A comparison of VO2(peak) between patients with congenital heart disease and healthy subjects, all aged 8-17 years

Single ventricular strain measures correlate with peak oxygen consumption in children and adolescents with Fontan circulation

INTRODUCTION

Children with a single ventricle post-Fontan palliation are at increased risk of poor outcomes with peak oxygen consumption acting as a surrogate outcome marker. The purpose of this study is to evaluate the relationship between peak oxygen consumption and echocardiographic measures of ventricular function and deformation, including ventricular global longitudinal strain and dyssynchrony, in children and adolescents following Fontan palliation.

METHODS

Patients (age 8-21 years) with single ventricle post-Fontan palliation were prospectively recruited and participated in an echocardiogram, including views optimised for two-dimensional speckle tracking, and a cardiopulmonary exercise test on a cycle ergometer to maximal volitional fatigue.

RESULTS

Thirty-eight patients (mean age 13.7 ± 2.3 years) post-Fontan palliation had either a single left ventricular (n = 20), single right ventricular (n = 14), or biventricular (n = 4) morphology. Peak oxygen consumption (24.9 ± 5.6 ml/kg/minute) was correlated with global longitudinal strain (r = -0.435, p = 0.007), a strain discoordination time to peak index (r = -0.48, p = 0.003), and the presence of an electro-mechanical dyssynchrony strain pattern (p = 0.008). On multivariate regression modelling, these three variables were associated with peak oxygen consumption independently of age and sex. The single right ventricular group had evidence of possible diastolic dysfunction by E/e' compared to the single left ventricular and biventricular groups (p = 0.001).

CONCLUSIONS

Strain analysis measures are correlated with peak oxygen consumption in this cohort of children, adolescents, and young adults following Fontan palliation, suggesting that ventricular mechanics may influence the efficiency of the Fontan circulation.

Circulatory Response to Rapid Volume Expansion and Cardiorespiratory Fitness in Fontan Circulation

The role of dysfunction of the single ventricle in Fontan failure is incompletely understood. We aimed to evaluate hemodynamic responses to preload increase in Fontan circulation, to determine whether circulatory limitations in different locations identified by experimental preload increase are associated with cardiorespiratory fitness (CRF), and to assess the impact of left versus right ventricular morphology. In 38 consecutive patients (median age = 16.6 years, 16 females), heart catheterization was supplemented with a rapid 5-mL/kg body weight volume expansion. Central venous pressure (CVP), ventricular end-diastolic pressure (VEDP), and peak systolic pressure were averaged for 15‒30 s, 45‒120 s, and 4‒6 min (steady state), respectively. CRF was assessed by peak oxygen consumption (VO_2peak) and ventilatory threshold (VT). Median CVP increased from 13 mmHg at baseline to 14.5 mmHg (p < 0.001) at steady state. CVP increased by more than 20% in eight patients. Median VEDP increased from 10 mmHg at baseline to 11.5 mmHg (p < 0.001). Ten patients had elevated VEDP at steady state, and in 21, VEDP increased more than 20%. The transpulmonary pressure difference (CVP‒VEDP) and CVP were consistently higher in patients with right ventricular morphology across repeated measurements. CVP at any stage was associated with VO_2peak and VT. VEDP after volume expansion was associated with VT. Preload challenge demonstrates the limitations beyond baseline measurements. Elevation of both CVP and VEDP are associated with impaired CRF. Transpulmonary flow limitation was more pronounced in right ventricular morphology. Ventricular dysfunction may contribute to functional impairment after Fontan operation in young adulthood.ClinicalTrials.gov identifier NCT02378857.

Small effort, high impact: Focus on physical activity improves oxygen uptake (VO2peak ), quality of life, and mental health after pediatric renal transplantation

This study estimates the effects on peak oxygen uptake (VO2 peak ), QoL, and mental health after the introduction of an adjusted post-transplant follow-up program, that is, early physiotherapy and focus on the importance of physical activity. VO2 peak was measured by a treadmill exercise test in 20 renal-transplanted children on the adjusted post-transplant follow-up and compared with a group of 22 patients investigated in a previously, before the implementation of our new follow-up routines. PedsQL and The Strengths and Difficulties Questionnaire (SDQ) were used to assess QoL and mental health in 45 patients on the new as compared to 32 patients on the previous follow-up strategy. The patients exposed to early physiotherapy and a higher focus on physical activity had significantly higher VO2 peak (44.3 vs 33.5 mL kg-1  min-1 , P = .031) in addition to improved QoL (P = .003) and mental health scores (P = .012). The cardiovascular risk profile was similar in both groups aside from significantly higher triglycerides in the present cohort. Small efforts as early physiotherapy and increased focus on physical activity after pediatric renal transplantation have significant impact on cardiorespiratory fitness, QoL, and mental health. The importance of physical activity should therefore be emphasized in follow-up programs.

Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Background

Children and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing.

Objective

To evaluate the functional capacity of children and adolescents with congenital heart disease (CHD) with systematic review and meta-analyses.

Methods

The review included observational studies, data from the first evaluation of randomized clinical trials or observational follow-up periods after clinical trials which evaluated functional capacity by cardiopulmonary exercise test, stress testing, six-minute walk test or step test, in children and adolescents with CHD, aged between six and 18 years, and comparisons with healthy controls in the same age group. The quantitative assessment was performed by meta-analysis, by comparing the maximal oxygen consumption (VO₂max) of children and adolescents with CHD and respective control groups.

Results

Twenty-five of 2.683 studies identified in the search met the inclusion criteria. The VO₂max measurement showed that patients with CHD have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I², 94.3%, P for heterogeneity < 0.001) compared with the control group. The meta-analysis of the data of maximum heart rate (HR) reached during cardiopulmonary test and stress testing, retrieved from 18 studies, showed a HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I², 94.3%, P for heterogeneity < 0.001) compared with the control group.

Conclusion

Children and adolescents with CHD have lower VO₂max and HR compared to controls.

