An Evaluation of a Physical Activity and Exercise Promotion Pathway for Young Patients with Congenital Heart Disease

Abstract

BackgroundIncreased physical activity has been shown to result in improved physical fitness, quality of life, self-confidence, and reduced anxiety in adults with congenital heart disease (CHD). In comparison to adults there are relatively few data on the benefit of physical activity for children and adolescents with CHD. It is clear that increasing physical activity (PA) plays an important, beneficial role in long-term cardiovascular and general health. However, whilst clinicians recognise the importance of promoting PA to children with CHD, ‘how’ it is best promoted and delivered to the young patients is not known. Most guidelines for patients with CHD are focused on restriction of competitive sports and are also devised for adults. However, competitive sport is only one part of the physical activity continuum, with physical activity being defined as ‘any bodily movement produced by skeletal muscles that requires energy expenditure above resting levels’ (WHO, 2020) and can include activities such as walking, dancing, jogging and swimming.MethodsThis is a randomised control trial study and 76 participants (n=38 each in the intervention and control groups) will be recruited from the children’s CHD clinic. After baseline testing participants will be randomised to the exercise intervention or control arm of the study. Cardiovascular, physical and mental health assessments will be performed during 3 visits and will include cardiopulmonary exercise testing (CPET), electrocardiography (ECG), echocardiography (ECHO), accelerometer based physical activity measurements and qualitative mental health questionnaires. Identical assessments will be performed at baseline and the end of the 6 month intervention with an intermediate review of cardiac parameters also at 3 months. Encouragement for the home-based intervention, via media messaging, will be maintained throughout the pathway by the research fellow and clinical team. DiscussionThe study is designed to evaluate the effectiveness of a 6 month physical activity, plus follow up and exercise promotion pathway by assessing improvements in cardiovascular, physical and mental health. Patient interviews will be used to assess the acceptability and feasibility of the individualised plan with the aim of developing a simple exercise prescription strategy for this patient group.