Physical activity among children with congenital heart defects
DOI: 10.32364/2618-8430-2023-6-3-13
S.A. Pomeshkina, E.A. Demchenko
V.A. Almazov National Medical Research Center, St. Petersburg, Russian Federation
This article summarizes modern scientific data on the efficacy and safety of prescribing physical activity (PA) to children and adolescents with congenital heart defects (CHD), as well as practical recommendations for actual amount of PA in this category of patients, depending on their initial functional status. The preferences and benefits of PA with controlled amount, rather than its limitation in patients with CHD, have been demonstrated. An individual exercise regime can safely be indicated to each patient with CHD according to the team approach and thorough assessment. However, there remains a large gap in the literature regarding recommendations for PA in children with CHD, despite the fact that this research area is one of the priorities worldwide, since PA is a powerful tool in optimizing the health of children with CHD. There are only a limited number of publications with a small sample size, which indicates the need for further research to assess the PA contribution to the recovery of children with CHD, especially with combined defects.
Keywords: congenital heart defects, physical activity, children, adolescents, aerobic exercise, sedentary lifestyle, prevention, recommendations.
For citation: Pomeshkina S.A., Demchenko E.A. Physical activity among children with congenital heart defects. Russian Journal of Woman and Child Health. 2023;6(3):298–303 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-13.
About the authors:
Svetlana A. Pomeshkina — Dr. Sc. (Med.), Leading Researcher of the Rehabilitation Research Institute, V.A. Almazov National Medical Research Center; 2, Akkuratov str., St. Petersburg, 197341, Russian Federation.
Elena A. Demchenko — Dr. Sc. (Med.), Professor of the Department of Faculty Therapy with the Medical Institute Clinic, Head of the Rehabilitation Research Institute, V.A. Almazov National Medical Research Center; 2, Akkuratov str., St. Petersburg, 197341, Russian Federation; ORCID iD 0000-0002-7173-0575. Contact information: Svetlana A. Pomeshkina, e-mail: pomeshkina_sa@almazovcentre.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
This work was carried out within the framework of the state assignment of the V.A. Almazov National Medical Research Center.
There is no conflict of interest.
Received 21.04.2023.
Revised 19.05.2023.
Accepted 14.06.2023.
2. Garber C.E., Blissmer B., Deschenes M.R. et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359. DOI: 10.1249/MSS.0b013e318213fefb.
3. Global Recommendations on Physical Activity for Health. Geneva: World Health Organization; 2010. PMID: 26180873.
4. Tremblay M.S., Carson V., Chaput J.P. et al. Canadian 24-hour movement guidelines for children and youth: An integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S311–327. DOI: 10.1139/apnm-2016-0151.
5. Janssen I., Leblanc A.G. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40. DOI: 10.1186/1479-5868-7-40.
6. Thornton J.S., Fremont P., Khan K. et al. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian academy of sport and exercise medicine. Br J Sports Med. 2016;50(18):1109–1114. DOI: 10.1136/bjsports-2016-096291.
7. Siaplaouras J., Niessner C., Helm P.C. et al. Physical activity among children with congenital heart defects in Germany: A Nationwide Survey. Front Pediatr. 2020;8:170. DOI: 10.3389/fped.2020.00170.
8. Longmuir P.E., McCrindle B.W. Physical activity restrictions for children after the Fontan operation: Disagreement between parent, cardiologist, and medical record reports. Am Heart J. 2009;157(5):850–859. DOI: 10.1016/j.ahj.2009.02.014.
9. Ong L., Nolan R., Irvine J., Kovacs A. Parental overprotection and heart-focused anxiety in adults with congenital heart disease. Int J Behav Med. 2011;18(3):260–267. DOI: 10.1007/s12529-010-9112-y.
10. Liu Y., Chen S., Zühlke L. et al. Global birth prevalence of congenital heart defects 1970–2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019;48:455–63. DOI: 10.1093/ije/dyz009.
11. Best K.E., Rankin J. Long-Term survival of individuals born with congenital heart disease: a systematic review and meta-analysis. J Am Hear Assoc. 2016;5(6):e002846. DOI: 10.1161/JAHA.115.002846.
12. Krieger E.V. Physical activity and exercise in patients with congenital heart disease (CHD). Post T.W. (Ed). In: UpToDate, Waltham, MA; 2018.
13. Longmuir P.E., Brothers J.A., de Ferranti S.D. et al. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation. 2013;127(21):2147–2159. DOI: 10.1161/CIR.0b013e318293688f.
14. Takken T., Giardini A., Reybrouck T. et al. Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology. Eur J Prev Cardiol. 2012;19(5):1034–1065. DOI: 10.1177/1741826711420000.
15. Dean P.N., Gillespie C.W., Greene E.A. et al. Sports participation and quality of life in adolescents and young adults with congenital heart disease. Congenit Heart Dis. 2015;10(2):169–179. DOI: 10.1111/chd.12221.
16. O'Byrne M.L., McBride M.G., Paridon S., Goldmuntz E. Association of habitual activity and body mass index in survivors of congenital heart surgery: A study of children and adolescents with tetralogy of fallot, transposition of the great arteries, and fontan palliation. World J Pediatr Congenit Heart Surg. 2018;9(2):177–184. DOI: 10.1177/2150135117752122.