Rehabilitation during congenital heart disease in pediatric patients

Cardiac rehabilitation is an important part of daily routine for cardiac disorder patients in adults. However, pediatric rehabilitation is an emerging field, and is totally different and new field in case of pediatric patients. The main reason of variability is the Pediatric patients differ from adult patients in several ways. The main difference is they are dependent on their parents for meeting their needs, including for transportation and following of rehabilitation initiatives. Furthermore, rehabilitation initiatives are often connected to large urban university hospitals and unavailable to children whose parents cannot bring them for exercise training on a regular basis. The present review article is focused on these aspects of rehabilitation during congenital heart disease.

22q11.2 deletion status and disease burden in children and adolescents with tetralogy of Fallot

BACKGROUND

Patients with repaired tetralogy of Fallot experience variable outcomes for reasons that are incompletely understood. We hypothesize that genetic variants contribute to this variability. We sought to investigate the association of 22q11.2 deletion status with clinical outcome in patients with repaired tetralogy of Fallot.

METHODS AND RESULTS

We performed a cross-sectional study of tetralogy of Fallot subjects who were tested for 22q11.2 deletion, and underwent cardiac magnetic resonance, exercise stress test, and review of medical history. We studied 165 subjects (12.3±3.1 years), of which 30 (18%) had 22q11.2 deletion syndrome (22q11.2DS). Overall, by cardiac magnetic resonance the right ventricular ejection fraction was 60±8%, pulmonary regurgitant fraction was 34±17%, and right ventricular end-diastolic volume was 114±39 cc/m(2). On exercise stress test, maximum oxygen consumption was 76±16% predicted. Despite comparable right ventricular function and pulmonary regurgitant fraction, on exercise stress test the 22q11.2DS had significantly lower percent predicted: forced vital capacity (61.5±16 versus 80.5±14; P<0.0001), maximum oxygen consumption (61±17 versus 80±12; P<0.0001), and work (64±18 versus 86±22, P=0.0002). Similarly, the 22q11.2DS experienced more hospitalizations (6.5 [5-10] versus 3 [2-5]; P<0.0001), saw more specialists (3.5 [2-9] versus 0 [0-12]; P<0.0001), and used ≥1 medications (67% versus 34%; P<0.001).

CONCLUSIONS

22q11.2DS is associated with restrictive lung disease, worse aerobic capacity, and increased morbidity, and may explain some of the clinical variability seen in tetralogy of Fallot. These findings may provide avenues for intervention to improve outcomes, and should be re-evaluated longitudinally because these associations may become more pronounced with time.

Pulmonary Valve Replacement With a Bovine Pericardial Valve

Objectives:

From a population of 90 patients after pulmonary valve replacement with a biological valve (Carpentier-Edwards Perimount valve), 56 of 80 available patients were examined five years after surgery.

Background:

Pulmonary valve replacement is needed in many patients with congenital heart disease. Homografts have limited availability and predictable degeneration, and mechanical valves require anticoagulation. No superiority of one kind of pulmonary valve replacement has been shown. Biological valves that are readily available are being used and evaluated in increasing numbers.

Methods:

In this cross-sectional study, five years following surgery, data were gathered from hospital charts, echocardiography, stress echocardiography, magnetic resonance imaging, and exercise testing.

Results:

In 90 patients, there were three new valve replacements, one early cardiac death, and four late noncardiac deaths. Echocardiographic assessment of the study group showed pulmonary Doppler velocities (m/s) before, after operation, and at five-year follow-up of 2.8 ± 1.1, 1.6 ± 0.4, and 2.3 ± 0.7, respectively. The assessed insufficiencies (0-3) at the same times were 2.3 ± 1.0, 0.3 ± 0.4, and 1.1 ± 0.8. Maximal oxygen uptake increased from 65.6% ± 10.1% to 77.1% ± 18.2% of predicted and QRS width increased by 7 ± 23ms. Valve degeneration could be associated with young age but not with diagnosis or valve size.

Conclusion:

In our study, the biological valve in the pulmonary position showed excellent mid-term results with few reoperations, low gradients, and mild to moderate insufficiency. Oversizing, in contrast to young age, was not a risk factor for valve degeneration. In younger patients, this allows later percutaneous replacement, reducing the need for further surgery. However, longer follow-up is needed.

Effects of obstructive sleep apnea and obesity on exercise function in children

STUDY OBJECTIVES

Evaluate the relative contributions of weight status and obstructive sleep apnea (OSA) to cardiopulmonary exercise responses in children.

DESIGN

Prospective, cross-sectional study. Participants underwent anthropometric measurements, overnight polysomnography, spirometry, cardiopulmonary exercise function testing on a cycle ergometer, and cardiac doppler imaging. OSA was defined as ≥ 1 obstructive apnea or hypopnea per hour of sleep (OAHI). The effect of OSA on exercise function was evaluated after the parameters were corrected for body mass index (BMI) z-scores. Similarly, the effect of obesity on exercise function was examined when the variables were adjusted for OAHI.

SETTING

Tertiary pediatric hospital.

PARTICIPANTS

Healthy weight and obese children, aged 7-12 y.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Seventy-one children were studied. In comparison with weight-matched children without OSA, children with OSA had a lower cardiac output, stroke volume index, heart rate, and oxygen consumption (VO2 peak) at peak exercise capacity. After adjusting for BMI z-score, children with OSA had 1.5 L/min (95% confidence interval -2.3 to -0.6 L/min; P = 0.001) lower cardiac output at peak exercise capacity, but minute ventilation and ventilatory responses to exercise were not affected. Obesity was only associated with physical deconditioning. Cardiac dysfunction was associated with the frequency of respiratory-related arousals, the severity of hypoxia, and heart rate during sleep.

CONCLUSIONS

Children with OSA are exercise limited due to a reduced cardiac output and VO2 peak at peak exercise capacity, independent of their weight status. Comorbid OSA can further decrease exercise performance in obese children.

