacy was quite important in predicting physical activity, thus explaining almost ¼ of the variability in observed activities.

CONCLUSION

The low physical activity levels exhibited by Greek children with corrected CHD can lead to a sedentary adult lifestyle. Improving physical self-efficacy may help encourage them and consequently increase their physical activity levels. School-based education initiatives and athletic programs can play an important role in improving this.

Physical Activity-Related Drivers of Perceived Health Status in Adults With Congenital Heart Disease

Data on the differential impact of physical activity on perceived health status (PHS) in a large adult congenital heart disease (ACHD) patient population are lacking. We conducted a cross-sectional assessment of 4,028 ACHD patients recruited from 24 ACHD-specialized centers in 15 countries across 5 continents to examine the association between physical activity and PHS in a large international cohort of ACHD patients. A linear analog scale of the EuroQol-5D 3 level version and the 12-item Short Form Health Survey-version 2 were used to assess self-reported health status and the Health-Behavior Scale-Congenital Heart Disease was used as a subjective measurement of physical activity type, participation, and level. Correlation analyses and Wilcoxon Rank Sum tests examined bivariate relations between sample characteristics and PHS scores. Then, multivariable models were constructed to understand the impact of physical activity on PHS. Only 30% of our sample achieved recommended physical activity levels. Physically active patients reported better PHS than sedentary patients; however, the amount of physical activity was not associated with PHS. Further statistical analyses demonstrated that specifically sport participation regardless of physical activity level was a predictor of PHS. In conclusion, the majority of ACHD patients across the world are physically inactive. Sport participation appears to be the primary physical activity-related driver of PHS. By promoting sport-related exercise ACHD specialists thus may improve PHS in ACHD patients.

Perceptions of Health Care Professionals on the Effects of Residential Summer Camp in their Patients

PURPOSE

A growing body of literature exists regarding medical specialty camps for children. However, very little of the research focuses on the perspectives of healthcare providers. This study explored perceptions of pediatric healthcare providers on a medical specialty camp for children.

DESIGN AND METHODS

Interviews with five volunteer physicians and five nurses were conducted and analyzed using inductive content analysis.

RESULTS

Results showed that healthcare providers perceived camp to be a positive influence on campers' normalization and healthcare ownership, and to strengthen patient-provider relationships. Providers contextualized their assertions by discussing the settings of camp and of patients. However, providers also identified multiple barriers perceived as limiting a camp experience's ability to create lasting changes in patients' attitudes or behaviors.

CONCLUSIONS

While healthcare providers in this study perceived camp as being a positive opportunity for patients, the potential for long-lasting effects was seen to be hindered by factors external to the camp and changes in patients' attitudes or behaviors can be difficult to ascribe to the camp experience.

PRACTICE IMPLICATIONS

Healthcare providers can reinforce and extend positive health behavior messages from camp at follow-up appointments. Adding inquiries about camp attendance and experiences to patients' visits can provide healthcare providers with additional insights about patients. Health outcomes before and after camp could be measured to assess change. Camps can send home patient protocols on successes and challenges.

The Influence of Exercise Training on Quality of Life and Psychosocial Functioning in Children with Congenital Heart Disease:A Review of Intervention Studies

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.

Self-reported physical activities in patients after the Mustard or Senning operation: Comparison with healthy control subjects

Background

Some decades ago, the Mustard or Senning operation was used to treat patients who were born with Transposition of the Great Arteries (TGA). Although life expectancy is good, previous studies have demonstrated limitations in exercise capacity. To what extent these limitations affect day-to-day functioning of the patients is not yet known.

Aims

We therefore investigated self-reported physical activities in patients after the Mustard or Senning operation, compared this with those of matched, healthy counterparts, and explored potential associations with age, gender and complexity of the TGA.

Methods

Seventy patients were matched with healthy controls. Habitual physical activity was measured using the Baecke questionnaire, resulting in a work, sports, and leisure time index, which ranges from 1 to 5.

Results

The median index scores of patients were 2.63 for work, 2.50 for sports; and 2.75 for leisure time. Only for sports, a significantly lower index score was found in patients. Furthermore, we found that older patients were less frequently engaged in sport activities (Spearman's rho=–0.38; p=0.02).

Conclusion

The results showed that the level of physical activities of patients after the Mustard and Senning operation is normal, except for sport activities. This indicates that patients after a Mustard or Senning operation tend to partake in all activities that they can comfortably perform.

