Children with Congenital Heart Disease Are Active but Need to Keep Moving: A Cross-Sectional Study Using Wrist-Worn Physical Activity Trackers

Abstract

Objective To compare daily physical activity of children with congenital heart disease (CHD) with healthy peers measured using wearables bracelets in a large cohort. Additionally, subjectively estimated and objectively measured physical activity was compared. Study design From September 2017 to May 2019, 162 children (11.8 AE 3.2 years; 60 girls) with various CHD participated in a self-estimated and wearable-based physical activity assessment. Step-count and moderate-tovigorous physical activity were recorded with the Garmin vivofit jr. for 7 consecutive days and compared with a reference cohort (RC) of 96 healthy children (10.9 AE 3.8 years; 49 girls). Results Children with CHD were active and 123 (75.9%) achieved 60 minutes physical activity on a weekly average according to the World Health Organization criteria as 81 (84.3%) of the healthy peers did (P = .217). After correction for age, sex, and seasonal effects, only slightly lower step count (CHD: 10 206 AE 3178 steps vs RC: 11 142 AE 3136 steps; P = .040) but no lower moderate-to-vigorous physical activity (CHD: 80.5 AE 25.6 minutes/ day vs RC: 81.5 AE 25.3 minutes/day; P = .767) occurred comparing CHD with RC. In children with CHD higher age (P = .004), overweight or obesity (P = .016), complex severity (P = .046), and total cavopulmonary connection (P = .027) were associated with not meeting World Health Organization criteria. Subjective estimation of daily moderate-to-vigorous physical activity was fairly correct in half of all children with CHD. Conclusions Even though the majority is sufficiently active, physical activity needs to be promoted in overweight or obese patients, patients with complex CHD severity, and in particular in those with total cavopulmonary connection.

Physical activity modification in youth with congenital heart disease: a comprehensive narrative review

“…Five (22,33,35,37,38,40) out of eight (25,27,30) studies with self-or parent-reported outcomes found significantly lower PA levels in children with CHD. In contrast, five of nine studies with accelerometer-assessed PA found no differences between cases and controls, (26,28,29,31,33) and three found lower PA levels only in subgroups of patients. (36,39,40) The only accelerometer study that described a general lower PA level in children with CHD had no control group but compared the data to normative data from healthy children and adolescents participating in the Amherst Health and Activity Study.…”

“…All studies reported PA level, either expressed as time in PA, exercise frequency, score on a PA scale or expended energy. In addition, eight studies described the proportion of individuals meeting national or international PA recommendations, (24,26,28,29,31,34,36,37) while six studies also reported on the time spent sedentary. (26,29,31,33,34,37) In nine of the 18 (50%) studies, there were no statistically significant differences in PA level between children with CHD and age-matched healthy peers.…”

“…(26,29,31,33,34,37) In nine of the 18 (50%) studies, there were no statistically significant differences in PA level between children with CHD and age-matched healthy peers. (23,(26)(27)(28)(29)(30)(31)34) Of the remaining nine studies, four reported that children with CHD were generally more inactive than the control group(22, 24, 38) or than normative data. (35) The other studies were ambiguous or found diminished PA only in subgroups.…”

“…(33) The proportion of children with CHD reaching the prevailing national or international recommendations of minimum PA (at least 60 minutes a day for most countries) varied between studies, ranging from 7%(31) to 76%. (28) Six out of eight studies found that the proportion of children reaching these recommendations did not differ between children with CHD and either a control group (26,28,34,36) or regional estimates. (31,37) One study reported that 19% and 31% of the children after transposition of the great arteries and atrial septal defect/ventricular septal defect repair, respectively, reached national PA recommendations; significantly lower than 57% of controls.…”

Conhecimento sobre Atividade Física e seus Níveis em Crianças com Cardiopatia Congênita

“…6 In addition, when present, these health problems can be mitigated by an active lifestyle. [1][2][3] Although the health benefits of physical activity are well recognized, evidence shows that some children with CHD do not practice enough physical activity to achieve the recommended levels, 7 and activity declines and sedentary behaviors increase with age in both genders. 5 Furthermore, levels of physical activity of children with CHD are lower than those in healthy children.…”