Peak oxygen uptake and physical activity in 13- to 18-year-olds: the Young-HUNT study

PURPOSE

The present study describes the distribution of cardiorespiratory fitness (VO2peak) in a large sample of healthy adolescents and the associations between VO2peak, self-reported physical activity, and a selection of conventional markers for future cardiovascular health.

METHODS

In a substudy of the Young-HUNT study in Norway, 570 adolescents (289 girls and 281 boys) 13–18 yr. old were tested for directly measured VO2peak. Blood pressure, resting heart rate, height, weight, and waist circumference was measured by standardized procedures. Data about physical activity and pubertal development were obtained using self-administered questionnaires. General linear modeling and ANOVA were used to examine the relationships between VO2peak and age, physical activity, and cardiovascular risk factors.

RESULTS

The mean T SD VO2peak was 183.9 +/- 24.6 mL x kg(-0.67) x min(-1) (49.2 mL x kg(-0.67) x min(-1)) in girls and 235.1 +/- 35.3 mL x kg(-0.67) x min(-1) (59.5 mL x kg(-0.67) x min(-1)) in boys. Absolute VO2peak (L x min(-1)) was consistently higher in older age groups in both sexes (P trend < 0.001). VO2peak allometrically scaled to body mass (mL x kg(-0.67) x min(-1)) was similar across the age groups in girls (i.e., difference between 13- to 14-yr-olds and 17- to 18-yr-olds = -3.2 mL x kg(-0.67) x min(-1), 95% confidence interval = 3.8 to -10.1) and slightly higher in the older age groups in boys (i.e., difference between 13- to 14-yr-olds and 15- to 16-yr-olds = -31.0 mL x kg(-0.67) x min(-1), 95% confidence interval = -22.0 to -40.1). Physical activity was positively associated with VO2peak in all sex and age groups. Quartiles of VO2peak were inversely associated with resting heart rate (P trend = 0.004) in both sexes and body mass index (P trend = 0.004) and waist circumference (P trend = 0.006) in boys.

CONCLUSION

Although VO2peak was generally high across the age groups, VO2peak was higher in physically active adolescents of both sexes and physical activity in accordance with the recommended level may be sufficient to maintain or even increase VO2peak through adolescence.

Quality of life and psychosocial functioning of children with cardiac arrhythmias

Childhood cardiac arrhythmias may have a long-lasting impact on a family and typically require long-term medical follow-up. Whereas some arrhythmias are benign, others can be life threatening and require significant medical care. As with many chronic illnesses, it is important to study the potential psychosocial effects of childhood arrhythmias and how they may impact a child's quality of life. The purpose of this study was to create a quality of life measure specific to childhood arrhythmias and to describe the current psychosocial functioning of this population. A total of 46 families participated in a one-time paper and pencil assessment during their regularly scheduled clinic visits. Results indicated promise for the validity and reliability of this new measure. Children in the current sample also demonstrated a high degree of resiliency. Additional analyses with larger samples will be needed to verify the psychometric properties of this measure. Overall, the high functioning of many of these children despite medical trauma is promising. Future studies should consider using some screening measures to decide which children may be most in need of intervention.

Left ventricular function in children and adults after renal transplantation in childhood

BACKGROUND

Renal transplantation improves left ventricular (LV) function, but cardiovascular mortality remains elevated. The aim of this cross-sectional study was to determine whether subclinical abnormalities of LV longitudinal function also persist in patients who underwent renal transplant in childhood.

METHODS

Conventional and speckle tracking echocardiography was performed in 68 renal transplant recipients (34 children and 34 adults, median 9.8 years (range 2.0-28.4 years) after first transplantation and 68 age- and sex-matched healthy controls.

RESULTS

Mean age at first transplantation was 8.8 ± 4.8 years. Forty-three percent had a pre-emptive transplant. Of the remaining, 70% received haemodialysis and 30% peritoneal dialysis on average for 6.9 months. Thirty-one percent of paediatric and 35% of adult patients had hypertension. LV mass index was increased in adult patients (92 ± 24 vs 75 ± 11 g/m(2), P< 0.01). LV diastolic function and exercise capacity were impaired in both paediatric and adult patients. LV longitudinal peak systolic strain and strain rate were comparable in patients and controls. In multivariate analysis, systolic blood pressure and LV diastolic relaxation were the main covariates of LV peak systolic strain and strain rate (all P < 0.01).

CONCLUSIONS

Patients who underwent renal transplantation in childhood have abnormal LV diastolic function and impaired exercise capacity, despite preserved LV longitudinal systolic deformation.

Mechanisms of exercise-induced pulmonary hypertension in patients with cardiac septal defects

The objective of this study was to investigate mechanisms of exercise-induced pulmonary hypertension in patients with congenital cardiac septal defects. This was a randomized, placebo controlled, crossover drug trial in a single national pediatric cardiology centre that performs congenital cardiac defect surgery. There were 14 patients with cardiac septal defects and known exercise-induced pulmonary hypertension. The intervention consisted of 50 mg oral sildenafil versus placebo. Measurements included supine bicycle exercise echocardiography and oxygen uptake. The outcome measure was right-ventricular systolic pressure as estimated by Doppler tracings of tricuspid regurgitant jet as well as systolic and diastolic longitudinal myocardial velocities by color tissue Doppler echocardiography. Sildenafil did not change exercise right-ventricular systolic pressure during exercise; however, decreased systemic systolic pressure was seen. Enhanced biventricular longitudinal function with sildenafil compared with placebo was indicated by greater tissue Doppler velocities and displacement measurements during exercise. Finally, a less steep increase of right-ventricular pressure during exercise was associated with greater left-ventricular diastolic myocardial tissue Doppler velocity. Exercise-induced pulmonary hypertension in cardiac septal defects does not seem to have a pulmonary vasoconstrictive component, but it may be related to left-ventricular filling pressure. Furthermore, sildenafil improved biventricular systolic performance in this patient group, possibly related to decreased systemic afterload.

