Enablers and barriers for being physically active: experiences from adults with congenital heart disease

Children With Congenital Heart Disease and the Canadian 24-Hour Movement Guidelines: A Scoping Review

Factors such as physical activity (PA), sedentary time, screen time, and sleep affect the holistic health of children with congenital heart disease (CHD). Despite this, their proximity to reaching the Canadian 24-hour movement guidelines is unknown. This review sought to synthesize evidence for PA, sedentary time, screen time, and sleep behaviour of children with CHD and compare them with the Canadian 24-hour movement guidelines. Six online databases were searched for research published from January 2010 to May 2024. Eligible articles included research involving children aged 4-20 years with any type of CHD lesion as well as a measure of one of PA, sedentary time, screen time, or sleep, reported in a unit of time. The search resulted in 9199 articles, and after removing ineligible articles, 30 were identified for this review. Of the included articles, 30 measured moderate-to-vigorous PA (MVPA), 8 measured light PA, 14 measured sedentary time, 1 measured screen time, and 3 measured sleep time. Forty percent of studies reported that children with CHD met the MVPA guidelines. Within these, a subset of studies (n = 20) examined the percentage of the sample that reached the guideline and found that an average of 43% of children with CHD attained the MVPA guideline. No conclusions could be made for light PA or sedentary time because there is no clear quantification or numerical recommendation in the Canadian 24-hour movement guidelines. In addition, future research should include evaluations of the screen and sleep time of children with CHD due to very limited research in the area.

Daily physical activity and cardiorespiratory fitness in adults with Down syndrome with and without congenital heart disease

BACKGROUND

Individuals with Down syndrome (DS) typically exhibit lower cardiorespiratory fitness and reduced moderate-to-vigorous physical activity (MVPA) compared to persons without disability. Approximately 50-55 % of individuals with DS have congenital heart disease (CHD), which is associated with cardiopulmonary deficiencies and reduced MVPA participation in non-DS populations. It is unknown if CHD related comorbidities compound with DS associated deficits in physical activity and fitness.

OBJECTIVE

To compare physical activity, cardiorespiratory fitness, and cardiovascular function, of persons with DS with and without CHD.

METHODS

Baseline data were used from a 12-month randomized controlled physical activity intervention of adults with DS. Participants with DS were age and sex matched based on presence of CHD. Measures of physical activity through accelerometry (n = 42; CHD, n = 21), cardiorespiratory fitness (VO2peak; n = 34, CHD n = 17), and cardiovascular function (anaerobic threshold, chronotropic index, O2 pulse; n = 34, CHD n = 17) were compared by CHD status using Wilcoxon rank sum tests.

RESULTS

There were no differences in VO2peak between those with and without CHD (CHD 20.3 ml/kg/min; no CHD 21.3 ml/kg/min, p = 0.44). MVPA was lower for those with CHD vs. without CHD (10.0 vs 13.3 min/week, p = 0.05). There were no differences in cardiovascular function by group.

CONCLUSION

Fitness and physical activity were low regardless of CHD status. Adults with DS and CHD may engage in less physical activity than those without CHD, however fitness and cardiovascular function were not further impaired by CHD. Given the prevalence of CHD in DS, it is important to include those with CHD in work increasing physical activity and fitness.

Muscle Metabolism During Multiple Muscle Stimulation Using an Affordable Equipment

Background/Objectives: Previous studies have shown that neuromuscular electrical stimulation (NMES), while expensive, can provide some of the health benefits of exercise to people who cannot exercise their legs normally. The aim of this study was to quantify the increases in muscle metabolism in four muscles of the legs of able-bodied individuals with NMES. Methods: Healthy college-aged students were tested. NMES of four muscle groups was performed with inexpensive stimulators and reusable tin foil electrodes. The biceps femoris, vastus lateralis, medial gastrocnemius, and tibialis anterior muscles on one leg were stimulated for ten minutes with twitch stimulations at the highest comfortable stimulation current. Muscle metabolism was measured using the slope of oxygen consumption measured with near-infrared spectroscopy (NIRS) during 5 s of cuff ischemia. Results: Initial studies found fold increases in muscle metabolism above rest of 8.9 ± 8.6 for the vastus lateralis, 7.9 ± 11.9 for the biceps femoris, 6.6 ± 7.8 for the medial gastrocnemius, and 4.9 ± 3.9 for the tibialis anterior. Some participants were able to obtain large increases in muscle metabolism, while other participants had lower increases. Conclusions: The ability to produce large increases in metabolism has the potential to allow NMES to replace or augment exercise to improve health in people who cannot otherwise exercise. The devices used were inexpensive and could be adapted for easy use by a wide range of individuals.

Strategies to Overcome Barriers to Physical Activity Participation in Children and Adults Living With Congenital Heart Disease: A Narrative Review

Physical activity participation is critical for optimal physical, psychological, and cognitive health in children and adults living with congenital heart disease (CHD). Majority of the general population are not sufficiently active, and with the added psychological, physical, and socioeconomic barriers faced by individuals with CHD, it is unsurprising that many people living with CHD do not meet the recommendations for physical activity either. The aim of this review is to outline lifelong physical activity barriers faced by individuals living with CHD and provide age-appropriate strategies that can be used to ensure the development of long-term positive physical activity behaviours. Barriers to physical activity include safety fears, lack of encouragement, low exercise self-efficacy, body image concerns, limited education, socioeconomic status, reduced access to resources, and cardiac diagnosis and severity. These barriers are multifaceted and often begin in early childhood and continue to develop well into adulthood. Therefore, it is important for children to participate in physical activity from early stages of life as it has been shown to improve cardiorespiratory fitness, muscular endurance, and quality of life. Current literature demonstrates that participation in physical activity and higher intensity exercise after appropriate screening is safe and should be encouraged rather than dissuaded in people born with a congenital heart condition.