Psychosocial outcomes of a summer overnight recreational experience for children with heart disease

Children with chronic heart disease (CHD) are often turned away from recreational summer overnight experiences because of complicated medical histories and medication regimens. The purpose of this qualitative study was to evaluate the psychosocial impact of a five-day overnight recreational experience for children with CHD and their parents. Thirty-six children with CHD between the age of 8 and 15 years and their parents participated in the study. Data were collected from the children using photovoice interviews. Parent data were collected using a post camp survey. Results included the following external outcome themes: inclusion in a peer group and the importance of friendship, fun, and safety. Internal or personal outcome themes included counselor as a role model, increased self-confidence, and the realization of life's possibilities. Parent themes included increased child independence, increased child confidence, and child feelings of normalcy related to belonging to a peer group. Findings from this study can be used to encourage families of children with CHD to allow participation in a well-supervised overnight recreational experience. Such an experience can foster the child's overall development, provide peer group support, and reduce parent anxiety about overnight separation from the child.

The psychological and social impact of camp for children with chronic illnesses: a systematic review update

Advances in medicine have reduced mortality among children with complex medical conditions, resulting in a growing number of young patients living with chronic illnesses. Despite an improved prognosis, these children experience significant psychosocial morbidity, such as depression and anxiety. Therapeutic summer recreation camps have been proposed as an intervention to enhance quality of life among these children. The purpose of this systematic review was to assess the psychosocial impact of camp for children with chronic illnesses. A systematic review of central databases was undertaken using key words, and a rating tool – the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies – was employed to rate methodological quality. 21 studies were included in this systematic review. Although overall methodological quality was weak, camp participation appeared to offer short-term psychosocial benefits on some parameters in children with a variety of chronic illnesses. There was some consistency in improved social outcomes, such as social interaction and acceptance. Based on the available evidence, it is premature to make robust claims regarding the psychosocial impact of camp as a therapeutic intervention. Theoretically informed camp programs, long-term follow-up, and incorporating camp-based messaging into routine hospital care,may enhance the utility of camp as a potential psychosocial intervention in paediatrics.

A qualitative study exploring the psychosocial value of weekend camping experiences for children and adolescents with complex heart defects

BACKGROUND

Children living with complex heart defects (CHD) are likely to have ongoing social, emotional, physical, and health concerns, and are in need of additional psychosocial support. Summer camps can provide therapeutic benefits. Little research exists regarding the value of shorter camping experiences from the perspectives of children with CHD. The aim of our study was to explore what children and adolescents with CHD considered meaningful when attending a therapeutic camping weekend in the company of peers with similar medical diagnoses.

METHODS

Engaging a phenomenological approach we used participant generated photography and reflective semi-structured interviews to explore participants' lived experience and value derived from their weekend camping experiences. The study was completed with thirteen participants ranging in age from 9 to 16 years. Interviews were recorded and transcribed verbatim. Data were analysed using Van Manen's guidelines.

RESULTS

Three themes reflecting the camp experiences were generated from the data. Meaningful experiences spanned three outcomes which had some overlapping influences: (i) Developing relationships and feeling accepted by peers and counsellors at camp; (ii) Enjoying and learning during the weekend; and (iii) Experiencing the natural and human-built therapeutic environmental features of camp. The camping programme features, inputs, and processes as identified by the participants in contributing to these outcomes are described.

CONCLUSION

This qualitative study showed that children living with complex CHD valued the opportunity for participating in weekend camping experiences in the company of peers with similar heart defects. Findings contribute to a better understanding of what programme features and processes were considered meaningful. Given the scarcity of resources to devote to such social support activities, the findings may help professionals to plan effective interventions to maximize benefits during a shorter camping experience.

Aerobic exercise influences quality of life of children and youngsters with congenital heart disease: a randomized controlled trial

PURPOSE

To evaluate effects of an exercise program on health-related quality of life (HRQoL) in children and adolescents with tetralogy of Fallot (ToF) or a Fontan circulation.

METHODS

Stratified, randomized, controlled intervention study conducted in five participating centers of pediatric cardiology in The Netherlands. In total, 93 patients, aged 10-25 years, with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology were included. They were randomly allocated with a ratio of 2:1 to: (1) a 12-week period with an exercise program for 3 times per week or (2) to a control group. Randomization was stratified by age, gender, and cardiac diagnosis. At baseline and follow-up after 12 weeks, all participants completed Web-based age-appropriate HRQoL questionnaires. Primary analyses involved change in HRQoL during follow-up. Secondary analyses concerned influence of cardiac diagnosis and comparison with normative data.

RESULTS

Forty-eight (86%) and 32 (86%) patients in the exercise-group and control-group respectively completed all questionnaires at baseline and follow-up. Compared with the control-group, children, aged 10-15 years, in the exercise-group improved significantly on self-reported cognitive functioning, p < .05, r = .30, and parent-reported social functioning, p < .05, r = .30. Youngsters aged 16-25 years did not change their HRQoL. Cardiac diagnosis had no influence on pre/post changes. Children and youngsters in this study reported comparable or better HRQoL than norm groups.