17. Sutherland N., Jones B., Westcamp A.S. et al. Home- and hospital-based exercise training programme after Fontan surgery. Cardiol Young. 2018;28(11):1299–1305. DOI: 10.1017/S1047951118001166.
18. Lopez J.R., Voss C., Kuan M.T.Y. et al. Physical activity is associated with better vascular function in children and adolescents with congenital heart disease. Can J Cardiol. 2020;36:1474–1481. DOI: 10.1016/j.cjca.2019.12.019.
19. Dulfer K., Duppen N., Blom N.A. et al. Effects of exercise training on behavioral and emotional problems in adolescents with tetralogy of Fallot or a Fontan circulation: a randomized controlled trial. Int J Cardiol. 2014;172(3):e425–e427. DOI: 10.1016/j.ijcard.2013.12.244.
20. Schaan C.W., Macedo A.C.P., Sbruzzi G. et al. Functional capacity in congenital heart disease: a systematic review and meta-analysis. Arq Bras Cardiol. 2017;109(4):357–367. DOI: 10.5935/abc.20170125.
21. Amedro P., Gavotto A., Guillaumont S. et al. Cardiopulmonary fitness in children with congenital heart diseases versus healthy children. Heart. 2018;104(12):1026–1036. DOI: 10.1136/heartjnl-2017-312339.
22. Longmuir P.E., Wang S., Timmons B.W. et al. Inactive lifestyles among young children with innocent murmurs or congenital heart disease, regardless of disease severity or treatment. Can J Cardiol. 2022;38(1):59–67. DOI: 10.1016/j.cjca.2021.09.014.
23. Saxena S., Millage J., Wong D. et al. Perceptions of healthy lifestyles among children with complex heart disease and their caregivers. CJC Open. 2021;3(7):854–863. DOI: 10.1016/j.cjco.2021.01.013.
24. Brudy L., Häcker A.L., Meyer M. et al. Adults with congenital heart disease move well but lack intensity: a cross-sectional study using wrist-worn physical activity trackers. Cardiology. 2022;147(1):72–80. DOI: 10.1159/000519286.
25. Moschovi D., Kapetanakis E.I., Sfyridis P.G. et al. Physical activity levels and self-efficacy of Greek children with congenital heart disease compared to their healthy peers. Hellenic J Cardiol. 2020;61(3):180–186. DOI: 10.1016/j.hjc.2019.01.002.
26. Massin M.M., Hövels-Gürich H.H., Gerard P., Seghaye M.C. Physical activity patterns of children after neonatal arterial switch operation. Ann Thorac Surg. 2006;81(2):665–670. DOI: 10.1016/j.athoracsur.2005.07.034.
27. Barbour-Tuck E., Boyes N.G., Tomczak C.R. et al. A cardiovascular disease risk factor in children with congenital heart disease: unmasking elevated waist circumference — a CHAMPS* study *CHAMPS: Children's Healthy-Heart Activity Monitoring Program in Saskatchewan. BMC Cardiovasc Disord. 2020;20(1):231. DOI: 10.1186/s12872-020-01508-y.
28. West S.L., Banks L., Schneiderman J.E. et al. Physical activity for children with chronic disease; a narrative review and practical applications. BMC Pediatr. 2019;19(1):12. DOI: 10.1186/s12887-018-1377-3.
29. Lee I.M., Shiroma E.J., Lobelo F. et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectanc.y. Lancet. 2012;380(9838):219–229. DOI: 10.1016/S0140-6736(12)61031-9.
30. Piercy K.L., Troiano R.P., Ballard R.M. et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020–2028. DOI: 10.1001/jama.2018.14854.
31. Rhodes J., Curran T.J., Camil L. et al. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics. 2005;116(6):1339–1345. DOI: 10.1542/peds.2004-2697.
32. Härtel J.A., Herberg U., Jung T. et al. Physical activity and heart rate monitoring in Fontan patients — Should we recommend activities in higher intensities? PLoS One. 2020;15(1):e0228255. DOI: 10.1371/journal.pone.0228255.
33. Opocher F., Varnier M., Sanders S.P. et al. Effects of aerobic exercise training in children after the Fontan operation. Am J Cardiol. 2005;95(1):150–152. DOI: 10.1016/j.amjcard.2004.08.085.
34. Dold S.K., Haas N.A., Apitz C. Effects of sports, exercise training, and physical activity in children with congenital heart disease — a review of the published evidence. Children. 2023;10(2):296. DOI: 10.3390/children10020296.
35. Pollock M.L., Gaesser G.A., Butcher J.D. et al. ACSM Position Stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30(6):975–991. DOI: 10.1097/00005768-199806000-00032.
36. Hui S.S., Chan J.W. The relationship between heart rate reserve and oxygen uptake reserve in children and adolescents. Res Q Exerc Sport. 2006;77(1):41–49. DOI: 10.1080/02701367.2006.10599330.
37. Carvalho V.O., Mezzani A. Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. Eur J Cardiovasc Prev Rehabil. 2010;18(1):5–14. DOI: 10.1097/HJR.0b013e32833a9c63.
38. McBride M.G., Binder T.J., Paridon S.M. Safety and feasibility of inpatient exercise training in pediatric heart failure: a preliminary report. J Cardiopulm Rehabil Prev. 2007;27(4):219–222. DOI: 10.1097/01.HCR.0000281766.59781.e8.
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