Recent research

Scand J Med Sci Sports. 2015 Jul 29. doi: 10.1111/sms.12523. [Epub ahead of print]

Associations of cardiorespiratory fitness, physical activity, and adiposity with arterial stiffness in children.

Veijalainen A, Tompuri T, Haapala EA, Viitasalo A, Lintu N, Väistö J, Laitinen T, Lindi V, Lakka TA

Associations of cardiorespiratory fitness (CRF), physical activity (PA), sedentary behavior, and body fat percentage (BF%) with arterial stiffness and dilation capacity were investigated in 160 prepubertal children (83 girls) 6-8 years of age. We assessed CRF (watts/lean mass) by maximal cycle ergometer exercise test, total PA, structured exercise, unstructured PA, commuting to and from school, recess PA and total and screen-based sedentary behavior by questionnaire, BF% using dual-energy X-ray absorptiometry, and arterial stiffness and dilation capacity using pulse contour analysis. Data were adjusted for sex and age. Poorer CRF (standardized regression coefficient β = -0.297, P < 0.001), lower unstructured PA (β = -0.162, P = 0.042), and higher BF% (β = 0.176, P = 0.044) were related to higher arterial stiffness. When CRF, unstructured PA, and BF% were in the same model, only CRF was associated with arterial stiffness (β = -0.246, P = 0.006). Poorer CRF was also related to lower arterial dilation capacity (β = 0.316, P < 0.001). Children with low CRF (< median) and high BF% (≥ median; P = 0.002), low CRF and low unstructured PA (< median; P = 0.006) or children with low unstructured PA and high BF% (P = 0.005) had higher arterial stiffness than children in the opposite halves of these variables. Poor CRF was independently associated with increased arterial stiffness and impaired arterial dilation capacity among children.

Eur Heart J. 2015 Sep 4. pii: ehv478.

Sudden unexpected death in children with congenital heart defects

Jarle Jortveit, Leif Eskedal, Asle Hirth, Tatiana Fomina, Gaute Døhlen, Petter Hagemo, Grethe S. Tell, Sigurd Birkeland, Nina Øyen, and Henrik Holmstrøm (2015)

Aims: Congenital heart defects (CHDs) are the most common birth defects and are an important cause of death in children. The fear of sudden unexpected death has led to restrictions of physical activity and competitive sports. The aim of the present study was to investigate the rate of sudden unexpected deaths unrelated to surgery in children 2 – 18 years old with CHDs and, secondarily, to determine whether these deaths were related to cardiac disease, comorbidity, or physical activity.

Methods and results: To identify children with CHDs and to determine the number of deaths, data concerning all 943 871 live births in Norway in 1994 – 2009 were retrieved from the Medical Birth Registry of Norway, the Cardiovascular Disease in Norway project, the Oslo University Hospital’s Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and information for the deceased children was retrieved from medical records at Norwegian hospitals. Among 11 272 children with CHDs, we identified 19 (0.2%) children 2–18 years old who experienced sudden unexpected deaths unrelated to cardiac surgery. A cardiac cause of death was identified in seven of these cases. None of the children died during physical activity, whereas two children survived cardiac arrest during sports.

Conclusion: Sudden unexpected death was infrequent among children with CHDs who survived 2 years of age. Comorbidity was common among the children who died. This study indicates that sudden unexpected death in children with CHDs rarely occurs during physical activity.

Cardiol Young. 2007 Oct;17(5):487-98. Epub 2007 Aug 1.

Motor development in children with congenital cardiac diseases compared to their healthy peers

Bjarnason-Wehrens B, Dordel S, Schickendantz S, Krumm C, Bott D, Sreeram N, Brockmeier K
Contact: Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany.