Objectively assessed physical activity and sedentary behaviour does not differ between children and adolescents with and without a congenital heart defect: a pilot examination

OBJECTIVES

To objectively evaluate and describe physical activity levels in children with a stable congenital heart defect and compare those levels with children who do not have a congenital heart defect.

METHODS

We matched 21 pairs of children for gender and grade in school and gave them an accelerometer-based motion sensor to wear for 7 consecutive days.

RESULTS

Physical activity levels did not differ between children with and without a congenital heart defect. During the 7 days of monitoring, children in this study spent most of their time in sedentary behaviours, that is, 6.7 hours of the 13 monitored hours, 54 minutes in moderate-intensity physical activity, and 12 minutes in vigorous-intensity physical activity. Less than one-fifth of all participants, with or without a congenital heart defect, accumulated sufficient physical activity to meet current physical activity recommendations for children and adolescents.

CONCLUSION

Children with a stable congenital heart defect have activity behaviours that are similar to children without a congenital heart defect. Habitual physical activity in children with a congenital heart defect should be encouraged early on in life to develop strong physical activity habits that will hopefully follow them across their lifespan.

Physical activity and obesity in children with congenital cardiac disease

BACKGROUND

Children with congenital cardiac disease experience challenges in developing healthy patterns of physical activity due to decreased exercise capacity and parental fear and confusion about what is permissible. The purpose of this study was to describe physical activity habits in children 10-14 years of age with congenital cardiac disease and the relationship of those habits to obesity as defined by body mass index.

METHODS

This cross-sectional study used self-report measures and clinical data to describe the association between physical activity participation and body mass index in 10- to 14-year-old children with congenital cardiac disease. Further, physical activity levels were compared between children who were overweight or obese and those who were not.

RESULTS

Children (n = 84; 51 males; 33 females) reported low rates of physical activity compared to reports on healthy children. Only 9.5% were overweight (body mass index between the 85th and 94th percentile), and alarmingly 26% were obese (body mass index at or above the 95th percentile). Physical activity and body mass index were not significantly correlated (r = -0.11, p = 0.45) and there was no significant difference in mean physical activity (t = 0.67) between children who were overweight or obese and those who were not.

CONCLUSIONS

Children in this study reported low rates of physical activity and a higher obesity rate than was reported in previous studies. However, the two were not significantly correlated. Further research is indicated to determine the specific factors contributing to obesity and to test interventions to combat obesity in children with congenital cardiac disease.

Changes in cardiorespiratory fitness predict changes in body composition from childhood to adolescence: findings from the European Youth Heart Study

BACKGROUND

Several variables, such as waist circumference (WC) and trunk skinfolds (TS), are indicators of body fat. There is interest in evaluating the effect of cardiorespiratory fitness (CRF) measures on changes in these markers from childhood to adolescence.

PURPOSE

To examine CRF as a potential predictor of changes in body fat over an 8-year follow-up period in a pediatric population.

METHODS

A cohort study of 86 children (44 girls, 42 boys) with a mean age of 9.8 ± 0.3 years who participated in the Portuguese arm of the European Youth Heart Study in 2000 completed a follow-up evaluation in 2008 at a mean age of 17.0 ± 0.4 years. Cardiorespiratory fitness, expressed as maximal oxygen consumption (VO2 max) (mL·kg(-1)·min(-1)), was assessed during an incremental multistage bicycle test to exhaustion. Physical activity (PA) was objectively measured by accelerometry at both periods of evaluation. Fat mass (FM) was assessed using anthropometric models, sum of TS, and WC. Changes were expressed as a percentage of the baseline value. Comparison of means and linear regression analysis were used for data analysis.

RESULTS

While CRF significantly increased among boys (P < 0.05) and decreased in girls (P < 0.01), the percentage of body fat decreased over time in boys (P < 0.01) and increased among girls. Alone, CRF explained 39%, 26%, and 25% of the total variance in WC, FM, and TS, respectively (P < 0.01). Adjusting for PA, sex, and maturation changes, CRF remained a significant predictor of WC (β = -0.335; P < 0.01), FM (β = -2.084; P < 0.01), and TS (β = -1.500; P < 0.01).

CONCLUSION

Changes in CRF are a significant predictor of changes in body fat percentage from childhood to adolescence. School-based PA interventions are encouraged to maintain or improve CRF from childhood and throughout adolescence to prevent increased percentages of body fat, particularly in the abdominal region.

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.

Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children

Children with renal transplants (TX) are at increased risk of cardiovascular (CV) disease. Study objectives were to assess the level of cardiorespiratory fitness (CR fitness) and daily physical activity (PA) in renal TX children and adolescents in relation to traditional cardiovascular risk factors. Laboratory testing included assessment of CR fitness by treadmill exercise testing (VO(2peak)), 24-h ambulatory blood-pressure (ABPM) measurement, oral glucose tolerance test (OGTT), anthropometrics and measurement of lipid levels. PA was self-reported by questionnaire. Twenty-two TX patients with a median (range) age 14.5 (9-18) years were tested. Median V0(2peak) was 66% (36-97) of the expected values compared with controls. Nineteen (86%) children reported <60 min of daily moderate to vigorous physical activity (MVPA). Sixteen (73%) were hypertensive and 8 (34%) were overweight or obese. Four children fulfilled the criteria for a metabolic syndrome. Children with at least 2 of the 3 metabolic risk factors (hypertension, overweight, and glucose intolerance, n=7) achieved significantly lower VO(2peak) compared with those with one or none of these factors (median V0(2peak) 45% and 73% of the expected values respectively, p=0.003). Renal TX children and adolescents have severely impaired CR fitness and PA. Reduced CR fitness was associated with the clustering of CV risk factors. Routine counseling for increased PA is strongly recommended.