CONCLUSIONS

Participation in an exercise program improved HRQoL of children with ToF or a Fontan circulation, especially in those with low baseline QoL.

Evaluation of child and parent outcomes after a pediatric cardiac camp experience

PURPOSE

This study evaluated the effects of a cardiac camp experience on children with heart disease and their parents.

DESIGN AND METHODS

A repeated measures design was used with 49 parent-child dyads. Repeated measures evaluated the effects of camp on anxiety, attitude toward illness, and psychosocial functioning of the children. Parental anxiety was also evaluated.

RESULTS

Results demonstrated decreases in parent anxiety, decreases in child trait anxiety, and positive psychosocial outcomes in the areas of self-esteem, social, physical, and emotional functioning.

PRACTICE IMPLICATIONS

Findings can be used to support decisions for those contemplating a camping experience for the child with heart disease.

Associations between exercise capacity, physical activity, and psychosocial functioning in children with congenital heart disease: a systematic review

BACKGROUND

Children and adolescents operated upon for congenital heart disease (ConHD) may show reduced exercise capacity and physical activity, possibly associated with lowered self-esteem and quality of life (QoL). The studies into associations between these parameters have not been reviewed before.

OBJECTIVE

Review of studies into associations between exercise capacity, physical activity, respectively exercise training, and psychosocial functioning of ConHD youngsters.

DATA SOURCES

PubMed, Embase and reference lists of related articles.

STUDY SELECTION

Articles published between January 2000 and December 2012 into exercise capacity and/or physical activity, and a measure of psychosocial functioning in children with ConHD.

DATA EXTRACTION

Two investigators independently reviewed the identified articles for eligibility, and one author extracted the data.

RESULTS

Although exercise capacity was strongly related to physical domains of parent-reported and self-reported QoL, it was almost never associated with psychosocial domains of QoL. Physical activity was rarely associated with physical or psychosocial domains of QoL. Remarkably, self-reported depressive symptoms were associated with both physical and psychosocial QoL. The few studies into exercise-training programmes showed promising results in QoL and emotional and behavioral problems, but they contained methodological flaws.

CONCLUSIONS

No clear relationships were found between exercise capacity, physical activity, and QoL in children and adolescents with ConHD. Therefore we recommend assessing QoL separately, preferably both self-reported and parent-reported. Since depressive symptoms were associated with reduced physical and psychosocial QoL, screening on these symptoms is also recommended.

Relationship between camp attendance and self-perceptions in children with chronic health conditions: a meta-analysis

OBJECTIVE

A meta-analysis examined the association between camp attendance and changes in self-perceptions in children with chronic health conditions.

METHODS

Studies using quantitative methods to assess changes in self-perceptions while attending camps designed for children with chronic health conditions were included in analyses. A random-effects model was used, and Cohen's d was used to calculate effect sizes at both post-camp and follow-up. Some potential moderators of effects were examined (i.e., type of measure of self-perceptions, children's chronic health condition, camp components).

RESULTS

31 studies were included in the analyses. Children experienced small, but statistically significant, improvements in self-perceptions at both post-camp (d = .25, 95% CI [.16-.34]) and extended follow-up (d = .15, 95% CI [.05-.26]). This relationship was moderated by type of measure of self-perceptions and child health condition.

CONCLUSIONS

Camp attendance is associated with small improvements in self-perceptions for children with some chronic health conditions.

Education and support needs of the older adult with congenital heart disease

AIM

  This article is a report of a study exploring health-related quality of life in adults with congenital heart disease and the extent to which it is associated with patients' illness beliefs and emotional health.

BACKGROUND

  A reduction in mortality in patients with congenital heart disease has led to an increasingly older population that faces new challenges. Studies in a younger adult population have reported inconsistent findings regarding health-related quality of life. Factors such as, the complexity of the congenital heart defect, have not been found to be associated with quality of life. The association between illness beliefs and health-related quality of life has not previously been reported.

METHOD

  A cross-sectional questionnaire study of adults with congenital heart disease attending an outpatient clinic in a specialist centre in the United Kingdom between October 2007 and May 2008.

RESULTS

  The mean age of the study population was 37·2 years. Participants reported poorer physical functioning, role functioning and general health than a general population. High levels of anxiety were reported in 38% and high levels of depression in 17%. In multivariate analysis, higher levels of anxiety and depression were associated with poorer mental functioning and higher levels of depression with poorer physical quality of life.