SUMMARY: Their perceptual and motor experiences determine the physical and motor development of children, and impact also on their emotional, psychosocial, and cognitive development. Our aim, therefore, was to evaluate motor development in children with congenitally malformed hearts compared to their healthy peers. We compared 194 children, with a mean age of 10.0 years, and standard deviation of 2.7 years, representing the entire spectrum of congenital cardiac disease, to a control group of 455 healthy children, having a mean age 9.6 years, with standard deviation of 2.17 years. The bodily coordination test for children was used to examine motor development. Of the children with congenitally malformed hearts, 26.8% showed moderate, and 31.9% had severe disturbances of motor development, compared to 16.5% and 5.5% of the control group, the p-value for these differences being less than 0.001. The mean motor quotient adjusted for age and gender was lower in the children with congenitally malformed hearts than in their healthy peers, at 79.6, with standard deviation of 18.9 as opposed to 96.6, with standard deviation of 15, this difference having a p-value of less than 0.001. Depending on the presence, and/or the degree, of residual sequels, the children with congenitally malformed hearts were divided into two subgroups, with either no or mild residual sequels, or with significant sequels. The mean motor quotient was lower in those with significant residual sequels, at 75, with standard deviation of 19.3, as opposed to 83, with standard deviation of 17.9, the p-value for this difference being less than 0.01. In both subgroups, the mean motor quotient was lower, with a p-value of less than 0.01, than in the control group. Our findings show that children with congenitally malformed hearts have deficits in their motor development, these being found in the presence of no or mild sequels, as well as with significant residual sequels. Parental overprotection may contribute to these findings.

Mensch und Pferd international, 4/2009, 176-184

Therapeutic Riding for Children with Congenital Heart Disease

Schickendantz S, Bjarnason-Wehrens B, Sticker E, Dordel S, Sreeram N, Drache M

SUMMARY: Many children with congenital heart disease do not benefit from the experience of regular physical exercise due to overprotective parents and uncertainty on the part of physicians and trainers about the childrens’ physical capacity. This can result in deficits in motor development, body awareness, and coordination, as well as in anxiety, fearfulness about movement, lack of confidence, poor social skills and a restricted range of activities (Sticker 2004; Bjarnason-Wehrens et al. 2007). Therapeutic riding, especially psycho-educational riding/vaulting, but also hippotherapy and riding as a sport for people with disabilities, affect...
Psycho-educational riding/vaulting, hippotherapy, equestrian sports for handicapped people, vaulting, riding, therapeutic riding, equine assisted therapy, physical activity and congenital heart disease, coordination, physical capacity of children with congenital heart disease

Child Care Health Dev. 2008 Nov;34(6):781-8. Epub 2008 Sep 12.

I am almost like a fish: an investigation of how children with congenital heart disease experience and perform movement in daily life.

Bjorbaekmo W, Engelsrud G.
Contact: University of Oslo, Institute of Nursing and Health Sciences, Section of Health Sciences, Oslo, Norway.

BACKGROUND: Because of dramatic medical improvements, most children with congenital heart disease (CHD) survive into adulthood. Nevertheless, they remain in need of long-term health care. Living with CHD implies having diminished aerobic capacity. As far as we know, no previous study within healthcare research has focused on how children with CHD experience movement and activity in daily life.
METHODS: In order to examine this topic, a qualitative approach was employed that combined both interviews and observation of 11 children between 7 and 12 years of age and interviews with their parents. The theoretical base of the article is inspired by the philosopher Maurice Merleau-Ponty and his theory of movement. We use his descriptions of movement as intentional expressions to illuminate how children with CHD move in daily life.
RESULTS: The study shows how the children use different strategies to participate in play and that they move to fulfill their first priority: to be together with other children. Despite having limited physical endurance, the children perceive themselves as having the same capabilities as other children and as acting as they do. At the same time, they are not unaware of their own limitations. They adjust and respond to the challenges they face in the different situations to which they are exposed. On one hand, they want others to take their limitations into consideration, while, on the other hand, they do not want others to know about these limitations. CONCLUSIONS: In our analysis, we interpret that living with CHD creates situations where the children constantly face their limitations, the gazes of others and their own wish to participate.

Br J Sports Med 42(1): 31-5; discussion 35.

Bicuspid aortic valve in competitive athletes.

Stefani, L, Galanti, G, et al. (2008).
Contact: Sport Medicine Center, University of Florence, Florence, Italy.

AIM: Bicuspid aortic valve (BAV) is a common congenital cardiac condition. The presence of BAV in non-elite athletes has been poorly investigated; it is usually asymptomatic until valvular stenosis, regurgitation or other vascular alterations are evident.

DESIGN: Over a three-year period, 2273 competitive athletes were consecutively investigated with transthoracic echocardiography. The traditional parameters, the aortic root dimensions at four levels and the systolic and diastolic flow of aortic valve, were studied with continuous Doppler according to the echo guidelines.

