How healthy are sports for children with congenital heart defects?

Sabine Schickendantz (© Private)

Interview with Dr Sabine Schickendantz, paediatric cardiologist, University of Cologne, Germany.

Parents and doctors are sometimes unsure about what type of exercise and how much is recommended for children with congenital heart defects (CHD). The Cologne pilot project—Sports for children affected by CHD—led you to the conclusion that it would not be appropriate to recommend a specific type of sport for children affected by this disease. Could you please explain why?

All sports can be practised with different intensities. They range from leisure activities to competitive sports. Suggesting one specific type of sport cannot limit how intensively it will be practised.
Sports can be categorised as static or dynamic forms of exposure. Every sport is characterised by both static and dynamic components, but there are many differences. Sports such as bodybuilding, tug-of-war, diving and rock climbing are more static, whereas gymnastics, football, cycling and jogging are more dynamic. With static exposure, some patients might need high-pressure respiration. This should be strictly avoided by children with CHD because, among other things, it leads to a dangerous increase in pressure of the right side of the heart, involving the risk of serious cardiac arrhythmia. Therefore, the static component of the sport should not be too substantial; hence sports strongly characterised by static movements should be done with a low intensity.

What criteria should be followed when recommending a sport?

Sports should be recommended according to clinical findings after surgery. For this reason, physical activity has been rigorously classified on the basis of the operation’s outcome. Each category establishes what sport intensity is allowed for children presenting with different postoperative results. The danger of overexertion is lower than the children’s inability to improve their performance because of their restricted cardiac capacity. Their assigned category might further cause them, for example, to be unfairly graded in school.
If the heart disease is so severe that surgery is needed, sport should be avoided until the surgical procedure is undertaken. One should not practise any type of exercise for 3–6 months after the operation and until the wound has completely and naturally healed.

Have there been any changes in sport recommendations over the past few years?

After assessment of sports, some changes have occurred in the past few years heading towards a relaxation in recommendations. For example, sports requiring equipment, such as that used in gym studios, were not often recommended to people with CHD until now because of their fairly high-static nature. Nevertheless this type of sport supports uniform muscle formation. If exercises are practised correctly under professional supervision, and vascular circulation is not heavily loaded to prevent the rise of high pressure respiration (eg, using high weights), these sports seem to be more beneficial than harmful. Accordingly, climbing and sailing are now also allowed, if static exposure is kept to a minimum.

What about competitive sport and involvement in sport clubs?

For some postoperative clinical findings, competitive sports should be avoided. There is the risk that children could cross their boundaries under competitive circumstances (but not during training). Furthermore, competition does not seem to be a necessary element for neuromuscular development.
Involvement in sport clubs should not be ruled out completely because of the important social role of meeting and being part of a team. Entering a sport club that is designed for disabled people might be a good solution for children with severe physical restrictions. How appropriate the sport club is depends on how well the coach has been informed; the coach should be sure that the children do not over work themselves when in a group. Most of the time no problems arise, for example within the youngest children’s football groups (in Germany called “bambini-groups”). But when making a decision, one should consider that the child might not be able to keep up with the others later on and therefore might have to quit the group, potentially leaving the child very disappointed.

How would you sum up your recommendations?

• Total prohibition of sport activities is required very rarely.
• Sports should be allowed as much as possible.
• The recommendation should not depend too much on the heart disease itself, but should be based on the postoperative results.
• Suggestions should not depend on the sport but on the intensity with which it is practised.
• Imposed restrictions should be explained accurately to the children and their parents so that they are able to appreciate the reasons for such a constriction. This approach might also allow any restrictions to be better observed by the child.