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Hansen K. From Surviving to Thriving: A Roadmap for Reinventing Cardiac Rehabilitation in Pediatric Congenital Heart Disease. Can J Cardiol 2025; 41:375-385. [PMID: 39603342 DOI: 10.1016/j.cjca.2024.11.020] [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: 08/20/2024] [Revised: 11/11/2024] [Accepted: 11/12/2024] [Indexed: 11/29/2024] Open
Abstract
Exercise is an essential component of the cardiac care of children with congenital heart disease (CHD), and safe and effective exercise counselling by the medical team is important early in life to develop positive physical activity and exercise habits. Without it, children are at risk for sedentariness and related comorbidities in childhood and adulthood. Pediatric cardiologists can guide patients to a cycle of positive fitness through exercise counselling, promotion, prescription, and/or supervised exercise training similar to adult cardiac rehabilitation (ACR). ACR has improved exercise capacity, mortality, and quality of life in adults with acquired heart disease. Similar outcomes have been shown in exercise training for adult and pediatric CHD. Exercise training specific to pediatric CHD is not widely available but is expanding in response to growing need and increasing demand. Although ACR provides a framework for structured exercise training, approaches to pediatric exercise training must be individualized and innovated upon to be successful for children. I propose that the ACR model must be reinvented for children with CHD by integrating 6 missing pieces. First, the underlying goal should be to optimize fitness, not rehabilitate to a previous state of health. Second and third are training mental skills and motor skills. Fourth, play-based exercise training is needed to foster a positive relationship with exercise. Fifth, family-focused exercise interventions can address root causes of sedentariness. Finally, building communities in which positive fitness is a priority will be essential to long-term sustainability.
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Affiliation(s)
- Katherine Hansen
- Division of Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.
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Blanchard J, McCrindle BW, Longmuir PE. The Impact of Physical Activity Restrictions on Health-Related Fitness in Children with Congenital Heart Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084426. [PMID: 35457294 PMCID: PMC9028029 DOI: 10.3390/ijerph19084426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Children with congenital heart disease (CHD) are often restricted from some types of physical activity (PA) despite the lack of evidence regarding the need to restrict recreational PA, apart from those with rhythm disorders. This study retrospectively investigated the associations between parent-reported activity restrictions (on-going need to restrict exertion, body contact or competition) and measures of health-related fitness among 236 children (8.2 ± 2.1 years, range 4−12 years) treated for single ventricle (n = 104), tetralogy of Fallot (n = 48), transposition of the great arteries (n = 47) or atrial septal defect (n = 37). Body mass index (BMI), moderate-to-vigorous physical activity (MVPA; 7 day accelerometry), strength, flexibility, and movement skill assessment results were collected from the baseline assessment research records for two studies completed in Ontario, Canada. A subset of 62 children also had physician-reported activity restrictions. Regression models empirically tested the goodness of fit between the dependent and independent variables. Participants with body contact restrictions from both parents and physicians had significantly higher BMI z-scores (0.23 ± 1.19 vs. −0.32 ± 0.85; t = 2.55; p = 0.04 and 0.66 ± 1.33 vs. −0.02 ± 0.98; t = 2.25; p = 0.02 for CDC and WHO scores, respectively). Otherwise, BMI z-score was not associated with patient variables (p > 0.36; sex, cardiac diagnosis, age, or activity restriction). Children with any type of parent-reported restriction (0.98 ± 2.06 vs. −0.08 ± 1.99; t = 3.77; p = 0.0002) were less flexible. Movement skill (TGMD-2) scores were 50% lower (25.1 ± 31.2 vs. 52.6 ± 28.6; F = 6.93; p = 0.009) among children with parent-reported competitive sport restrictions. Weekly MVPA (p > 0.18) and strength (p > 0.05) were not associated with activity restriction. Children whose parents reported PA restrictions were less flexible, and had decreased movement skill and increased BMI z-scores if the restrictions impacted competitive sport or body contact, respectively. Future research is recommended to confirm these results among larger samples of children who have both parent- and physician-specified PA restrictions.