SETTING: The study protocol included all the non-elite athletes investigated for the first evaluation to obtain eligibility.

PATIENTS: 2273 competitive athletes aged 8-60 years from several sports and regularly trained were evaluated with anamnesis, clinical check-up and echocardiography in order to exclude subjects with systemic or congenital heart disease.

RESULTS: BAV was diagnosed in 58 athletes (2.5%). Of these, nine had normal valvular function, 47 had abnormal valvular function with mild-moderate aortic regurgitation, and two had moderate stenosis. Aortic root dimensions at all levels were significantly greater in athletes with BAV than in athletes with a normal tricuspid valve. No relation was found with age, body surface area, aortic regurgitation or years of training.

CONCLUSIONS: BAV is a relatively common congenital cardiac disease in athletes and commonly asymptomatic for a long time. This study suggests the usefulness of evaluating young athletes using echocardiography at least once when they start their sporting activity.

Int J Sports Med 29(1): 81-5.

The natural course of bicuspid aortic valve in athletes.

Spataro, A, Pelliccia, A, et al. (2008).
Contact: Department of Cardiology, National Institute of Sport Medicine, Rome, Italy.

The purpose of this study was to evaluate the impact of a long-term athletic training on the clinical course of bicuspid aortic valve. A group of 81 athletes (73 M, 8 F, 22.7 +/- 5.6 years) with bicuspid aortic valve was collected. Based on clinical and echocardiographic criteria, athletes were initially divided into 2 groups: the low-risk (51 athletes) and the high-risk group (30 athletes). The high-risk athletes were disqualified from training and competitions after the first evaluation. Over the follow-up period, all of them showed significant worsening of morphologic and hemodynamic features of bicuspid aortic valve; two underwent surgical valvular repair and one of them died suddenly. Over the same period, six of the initially low-risk athletes (7%) showed significant worsening of morphologic features of bicuspid aortic valve and/or incidence of symptoms which led to their disqualification from competition. At the end of follow-up, we observed that in high-risk subjects the progression of valvular disease occurred independently from the former athletic activity and that the majority of athletes with mild bicuspid aortic valve had a benign clinical course. However, athletes with bicuspid aortic valve should be viewed with caution, and continued clinical surveillance would be mandatory.

Downs Syndr Res Pract 12(1): 60-8.

Parents' perceptions of health and physical activity needs of children with Down syndrome.

Sayers Menear, K (2007).
Contact: University of Alabama at Birmingham, Department of Human Studies, Birmingham, AL, USA.

Individuals with Down syndrome typically have low fitness levels and obesity despite data that indicate physiological gains from physical activity and exercise interventions. Low fitness levels and obesity in individuals with Down syndrome may be related to sedentary lifestyles, social and recreational opportunities, or low motivation to be physically active. These causal influences on the overall health of individuals with Down syndrome may be related to parental or caregiver support. Through this study, parents of children with Down syndrome from preschool to adolescent ages were interviewed about their perceptions of the health and physical activity needs of their children. Data from four focus groups indicated the following most salient themes: (1) all parents believed participation in physical activity has immediate and long-term positive health impacts on their child with Down syndrome, and most of the parents thought their child would benefit from being more physically active, (2) most parents observed that their child participated in physical activities primarily for social reasons, most notably to be with their peers with or without Down syndrome or to be with their sibling(s), and that without such motivation their child would choose sedentary activities, (3) parents of teenagers identified a need for their child to learn an individual sport to have sporting opportunities that do not require ability-matched teammates and opponents, and (4) parents recognised their need for help from physical activity specialists through either parent education regarding home-based physical activity programmes or an increase in appropriate community-based physical activity programmes for their child with Down syndrome. The interview data suggest future research should evaluate the outcomes of long-term individualised home-based physical activity interventions for children with Down syndrome. Additionally, educators, recreation specialists, and therapists should assist children and youth with their acquisition of skills used in individual and dual sports.

Eur J Cardiovasc Prev Rehabil 14(2): 287-93.

Physical activity levels in adults with congenital heart disease.

Dua, JS, Cooper, AR, et al. (2007).
Contact: Bristol Congenital Heart Centre, Bristol Heart Institute and Bristol Royal Infirmary, Bristol, UK.