Right ventricular systolic pressure response during exercise in adolescents born with atrial or ventricular septal defect

Our study investigated the abnormal right ventricular systolic pressure response (RVPR) in young patients with isolated atrial septal defect (ASD) or ventricular septal defect (VSD). An abnormal RVPR >50 mm Hg during exercise has been identified as a precursor of pulmonary artery hypertension. The present study included a population-based selection of 44 patients (age 13 to 25 years) with either isolated VSD (n = 27) or ASD (n = 17) and without right ventricular outflow tract obstruction. Of the 44 defects, 28 had been surgically closed (17 ASDs and 11 VSDs); 16 minor VSDs were untreated. Cardiovascular exercise testing and echocardiography at rest and during exercise were performed for all patients and 88 healthy controls. The aerobic capacity was significantly reduced in all patient groups (open VSD, closed VSD, closed ASD). The measurements of right ventricular performance were significantly lower in patients with closed ASD or closed VSD compared to those of the controls and patients with open VSD. Finally, 5% of the controls, no patient with ASD, and 9 patients with VSD (33%), regardless of defect closure, had an abnormal RVPR during exercise. In conclusion, 1/3 of young patients with isolated VSD had an abnormal RVPR during exercise.

Non-invasive measurement of the response of right ventricular pressure to exercise, and its relation to aerobic capacity

INTRODUCTION

Exercise echocardiography assesses exercise-induced pulmonary hypertension. The upper normal limit of right ventricular systolic pressure during exercise is not well established. Our study aims to investigate the response of right ventricular systolic pressure in relation to aerobic capacity.

METHODS AND RESULTS

Cardiopulmonary exercise testing using a treadmill, and echocardiography during supine cycling, were performed in 113 healthy volunteers aged 13 to 25 years. Maximal right ventricular systolic pressure during evaluable exercise studies obtained in 108 subjects showed a Gaussian distribution only after separating the endurance trained subjects, specifically 12 athletes with Z-score of peak oxygen uptake higher than 2.0, from the normally trained group of 97 subjects. Maximal right ventricular systolic pressure during exercise in the normally trained group showed a mean of 38.0 millimetres of mercury, with standard deviation of 7.2, a median value of 39.0, and a range from 17 to 63, and the 95th percentile was 51 millimetres of mercury. In the athletes, the maximal right ventricular systolic pressure was higher, with a median of 55.5, a range from 28 to 69, this being significant, with p equal to 0.004). Of the 12 athletes, 8 (67%) showed a response of right ventricular systolic pressure to exercise exceeding 50 millimetres of mercury, but only 8 of 97 normally trained subjects (8%) showed a similar response, this also being significant, with p less than 0.001.

CONCLUSIONS

Our study confirms the great variability in the response of right ventricular systolic pressure to exercise in healthy individuals, with 50 millimetres of mercury representing the upper normal limit. Endurance-trained athletes show higher levels, and two-thirds have abnormal responses exceeding 50 millimetres of mercury.

Physical activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects

AIM

To investigate physical activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects.

SUBJECTS AND METHODS

Children who had undergone surgery for congenital heart defects and healthy controls in the Gothenburg area were invited to participate in the study. All participants were aged 9-11 or 14-16 years. The activity monitor ActiReg was used to assess physical activity. Participants were interviewed about their participation in sports and performed a maximal exercise test on a bicycle with measured oxygen uptake.

RESULTS

A total of 32 and 25 patients, and 61 and 45 controls, in the two age-groups were included, respectively. The patients had a wide range of severity of congenital heart defects. The physical activity level was similar in the patients and the controls. The rate of sports participation was high for both patients and controls; 80-94% of all participants took part in sports at least once a week. The majority of the patients were considered to have at least a moderate level of aerobic fitness.

CONCLUSIONS

Although children who have undergone surgery for congenital heart defects have a similar level of physical activity compared with that of healthy children, some of them may require support to participate in exercise and vigorous physical activity.

Ventricular function in patients with transposition of the great arteries operated with arterial switch

The study aim was to investigate ventricular function at long-term follow-up in patients operated with arterial switch for transposition of the great arteries (TGAs). Although midterm results for anatomic correction of TGA are promising, there are reported minor alterations in left ventricular (LV) function possibly indicating myocardial dysfunction. Twenty-two patients with TGAs 12.4 +/- 2.3 years old operated with arterial switch were studied by magnetic resonance imaging and echocardiography. Twenty-two age-matched healthy subjects served as controls. Myocardial deformation was described by longitudinal and circumferential shortening (measured as strain and strain rate) and ventricular torsion, measured by speckle-tracking echocardiography. Although standard measurements of global systolic LV function were normal in patients with TGAs, longitudinal shortening was decreased compared with controls. Longitudinal strain was decreased in all ventricular regions except the posterior wall and most pronounced in the apical segments. LV circumferential shortening was similar in the 2 groups. Also, in the right ventricular free wall patients displayed decreased longitudinal shortening in the mid and apical segment. Moreover, LV torsion was decreased in the TGA group. Although rotation was relatively homogenous at the apical and basal levels in controls, there was greater dispersion in rotation in the patient group, with basal rotation being greatest in the inferior wall and apical rotation being greatest in the anterior wall. In conclusion, there was slightly decreased longitudinal shortening in the 2 ventricles and decreased LV torsion in patients with TGAs, although standard measurements of global ventricular function were normal.

Children and adolescents with congenital heart disease: assessment of behavioural and emotional problems

OBJECTIVE

The objective of the study was to assess behavioural and emotional problems in children and adolescents with congenital cardiac disease.

DESIGN

From the database of Paediatric Heart Section, Rikshospitalet University Hospital, Norway, 430 patients and their parents were included and received questionnaires of youth self-report and child behavior checklist. The response rate was 71.4%.

RESULTS

Compared to their parents children with congenital heart disease reported more behavioural and emotional problems. Boys scored significantly higher than girls in total problem score and externalising scores with more social problems, attention problems, delinquent behaviour and aggressive behaviour. No gender difference was found regarding internalising problem score. Compared to healthy boys, no differences were found in total problem, externalising or internalising score. In girls lower values were found in patients than healthy children for total problem, externalising and internalising scores.

