Physical activity in children and adolescents with CHD: review from a measurement methodological perspective

Abstract

Aim: To compile a literature overview of physical activity in children with CHD and to critically evaluate the methodology used for physical activity assessment. Methods: A review of the literature was performed using PubMed to identify studies examining accelerometer and subjectively assessed physical activity in children and adolescents with CHD. Result: A total of 15 studies were included (6 studies using subjective measures and 9 articles using accelerometers for the assessment of physical activity). The patients generally failed to meet the recommendations of physical activity. When compared to healthy controls, the results were widely divergent in the subjectively assessed measures and the accelerometer-based studies showed a tendency of no difference in physical activity. Neither subjective methods nor accelerometer-based studies reported any difference in physical activity in general, in relation to the severity of the heart disease. Conclusion: Methodological variation and limitations in the assessment of physical activity largely explain the divergent results and the inability to establish differences in physical activity between children with CHD of different severity and compared to healthy controls. Methodological knowledge and guidelines are provided for improved assessment of physical activity using accelerometers in clinical research.

ehealth technology in cardiac exercise therapeutics for pediatric patients with congenital and acquired heart conditions: a summary of evidence and future directions

“…Research by Voss and colleagues studied the Physical Activity Questionnaire for Children (PAQ-C) in children and adolescents with CHD and found the PAQ-C summary score was significantly correlated with total PA (counts per day), PA intensity, moderate-to-vigorous intensity PA (MVPA), vigorous intensity PA, and sedentary time measured with waist-worn, research grade ActiGraph accelerometer (24). Although self-report PA questionnaires can provide some estimates of PA, device-based assessments of PA present an objective and more accurate estimate of PA participation when compared to self-reported PA. A review by Skovdahl and colleagues of 15 studies that examined various methodologies in the assessment of PA in patients with CHD, the authors found wide variations self-reported PA when compared to healthy peers, but no between-group differences when PA is measured with wearable devices (25). The authors suggest methodological variation and limitations in self-report assessment may be responsible for these differences.…”

“…Short, sporadic, and high-intensity bouts of PA are difficult to quantify via recall questionnaires, and youth tend to over-estimate PA when self-reported on valid and reliable questionnaires (4,25). Device-based measures of PA allow clinicians and researchers to perform well-described analysis methods providing insights into specific patterns of PA, including weekly frequency, bout pattern, intensity metrics and daily timing (26)(27)(28).…”

“…Researchers and clinicians should be cognizant of the potential for methodological error when measuring PA with self-report or wearable devices. Skovdahl et al noted that that the utilization of accelerometry to measure PA can be influenced by measurement protocol, device settings, body placement, processing of raw data, method of calibration and statistics (25). Lack of training of study personnel resulting in participants receiving inadequate instructions and anchoring to the device often results in limited device wear-time, reducing the quality of the data and ability to apply validated intensity cut-points.…”

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

“…Cut-off points recommended by Phillips et al (30) will be used and are specific for GENEActiv wrist-worn accelerometers in children ranging between 6-19 (g/s) for light PA, 20-60 (g/s) for moderate PA, >60 (g/s) for vigorous PA, and anything less that 6 (g/s) is regarded as sedentary. An increased number of days and hours of wear time are recommended for higher precision and therefore participants' will be included in the data analysis if the wear time has been at least 16 hours/day for at least 4 days of the week (≥ 3 weekdays and ≥1 weekend day) (32).…”