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Affiliation(s)
- Joel Blanchard
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada;
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Brian W. McCrindle
- The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada;
| | - Patricia E. Longmuir
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada;
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence: ; Tel.: +1-613-738-3908
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Chen CH, De Souza AM, Franciosi S, Harris KC, Sanatani S. Physical Activity in Paediatric Long QT Syndrome Patients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:80-85. [PMID: 38058492 PMCID: PMC10697215 DOI: 10.1016/j.cjcpc.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/08/2023]
Abstract
Background Physical activity (PA) is important for cardiovascular health as well as social and emotional well-being of children. Patients with long QT syndrome (LQTS) often face PA restrictions and are often prescribed beta-blockers for disease management. The aim of this study was to determine if PA levels were lower in patients with LQTS compared with healthy controls. Methods Participants with LQTS from an inherited arrhythmia clinic completed the Physical Activity Questionnaire for Children and Adolescents (PAQ-C/A) and an exercise stress test. PAQ score (a general measure of PA for youth, unitless) and endurance time were compared with healthy controls. Results Twenty-three patients with LQTS completed the PAQ and had an exercise stress test within a year of having completed the PAQ. No difference was observed in PAQ scores between LQTS and control groups (LQTS: 2.3 ± 0.15 vs controls: 2.3 ± 0.18; P = 0.78). There was no effect of age on PA in patients with LQTS (P > 0.05), whereas PA significantly decreased in controls with age (eg, 11-12 vs 17-20 years: 3.2 ± 0.07 vs 1.5 ± 0.08, P = 0.005). Endurance time and heart rate at peak exercise were significantly lower in patients with LQTS compared with controls (11 ± 0.5 vs 15 ± 0.5 minutes, P < 0.0001; 169 ± 5 vs 198 ± 2 beats per minute, P < 0.0001). Conclusions Despite guideline recommendations restricting PA, risk of sudden cardiac death, and use of beta-blockers, our cohort of patients with LQTS reported similar PA levels as healthy controls.
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Affiliation(s)
- Chi Hung Chen
- Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Astrid-Marie De Souza
- Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia Franciosi
- Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin C. Harris
- Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Chang P, Beach C, Vinocur J, Das S. Expanding the Reach of Pediatric Transcatheter Pacing. J Innov Card Rhythm Manag 2021; 12:4487-4492. [PMID: 33939789 PMCID: PMC8081454 DOI: 10.19102/icrm.2021.120408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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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: 0.8] [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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Blais AZ, Lougheed J, Adamo KB, Longmuir PE. Participation in a Community-Based Sport Program is Feasible for Children with Congenital Heart Disease and May Benefit Physical Literacy Development: A Pilot Study. EXERCISE MEDICINE 2020. [DOI: 10.26644/em.2020.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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: 3.4] [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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Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease. Clin J Sport Med 2018; 28:540-560. [PMID: 28742603 DOI: 10.1097/jsm.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk-benefit ratio of sport participation versus restriction. DATA SOURCE A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria. MAIN RESULTS Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated. CONCLUSIONS Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.
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Amedro P, Gavotto A, Bredy C, Guillaumont S. [Cardiac rehabilitation for children and adults with congenital heart disease]. Presse Med 2017; 46:530-537. [PMID: 28126509 DOI: 10.1016/j.lpm.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/27/2016] [Accepted: 12/20/2016] [Indexed: 01/02/2023] Open
Abstract
Advances in heart surgery over the past 30 years have significantly improved the prognosis of congenital heart diseases (CHD). Therefore, the epidemiology of CHD has changed dramatically with a shift of mortality from pediatrics to adulthood and an increased prevalence of complex CHD. Today, caregivers and patients focus their interests to new perspectives: improving the quality of life, practicing sports, improving psychosocial care. Cardiac rehabilitation is completely integrated in these new therapeutic strategies. The starting point is the cardiopulmonary exercise test (CPET), with the measurement of oxygen uptake, or "VO2". CPET is now recommended in the follow-up of the adults with CHD. Maximum oxygen uptake correlates to the quality of life of children and adults with CHD. The principles of the rehabilitation in patients with heart failure may usually be applied to CHD patients. Some studies in complex CHD showed improvement of VO2 and quality of life after rehabilitation, without any adverse events. However few physicians have the experience in rehabilitation among CHD patients, especially children. Randomized trials on cardiac rehabilitation in adult and pediatric CHD patients are essential to increase the level of evidence and lead to specific guidelines in this population.