CONCLUSIONS

In the present study boys scored themselves higher with regard to total problem score than girls. No effect was found of due to different diagnoses. The data indicate that the children experience more problems than the parents are aware of. However, the behaviour problem scores in children with cardiac disease are significantly lower than in healthy children. A close parental follow-up and an experience of being exposed to life-threatening situation may play a role for the latter results.

Objectively assessed physical activity and aerobic fitness in a population-based sample of Norwegian 9- and 15-year-olds

The present study described current physical activity, determined compliance with physical activity guidelines and assessed aerobic fitness in a nationally representative sample of 9- and 15-year-olds in Norway. In 2005-2006, 2299 children and adolescents were randomly recruited. The participation rate was 89% and 74% among the 9- and 15-year-olds, respectively. Physical activity was assessed objectively by accelerometry, and aerobic fitness was measured directly as peak oxygen uptake during a cycle ergometry test. Boys were more physically active than girls, and 9-year-olds were substantially more active than 15-year-olds. Physical activity was higher during weekdays than weekends, and 9-year-olds were most active during spring. While four out of five children met current physical activity guidelines, only half of the adolescents did. The mean (SD) values for peak VO2 were: 9-year-old boys, 48.2 (7.1) mL/min/kg; 9-year-old girls, 42.9 (6.7) mL/min/kg; and 15-year-old girls 41.1 (6.0) mL/min/kg and 15-year-old boys 51.9 (8.0) mL/min/kg. Because of the high participation rate, this study provides a good description of the physical activity and aerobic fitness in the young population. Finally, girls and adolescents seem appropriate targets when promoting physical activity in order to increase the proportion meeting the recommendations.

Declining aerobic capacity of patients with arterial and atrial switch procedures

BACKGROUND

Patients with transposition of the great arteries corrected by an atrial switch procedure are believed to have a worse physical outcome than patients with an arterial switch procedure correction. This study aimed to compare exercise data for patients with the two surgical methods.

METHODS

This study retrospectively analyzed exercise treadmill test results for 7- to 17-year-old patients who underwent either an atrial switch procedure (n=45) or an arterial switch procedure (n=44). The results were compared with reference material.

RESULTS

Both groups showed significantly less aerobic capacity than healthy subjects. The atrial switch patients achieved 69% of reference status, and the arterial switch patients achieved 82%. A gradual decline in exercise capacity with increasing age was shown for patients with atrial switch circulation (p<0.0001). No significant difference was found for the arterial switch group (p=0.319).

CONCLUSIONS

Significantly less aerobic capacity was found in atrial and arterial switch patients than in healthy subjects. A decline in aerobic capacity with increasing age was found in the atrial switch patients. However, the small number of teenagers in the arterial switch group limits the ability to be conclusive. The results indicate that chronotropic incompetence may be one of the reasons for diminishing capacity. The decline in exercise performance leads the authors to recommend regular follow-up exercise testing.

A practical and transferable new protocol for treadmill testing of children and adults

BACKGROUND

It is just as vital to have an exact overview of the physical fitness of young and growing people as it is for adults. The currently used exercise protocols have limitations in healthy small children, and in senior citizens. In particular with chronically ill patients, regardless of their age, there is a need for an exercise protocol that permits observations over the long term. With this need in mind, we have designed a new transferable standardised exercise protocol, constructing reference values based on improved assessments on a treadmill that permitted stepwise increases of speed and gradient every 90 seconds - the so called treadmill protocol from the German Society of Paediatric Cardiology.

OBJECTIVES

We investigated the exercise performance in a healthy Caucasian population ranging in age from 4 to 75 years.

METHODS

We measured, using a prospective study design, the distance run, the endurance, and the consumption of oxygen in 548 females and 647 males undergoing an enhanced spiroergometric treadmill protocol in two centres.

RESULTS AND CONCLUSIONS

Until puberty, boys and girls have the same indicators of exercise performance. Subsequent to puberty, uptake of oxygen and distance run differ, with males showing higher uptake of oxygen. There is still an age-dependent dynamic of peak uptake of oxygen related to body surface area. Using these new reference values, covering the whole range of age, it proves possible to compare performance during growth and aging of the individual. In this fashion, we have calculated centiles for all recorded variables. External calibration, validation and quality control ensures transferability of our data to other spiroergometry units.

Exercise capacity and participation of children with a ventricular septal defect

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

Exercise capacity and exercise hypertension after surgical repair of isolated aortic coarctation

There are contradictory reports whether exercise capacity is reduced in patients on long-term follow-up after coarctation repair. Data from unselected patient groups are missing. In a cross-sectional, long-term follow-up study of a tertiary congenital cardiology referral center, 260 patients (30.2+/-11.4 years old, 84 women), after surgical repair for isolated aortic coarctation (age at surgery 11.5+/-11.2 years), underwent a symptom-limited exercise test. Peak workload was 180+/-52 W, significantly less than the age- and height-related reference values (p<0.0005). A peak workload under 80% of expected was found in 200 patients (77%). Exercise performance of the patients was independent from age at surgery, type of surgery, or the systolic brachial-ankle blood pressure difference. The only exercise-limiting factor found was the chronic administration of diuretics to treat hypertension (p=0.005). Exercise hypertension, defined as a systolic blood pressure >2 SD above the load-dependent reference value, was found in 73 patients (28%). It was independently related to the systolic brachial-ankle blood pressure difference (p<0.0005) and diuretics administration (p=0.037). In conclusion, most patients after coarctation repair have a reduced exercise performance. This reduction is not related to the surgical results. Particularly, as these patients are at risk of early atherosclerosis, exercise should be promoted as primary prevention after restenosis, aortic or cerebral aneurysms, and severe exercise hypertension are ruled out.

