New study encourages heart children to engage in physical activity

© Sergey Novikov -

It does not happen often but, when it does, there is always a huge media response: when top athletes drop dead in the midst of a match. Often, some sort of heart disease is afterwards identified as the cause. This leaves especially those who suffer from congenital heart disease feeling insecure. Many parents, out of fear of danger, keep their heart child from practising sport. A recent study now seems to give a partial all-clear.

The nationwide Norwegian survey of events of sudden cardiac death in children with congenital heart disease revealed no connection between the deaths surveyed and physical exercise.

The researchers analysed the data of all 11,272 children with congenital heart disease that were born in Norway between 1994 and 2009. Just a marginal number of these children (0.2%) had suffered sudden cardiac death that was not related to heart surgery. In less than half of these deceased children (seven out of 19), a cardiac cause could be identified. None of the examined deaths was related to physical exercise.
Two of the surveyed children had survived a cardiac arrest which had occurred in connection with physical stress. Both had carried a known risk of severe rhythm disorders.

Sudden cardiac death and physical exercise

During exercise, everybody faces an increased risk of sudden cardiac death – including people with healthy hearts. This risk is slightly increased in adults with congenital heart disease. However, the death rates as calculated for this patient group are relatively low (between 1.5% and 8%). As it turned out, children with congenital heart disease who engage in physical activity seem to have an even lower risk: in the recent study by Jortveit and others their risk tends toward zero.

Exercise is important!

The study authors conclude that the beneficial effects of physical exercise outweigh the low risk of sudden cardiac death. In an editorial related to the study, Gerhard-Paul Diller and Helmut Baumgartner, congenital heart disease specialists from the University Hospital Muenster, Germany, emphasise the importance of sufficient exercise for patients with congenital heart disease, starting in childhood. They contrast the fear of potential detrimental side effects with the risk of obesity, which, in the long term, can lead to secondary damage. Accordingly, obesity is considered to be an increasing problem since it is a risk factor for later complications such as arteriosclerosis, i.e. the hardening and thickening of the walls of the arteries. Physical activity is assumed to be an effective antidote. Diller and Baumgartner thus advise individuals with congenital heart disease to exercise to the extent to which they are physically able.

Individual exercise plans

Persons with congenital heart disease are often unsure about the extent and amount of physical activity that is beneficial to their health. This calls for appropriate counselling by the treating physicians. The individual risk is subject to different factors such as age, severity of the heart defect and certain concomitant diseases. In case of doubt, supervised exercise tolerance tests can help.

Risk factors connected to physical activity in congenital heart disease

In general, the risk increases with increasing age and severity of the heart defect.
Further risk factors are:

-         Limited heart function
-         Previous rhythm disorders
-         Pulmonary hypertension
-         Cyanosis
-         Dilatation of the aorta (aortic disease)
-         Lack of habituation to sports activity

Author(s): Eva Niggemeyer
Last updated: 2015-11-12