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Affiliation(s)
- Pascal Amedro
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France.
| | - Arthur Gavotto
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Université de Montpellier, PHYMEDEXP, UMR CNRS 9214, Inserm U1046, laboratoire de physiologie et médecine expérimentale du cœur et des muscles, Montpellier, France
| | - Charlène Bredy
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Clinique Fontfroide, service de réhabilitation cardiaque, Montpellier, France
| | - Sophie Guillaumont
- CHU de Montpellier, centre de compétences M3C, cardiologie pédiatrique et congénitale, Montpellier, France; Institut-Saint-Pierre, unité d'évaluation et de réhabilitation en cardiologie pédiatrique, Palavas-Les-Flots, France
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Abstract
BACKGROUND Management of individuals with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy may involve exercise restriction and/or β-blocker therapy. OBJECTIVE This study assessed the practices of a group of paediatric electrophysiologists regarding the management of genotype-positive/phenotype-positive and genotype-positive/phenotype-negative individuals with these conditions. METHOD An online survey was circulated to members of the Pediatric and Congenital Electrophysiology Society in May, 2014. The survey included questions addressing the respondents' approach regarding exercise recommendations and prescription of β-blocker therapy. RESULTS A total of 45 cardiologists completed the survey. The majority of respondents restricted symptomatic patients from competitive sports; however, only approximately half restricted phenotype-negative mutation carriers from this level of activity. Recommendations were less consistent regarding other types of activities. A trend was identified regarding physician physical activity and exercise recommendations for phenotype-negative mutation carriers. Less-active physicians were more likely to restrict exercise. β-blocker therapy was discussed by the majority of respondents for symptomatic patients and a significant number of asymptomatic patients. CONCLUSION Exercise restriction for patients with long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy varies based on several factors including phenotype, type of exercise, guidelines referred to, and physicians' own level of activity.
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Gow RM, Borghese MM, Honeywell CR, Colley RC. Activity intensity during free-living activities in children and adolescents with inherited arrhythmia syndromes: assessment by combined accelerometer and heart rate monitor. Circ Arrhythm Electrophysiol 2013; 6:939-45. [PMID: 23994883 DOI: 10.1161/circep.113.000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND International guidelines recommend restriction of activities for many children and adolescents with inherited arrhythmia syndromes to moderate activity (<7 metabolic equivalents [METs]). We hypothesized that moderate levels of intensity would be exceeded during free-living daily activity in these individuals when assessed objectively by combined heart rate and accelerometry monitor (Actiheart). METHODS AND RESULTS Participants wore the Actiheart for ≤7 days on 2 occasions after a maximal exercise test that was used to calibrate the monitor individually against intensity levels. Of 16 participants, 13 (81%) had long QT syndrome, 9 (56%) were female, and median age was 12 years. Monitors were worn for a median (range) of 13 (6-14) days, and a mean (SD) of 11.3 (1.7) hours per day. Vigorous (7 MET) and very vigorous (10 MET) thresholds were exceeded by 15 and 13 participants, respectively. The median (interquartile range), individual, total weekly time spent >7 MET threshold was 113 (65-330) minutes, whereas such time spent >10 MET threshold was 53 (9-115) minutes. Total time>7 MET threshold was 2.3% of monitor wear time. There were no differences in time above threshold between male and female participants (P=0.357) or among those with different levels of activity restriction (P=0.769). CONCLUSIONS Current recommended activity guidelines are frequently exceeded during routine free-living activities in young participants with inherited arrhythmia syndromes. Whether this indicates increased risk for these individuals or excessively restrictive guidelines remains to be determined.
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