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Sports participation, activity, and obesity in children who have undergone the Fontan procedure

Published online by Cambridge University Press:  03 September 2021

Marica E. Baleilevuka-Hart*
Affiliation:
Oregon Health and Science University, Division of Pediatric Cardiology, Portland, USA
Ayesha Khader
Affiliation:
Oregon Health and Science University School of Medicine, Portland, USA
Cesar E Gonzalez De Alba
Affiliation:
University of Colorado, Pediatric Heart Institute, Children’s Hospital Colorado, Denver, USA
Kathryn W. Holmes
Affiliation:
Oregon Health and Science University, Division of Pediatric Cardiology, Portland, USA
Jennifer H. Huang
Affiliation:
Oregon Health and Science University, Division of Pediatric Cardiology, Portland, USA
*
Author for correspondence: M. Baleilevuka-Hart, 707 SW Gaines St, Mail code CDRC-P, Portland, OR 97239, USA. Tel: +1 (503) 494-2153. E-mail: maricahart@gmail.com

Abstract

Background:

Children with CHD are at risk for obesity and low levels of activity. These factors are associated with an increased risk of poor outcome. Participation in organised sports is an important avenue for children to maintain physical activity, though the relationship between sports participation and obesity has not been examined in the Fontan population.

Methods:

We performed a cross-sectional study of children aged 8–18 who had been evaluated between January 1, 2015 and October 1, 2019 at the Doernbecher Children’s Hospital outpatient paediatric cardiology clinic and had previously undergone a Fontan. Patients were excluded if they were unable to ambulate independently or if they had undergone a heart transplant. Patient characteristics were recorded from the electronic medical record. Parents were interviewed via a telephone survey and asked to describe their child’s activity levels and sports participation.

Results:

Our final cohort included 40 individuals, 74% were male. The overall prevalence of obesity (CDC BMI >95% for sex/age) in the cohort (23%) was significantly higher in non-athletes (33%) than athletes (0) (p = 0.02). There was no difference in cardiac complications or comorbidities between athletes and non-athletes. Athletes were more likely to meet daily activity recommendations (p = 0.05).

Conclusion:

