Physical activity evaluation in children with congenital heart disease

Abstract

Significant advances in the management of children with congenital heart disease (CHD) have resulted in marked improvements in survival and life expectancy. Thus, there is an increased emphasis on promoting physical activity to optimise healthy development and long-term cardiovascular health. Evaluation of physical activity levels as part of ongoing clinical care is recommended to facilitate physical activity counselling and/or exercise prescription. Physical activity is a complex health behaviour that is challenging to evaluate. We provide an overview of techniques for measuring physical activity in children with CHD with a focus on how to do this in the clinical context. Accelerometers are devices that objectively assess intensity and duration of physical activity under free living conditions. They enable evaluation against physical activity guidelines, but are costly and require advanced technical expertise. Pedometers are a simple-to-use and cost-effective alternative, but an outcome metric of daily step count limits classification against guidelines. Commercial wearable activity trackers offer an appealing user experience and can provide valid estimates in children. Furthermore, activity trackers enable remote monitoring of physical activity levels, which may facilitate exercise prescription and activity counselling. Questionnaires are the most cost-effective and time-effective method, but recall error in younger children is a consideration. Routine exercise testing in children with CHD provides important insight into functional status but should not be viewed as a proxy measure of habitual physical activity. Understanding the spectrum and role of physical activity measurement tools is important for clinicians focused on optimising cardiovascular health in children with CHD.

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

“…Furthermore, accurately assessing physical activity remains a challenging yet vital research endeavor in children with CHD. 8 The findings of this study underline the importance of objective and reliable measures in clinical pediatric settings as subjective reports in the form of questionnaires lack accuracy. Routine exercise testing is insightful in determining functional status but lacks the ability to determine habitual physical activity which is where commercially available wearables offer unique advantages.…”

“…Whereas recalling physical activity in questionnaires lacks objectivity, more valid and reliable pedometers and accelerometers are often bulky, require technical expertise, are expensive, and not necessarily appealing to young children. 7,8 Furthermore, findings on childhood activity in CHD are conflicting. Smaller studies on children with complex CHD reported lower physical activity, [9][10][11] whereas more recent studies on a broad spectrum of CHD revealed these children to be of similar activity as healthy peers.…”

Physical Activity Among Children With Congenital Heart Defects in Germany: A Nationwide Survey

“…In addition, at the end of the survey there was the possibility to provide ambiguities and questions directly as free text. Clearly, measuring PA by objective methods (i.e., accelerometry, pedometers, activity trackers) might be more precise (14). However, the objective assessment of PA in different domains can be challenging and requires complex strategies, which can hardly be applied in large patient populations.…”

“…Previous studies investigating PA in children with CHD showed rather conflicting results. While some authors reported of reduced PA, especially in complex CHD, others revealed similar PA-levels compared to healthy controls (12)(13)(14)(15)(16)(17)(18)(19)(20). Discrepancies of results might be explained by differences in study designs and PA assessment tools, and furthermore, common to all of these studies are relatively small patient numbers included.…”

A Prototype Exercise–Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases

“…Exercise improves cardiovascular function and exercise capacity ( 84 , 85 ) and psychosocial interventions, including eHealth, promote disease knowledge, compliance, and empowerment in these patients ( 86 , 87 ). For children with congenital heart disease, participation in both hospital and home-based cardiac physical activity programs is safe and feasible and improves QOL and exercise capacity ( 90 – 92 , 112 ). Finding proactive, engaging ways that promote physical activity and empowerment is important in promoting disease self-management as these teens transition into adulthood ( 5 ).…”