Assessment of exercise capacity and respiratory muscle oxygenation in healthy children and children with congenital heart diseases

Muscular and cardiorespiratory dysfunction contributes to exercise intolerance. Therefore, the aim of the present study was to characterize the cardiopulmonary response andrespiratory muscle oxygenation of children with congenital heart diseases (CHD) when compared with those of healthy children. Twelve children with CHD in New York Heart Association (NYHA) class II or III, and 14 healthy children participated in the study. All subjects performed conventional spirographic measurements and a cardiopulmonary exercise test on a cycle ergometer. Oxygen uptake (VO2), carbon dioxide production (VCO2), minute ventilation (VE), heart rate (HR), and power output were measured. Oxygenation of respiratory muscles was assessed by near-infrared spectroscopy (NIRS) during exercise and recovery. Pulmonary function was normal and no significant difference was found between groups. At rest, CHD patients had cardiorespiratory variables comparable with those of the healthy group. At submaximal intensity (ventilatory threshold) and at peak exercise, power output, HR, VO2, VCO2, and VE were significantly reduced (p < 0.01) in CHD patients. Respiratory muscles deoxygenated during exercise in both groups. However, deoxygenation was more pronounced in the CHD group than in the healthy children from an intensity of 40% up to exhaustion. Likewise, children with CHD showed a slower recovery of oxygenation than healthy children (113.4 ± 17.5 vs. 74.6 ± 13.0 s; p < 0.001). Compared with healthy children, these results demonstrated that children with CHD have reduced performance and present a defected exercise capacity. Children with CHD showed a more pronounced decrease of respiratory muscle oxygenation and slower recovery of oxygen kinetics.

Health-promoting behavior of adolescents with congenital heart disease

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Motor development in children with congenital cardiac diseases compared to their healthy peers

Their perceptual and motor experiences determine the physical and motor development of children, and impact also on their emotional, psychosocial, and cognitive development. Our aim, therefore, was to evaluate motor development in children with congenitally malformed hearts compared to their healthy peers. We compared 194 children, with a mean age of 10.0 years, and standard deviation of 2.7 years, representing the entire spectrum of congenital cardiac disease, to a control group of 455 healthy children, having a mean age 9.6 years, with standard deviation of 2.17 years. The bodily coordination test for children was used to examine motor development. Of the children with congenitally malformed hearts, 26.8% showed moderate, and 31.9% had severe disturbances of motor development, compared to 16.5% and 5.5% of the control group, the p-value for these differences being less than 0.001. The mean motor quotient adjusted for age and gender was lower in the children with congenitally malformed hearts than in their healthy peers, at 79.6, with standard deviation of 18.9 as opposed to 96.6, with standard deviation of 15, this difference having a p-value of less than 0.001. Depending on the presence, and/or the degree, of residual sequels, the children with congenitally malformed hearts were divided into two subgroups, with either no or mild residual sequels, or with significant sequels. The mean motor quotient was lower in those with significant residual sequels, at 75, with standard deviation of 19.3, as opposed to 83, with standard deviation of 17.9, the p-value for this difference being less than 0.01. In both subgroups, the mean motor quotient was lower, with a p-value of less than 0.01, than in the control group. Our findings show that children with congenitally malformed hearts have deficits in their motor development, these being found in the presence of no or mild sequels, as well as with significant residual sequels. Parental overprotection may contribute to these findings.

Indications for Heart Transplantation in Pediatric Heart Disease

Background— Since the initial utilization of heart transplantation as therapy for end-stage pediatric heart disease, improvements have occurred in outcomes with heart transplantation and surgical therapies for congenital heart disease along with the application of medical therapies to pediatric heart failure that have improved outcomes in adults. These events justify a reevaluation of the indications for heart transplantation in congenital heart disease and other causes of pediatric heart failure.

Methods and Results— A working group was commissioned to review accumulated experience with pediatric heart transplantation and its use in patients with unrepaired and/or previously repaired or palliated congenital heart disease (children and adults), in patients with pediatric cardiomyopathies, and in pediatric patients with prior heart transplantation. Evidence-based guidelines for the indications for heart transplantation or retransplantation for these conditions were developed.

Conclusions— This evaluation has led to the development and refinement of indications for heart transplantation for patients with congenital heart disease and pediatric cardiomyopathies in addition to indications for pediatric heart retransplantation.

Understanding the basics of cardiopulmonary exercise testing

Cardiopulmonary exercise testing adds important additional information to that provided by the standard exercise test. In particular, cardiopulmonary exercise testing provides precise determination of aerobic capacity, the causes of dyspnea with exertion, and prognosis in patients with systolic heart failure. This review provides basic, practical information about cardiopulmonary exercise testing for the clinician.

Exercise Intolerance in Adults with Congenital Heart Disease

This article describes the ways to assess exercise capacity in adults with congenital heart disease (ACHD) and the impact of exercise intolerance in the population. It also discusses the likely pathogenesis of exercise intolerance in ACHD, the similarities between ACHD and acquired heart failure, and potential therapeutic options.

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

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

Exercise capacity in pediatric heart transplant candidates: is there any role for the 14 ml/kg/min guideline?

A peak oxygen consumption (VO2) of < 14 ml/kg/min has been identified as a predictor of l-year mortality in adults with congestive heart failure (CHF) and is used as a criterion for listing for cardiac transplantation (OHT). The role of VO2 measurement in children awaiting OHT has not been thoroughly evaluated. We sought to assess the degree of exercise impairment and the clinical applicability of the 14 ml/kg/min rule in children awaiting OHT. Cardiopulmonary exercise test (CPT) and cardiac catheterization data in all patients listed for OHT during the period of 1995-2003 were reviewed. Fourteen patients with a mean age of 15.5 +/- 2.9 years underwent CPT with no serious adverse events at an interval of 6.6 +/- 5.1 months prior to OHT. The etiology of CHF was multifactorial. Patients had impaired aerobic capacity with a mean peak VO2 of 20.4 +/- 6.8 ml/kg/min. Eleven of 14 patients (79%) had a peak VO2 higher than the adult cutoff value of 14 ml/kg/min. Pediatric ambulatory patients with CHF can safely undergo CPT. Because of age-related differences in oxygen consumption and varied etiologies of CHF a peak VO2 of < 14 ml/kg/min is not a useful criterion for listing for OHT in this population.