BACKGROUND: Regular physical activity is associated with many health benefits in patients with cardiac disease. Advances in treatment have resulted in an increasing population of adults with congenital heart disease. Few data are available on physical activity levels and attitude to exercise in this group.

DESIGN: Prospective, cross-sectional study of patients attending the adult congenital heart disease clinic in a supra-regional centre.

METHODS: Physical activity assessed over 1 week using two accelerometers. The Actigraph was used to measure total activity volume and intensity and the Caltrac used to measure energy expenditure in physical activity. Patients completed a questionnaire to assess exercise self-efficacy.

RESULTS: In all, 61 adults recruited (36 male; mean-age 31.7+/-10.9 years); divided into three groups according to New York Heart Association class [Group I (n=26; 14 male), Group II (n=18; 10 male), Group III (n=17; 11 male)]. Fourteen patients were overweight (body mass index 25-29.9) and seven obese (body mass index>30). Group 1 achieved similar activity levels to a sedentary reference population. Group II and III had significantly lower activity (55 and 40% of Group I). Most study patients failed to achieve UK national guidelines for physical activity (Groups I: 77%, II: 84%, III: 100%). Despite this, questionnaire responses suggested a willingness to participate in exercise in the majority of each group.

CONCLUSIONS: Adults with congenital heart disease have a range of physical activity levels between normal and severely limited. Most patients showed a willingness to participate in exercise but were uncertain of the safety or benefit. Intervention to increase physical activity levels may be a low risk, low cost treatment strategy.

Eur Heart J 28(2): 150-3.

Soccer world championship: a challenge for the cardiologist.

Baumhakel, M, Kindermann, M, et al. (2007).
Contact: Klinik fur Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitatsklinikum des Saarlandes, D-66421 Homburg/Saar, Germany.

The 18th FIFA Soccer World Cup 2006 in Germany enthused millions of people worldwide, but only little is known about the association of such an event with cardiovascular events. Modest physical activity is known to reduce the cardiovascular risk significantly. On the other hand, vigorous physical activity and emotional strain increase the cardiovascular risk and the incidence of cardiovascular events likely due to an increased sympathetic tone with consecutive catecholamine stimulation of the heart. Few reviews and case-reports are dealing with the risk of physical activity in cardiovascular high-risk patients or athletes with congenital heart diseases (e.g. hypertrophic obstructive cardiomyopathy), but the impact of highly competitive events on cardiovascular events, especially in spectators were rarely addressed. Thus, the increased risk of cardiovascular events in players and spectators were addressed in this review with respect to various soccer matches and tournaments, such as the FIFA World Cup.

Eur J Pediatr 165(11): 767-72.

Improved perceived health status persists three months after a special sports camp for children with congenital heart disease.

Moons, P, Barrea, C, et al. (2006).
Contact: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.

INTRODUCTION: Although summer and sports camps for children with congenital heart disease are organized in many countries and regions, empirical data on the effects of such camps is limited.

OBJECTIVES: The aim of the present study was to investigate changes in the perceived health status and habitual physical activities in children attending a special sports camp.

MATERIALS AND METHODS: In this longitudinal study, 25 children with congenital heart disease who participated in a three-day multi-sports camp were included. The perceived health status was measured using the Child Health Questionnaire-Child Form, CHQ-CF87, completed by the child at the start of the camp (T1), at the end of the camp (T2), and 3 months after the camp concluded (T3). Habitual physical activities were assessed by means of a modified version of the Baecke questionnaire, which was completed by one of the parents at T1 and T3.

RESULTS: During the sports camp, we observed significant improvements in the children's perception of their physical functioning, role-physical functioning, general health, role-emotional functioning, self-esteem, mental health, and general behavior. For physical functioning, role-emotional functioning, and family activities, high scores persisted three months after the sports camp concluded. The habitual physical activities (sport and leisure time) of the children remained unchanged.

DISCUSSION AND CONCLUSION: In conclusion, we propose that a special sports camp for children with congenital heart disease may improve specific dimensions of subjective health status. Our study confirms a previous report on the benefits of such camps for afflicted children. If these findings can be further corroborated in other settings, participation in sport camps should be advocated as a simple, noninvasive means to promote healthier children.