CONCLUSION

  We have reported that high levels of anxiety and depression in an older population of patients with congenital heart disease are associated with poorer quality of life. This highlights the need to routinely assess anxiety and depression in this patient group and to provide psychological support appropriately.

Physical activity participation in youth with surgically corrected congenital heart disease: Devising guidelines so Johnny can participate

While most youth with congenital heart disease have simple structural lesions and near-normal activity tolerance and functioning, youth with complex structural defects may be affected by significant morbidity. Efforts are being made to consider the impact of exercise and physical activity on quality of life. The benefits of physical activity are well documented; however, the levels of participation and self-efficacy for activity remain low, thus increasing the risk of obesity and cardiovascular morbidity. Rehabilitation is a novel and emerging area, and decisions regarding advocacy versus restriction of physical activity may pose a challenge for both cardiologists and nonspecialists. The present article outlines the rationale for physical activity recommendations in youth with surgically corrected congenital heart disease and the psychosocial determinants of participation. Clinical recommendations and future directions are proposed.

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

PURPOSE

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

DESIGN AND METHODS

Cross-sectional study using self-report instruments.

RESULTS

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

PRACTICE IMPLICATIONS

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

The perceptions of caregivers toward physical activity and health in youth with congenital heart disease

Medical advances have reduced mortality in youth with congenital heart disease (CHD). Although physical activity is associated with enhanced quality of life, most patients are inactive. By addressing medical and psychological barriers, previous literature has reproduced discourses of individualism which position cardiac youth as personally responsible for physical inactivity. Few sociological investigations have sought to address the influence of social barriers to physical activity, and the insights of caregivers are absent from the literature. In this study, caregiver perceptions toward physical activity for youth with CHD were investigated at a Canadian hospital. Media representations, school liability, and parental overprotection construct cardiac youth as "at risk" during physical activity, and position their health precariously. Indeed, from the perspective of hospital staff, the findings indicate the centrality of sociological factors to the physical activity experiences of youth with CHD, and the importance of attending to the contextual barriers that constrain their health and physical activity.

Decreases in anxiety associated with participation in a camp for children with cardiac defects

The aim of our study was to examine psychosocial changes associated with participation in a camp for children with cardiac defects. We enrolled 29 children with cardiac defects aged from 8 to 18 years, along with their parents. Both the parents and the children completed measures of expectations for the camp and anxiety. Analyses of repeated measures indicated that levels of anxiety amongst the children decreased significantly at the end of camp when compared to its beginning. Levels of anxiety amongst the children were not statistically different at follow-up. Anxiety amongst the parents concerning the separation from their children also decreased at follow-up when compared to before the camp. Higher levels of anxiety reported by the children prior to the camp were associated with greater anxiety amongst the parents concerning the anticipated separation, more negative parental expectations of the camp, fewer experiences of separation from their children, and lower expectations by the children for the camping experience. Reductions in anxiety amongst the children following the camp were associated with negative parental expectations about the camping experience. The camping environment can provide a naturalistic exposure to new experiences for the child, and a successful separation for the parent, thereby promoting confidence amongst the parents in the ability of their children to function independently.

Improved perceived health status persists three months after a special sports camp for children with congenital heart disease

INTRODUCTION

Although summer and sports camps for children with congenital heart disease are organized in many countries and regions, empirical data on the effects of such camps is limited.

OBJECTIVES

The aim of the present study was to investigate changes in the perceived health status and habitual physical activities in children attending a special sports camp.

MATERIALS AND METHODS

In this longitudinal study, 25 children with congenital heart disease who participated in a three-day multi-sports camp were included. The perceived health status was measured using the Child Health Questionnaire-Child Form, CHQ-CF87, completed by the child at the start of the camp (T1), at the end of the camp (T2), and 3 months after the camp concluded (T3). Habitual physical activities were assessed by means of a modified version of the Baecke questionnaire, which was completed by one of the parents at T1 and T3.

RESULTS

During the sports camp, we observed significant improvements in the children's perception of their physical functioning, role-physical functioning, general health, role-emotional functioning, self-esteem, mental health, and general behavior. For physical functioning, role-emotional functioning, and family activities, high scores persisted three months after the sports camp concluded. The habitual physical activities (sport and leisure time) of the children remained unchanged.

DISCUSSION AND CONCLUSION

In conclusion, we propose that a special sports camp for children with congenital heart disease may improve specific dimensions of subjective health status. Our study confirms a previous report on the benefits of such camps for afflicted children. If these findings can be further corroborated in other settings, participation in sport camps should be advocated as a simple, noninvasive means to promote healthier children.