Follow-up in patients with congenital cardiac disease more complex than haemodynamic assessment

The objective of the study was to assess behavioural and emotional problems, as well as physical capacity, in children and adolescents with congenital cardiac disease. From the database of Paediatric Heart Section, Children's Clinic, Rikshospitalet University Hospital, Oslo, Norway, we identified 430 patients whose parents received questionnaires using the Child Behaviour Check-List. The response rate was 75.8%. In addition, the parents received a questionnaire focusing on special issues with regard to physical activity. Parents of children and adolescents with congenital cardiac diseases reported significantly more behavioural problems than did a reference population and boys were scored higher compared to girls. Analysis showed a significant impact of physical capacity on the score representing total problems, as well as scores for externalising and internalising behaviour. Compared to a reference population, parents of children and adolescents with congenital cardiac disease score their children higher on most scales when rated using the Child Behaviour Check-List. The type of diagnosis did not affect the scores reflecting the total problem. The main factor of impact on behavioural problems was, as evaluated by the parents, the physical capacity of the children.

Physical activity levels of adolescents with congenital heart disease

Regular physical activity prevents chronic disease and moderate to vigorous participation provides additional health benefits. Therefore, adolescents with congenital heart disease risk developing latent diseases due to real or perceived physical activity restrictions. Habitual physical activity levels, psychological determinants and advice received were examined by postal survey of 434 West Australian adolescents aged 12-18 years with congenital heart disease. Survey results (n = 153) were compared with published normative adolescent data. Total activity was classified as vigorous, adequate or inadequate according to metabolic equivalents, reported frequency and duration. Comparable numbers of respondents and healthy peers were active (winter 62% vs 74%; and summer 73% vs 82% respectively, p = 0.27). However, significantly fewer male respondents were classified as vigorously active compared with healthy peers, in both winter (48% vs 67%, p < 0.02), and summer (48% vs 69%, p = 0.04). Similar, but non-significant, trends were found when comparing female respondents with healthy peers and for mild versus severe disease groups. Self-efficacy ratings did not explain differences in physical activity intensity. Congenital heart disease may impact on the intensity of physical activity undertaken by affected adolescents thus denying additional health benefits. Physiotherapists could facilitate these adolescents to achieve more moderate to vigorous physical activity, to offset adult sedentary behaviour.

Aerobic capacity in adults with various congenital heart diseases

As an increasing number of patients with congenital heart disease reach adulthood, more information is needed regarding outcomes. The first signs of impaired heart function may appear during exercise testing. The aim of the present study was to establish mean values for maximal oxygen uptake in adults with various congenital heart diseases. Patients from 6 major diagnostic groups were identified, including patients with atrial septal defect (ASD, n = 93), transposition of the great arteries corrected with the Mustard procedure (n = 84), congenitally corrected transposition of the great arteries (CCTGA, n = 41), Tetralogy of Fallot (n = 168), Ebstein's anomaly (n = 37), and Modified Fontan procedure (n = 52). Diminished maximal oxygen uptake was found in all diagnostic groups across age compared with healthy subjects. A significant decrease in maximal oxygen uptake with aging was found in those with ASD (p <0.0001), CCTGA (p = 0.01), and Tetralogy of Fallot (p <0.0001). There was no significant decline, however, in Ebstein's anomaly (p = 0.270), Fontan procedure (p = 0.182), and in the Mustard patients (p = 0.188). All patients achieved significantly lower heart rates than predicted (mean for all groups, p <0.0001). Forced vital capacity values (3.51 L, mean SD +/- 1.02) were lower than predicted values (4.10 L, mean SD +/- 0.90, p <0.0001) for all patients groups except those with ASD. Mean values, however, were within the accepted 20% range of variance. This study showed diminished aerobic capacity in all diagnostic groups when compared with a healthy population. The maximal oxygen uptake values across age groups can be used as reference values in patients with similar diagnoses and as the basis for further research.

Effect of physical training in children and adolescents with congenital heart disease

In order to test the effect of systematic supervised physical training, we divided a total of 129 children and adolescents with congenital heart disease into a group undergoing intervention and a control group. All patients underwent exercise tests, measurements of physical activity, and a survey of psychosocial factors. An improvement in uptake of peak level of oxygen was observed after intervention. There was also an improvement in physical activity in both groups measured by a monitor, although this was significant only in those with intervention. The psychosocial scales measured by the Child Behavior Checklist showed a decrease in internalizing scores for those subjected to intervention. This was decreased due to decreased withdrawal and somatic complaints. In conclusion, we recommend systematic supervised training, including testing of routine follow-ups, in patients with congenital heart disease.

Physical activity in children and adolescents with congenital heart disease. Aspects of measurements with an activity monitor

The aim of the present study was to evaluate different aspects of a device designed to monitor physical activity. Measurements of different axes and placement of the monitor were tested using a treadmill with ranging increments in incline or speed. The monitor was also used to assess the level of physical activity among children and adolescents with congenital heart disease and in healthy controls at the same age. The results indicate that the monitor is a valid and reproducible instrument for measurements of physical activity. The study revealed that the level of activity was higher for healthy boys than healthy girls (p<0.0001). Boys with congenital heart disease also displayed higher values compared to girls with congenital heart disease, although the difference was not significant (p=0.067). Healthy boys revealed a significantly higher level of activity than did boys with congenital heart disease (p=0.003), but no such difference was found in girls (p=0.757). Nor were any differences found between younger and older individuals among patients with congenital heart disease. Young healthy controls, however, showed significantly higher levels of activity than their older counterparts. There were differences in activity monitored during the week, with lower activity in the weekends, but the activity on the same day in different weeks seemed stable. Neither were there any differences between measurements over whole weeks. The results indicate that the Computer Science & Application monitor is a valid instrument for assessing physical activity. The monitor may also be used, therefore, to validate the levels of physical activity level in children with congenital heart disease after medical and surgical treatment.