Fontan patients who do not participate in sports are significantly more likely to be obese and less likely to be active than those who do. This is the first study to demonstrate the association between competitive sports participation and decreased likelihood of obesity in the Fontan population.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Jacobsen, RM, Ginde, S, Mussatto, K, et al. Can a home-based cardiac physical activity program improve the physical function quality of life in children with fontan circulation? Congenit Heart Dis 2016; 11: 175182.CrossRefGoogle ScholarPubMed
Opocher, F, Varnier, M, Sanders, SP, et al. Effects of aerobic exercise training in children after the fontan operation. Am J Cardiol 2005; 95: 150152.CrossRefGoogle ScholarPubMed
Sutherland, N, Jones, B, d’Udekem, Y. Should we recommend exercise after the fontan procedure? Hear Lung Circ 2015; 24: 753768.CrossRefGoogle ScholarPubMed
Hedlund, ER, Lundell, B, Soderstrom, L, et al. Can endurance training improve physical capacity and quality of life in young fontan patients? Cardiol Young 2018; 28: 438446.CrossRefGoogle ScholarPubMed
Rhodes, J, Curran, TJ, Camil, L, et al. Sustained effects of cardiac rehabilitation in children with serious congenital heart disease. Pediatrics 2006; 118: e586e593.10.1542/peds.2006-0264CrossRefGoogle ScholarPubMed
Hedlund, ER, Villard, L, Lundell, B, et al. Physical exercise may improve sleep quality in children and adolescents with fontan circulation. Cardiol Young 2019; 29: 922929.10.1017/S1047951119001136CrossRefGoogle ScholarPubMed
Hedlund, ER, Ljungberg, H, Söderström, L, et al. Impaired lung function in children and adolescents with fontan circulation may improve after endurance training. Cardiol Young 2018; 28: 11151122.CrossRefGoogle ScholarPubMed
Rhodes, J, Curran, TJ, Camil, L, et al. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 2005; 116: 13391345.10.1542/peds.2004-2697CrossRefGoogle ScholarPubMed
Cordina, RL, O’Meagher, S, Karmali, A, et al. Resistance training improves cardiac output, exercise capacity and tolerance to positive airway pressure in fontan physiology. Int J Cardiol 2013; 168: 780788.CrossRefGoogle ScholarPubMed
Rato, J, Sousa, A, Cordeiro, S, et al. Sports practice predicts better functional capacity in children and adults with fontan circulation. Int J Cardiol 2020; 306: 6772.CrossRefGoogle ScholarPubMed
Sutherland, N, Jones, B, Westcamp Aguero, S, et al. Home- and hospital-based exercise training programme after fontan surgery. Cardiol Young 2018; 28: 12991305.CrossRefGoogle ScholarPubMed
Laohachai, K, Winlaw, D, Selvadurai, H, et al. Inspiratory muscle training is associated with improved inspiratory muscle strength, resting cardiac output, and the ventilatory efficiency of exercise in patients with a fontan circulation. J Am Heart Assoc 2017; 6: 111.CrossRefGoogle ScholarPubMed
Scheffers, LE, vd, Berg LE, Ismailova, G, et al. Physical exercise training in patients with a fontan circulation: a systematic review. Eur J Prev Cardiol 2020; 27: 204748732094286. DOI: 10.1177/2047487320942869.Google Scholar
Dulfer, K, Duppen, N, Kuipers, IM, et al. Aerobic exercise influences quality of life of children and youngsters with congenital heart disease: a randomized controlled trial. J Adolesc Heal 2014; 55: 6572.10.1016/j.jadohealth.2013.12.010CrossRefGoogle ScholarPubMed
Hjortdal, VE, Emmertsen, K, Stenbøg, E, et al. Effects of exercise and respiration on blood flow in total cavopulmonary connection: a real-time magnetic resonance flow study. Circulation 2003; 108: 12271231.10.1161/01.CIR.0000087406.27922.6BCrossRefGoogle ScholarPubMed
Siaplaouras, J, Niessner, C, Helm, PC, et al. Physical activity among children with congenital heart defects in Germany: a nationwide survey. Front Pediatr 2020; 8: 18.CrossRefGoogle ScholarPubMed
McCrindle, BW, Williams, RV, Mital, S, et al. Physical activity levels in children and adolescents are reduced after the fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509514.CrossRefGoogle ScholarPubMed
Brassard, P, Poirier, P, Martin, J, et al. Impact of exercise training on muscle function and ergoreflex in fontan patients: a pilot study. Int J Cardiol 2006; 107: 8594.CrossRefGoogle ScholarPubMed
Cordina, R, O’Meagher, S, Gould, H, et al. Skeletal muscle abnormalities and exercise capacity in adults with a fontan circulation. Heart 2013; 99: 15301534.CrossRefGoogle ScholarPubMed
Noortman, LCM, Haapala, EA, Takken, T. Arterial stiffness and its relationship to cardiorespiratory fitness in children and young adults with a fontan circulation. Pediatr Cardiol 2019; 40: 784791.CrossRefGoogle Scholar
Paridon, SM, Mitchell, PD, Colan, SD, et al. A Cross-Sectional study of exercise performance during the first 2 decades of life after the fontan operation. J Am Coll Cardiol 2008; 52: 99107.10.1016/j.jacc.2008.02.081CrossRefGoogle ScholarPubMed
Zajc, A, Tomkiewicz, L, Podolec, P, et al. Cardiorespiratory response to exercise in children after modified fontan operation. Scand Cardiovasc J 2002; 36: 8085.CrossRefGoogle Scholar
Tomkiewicz-Pajak, L, Podolec, P, Drabik, L, et al. Single ventricle function and exercise tolerance in adult patients after fontan operation. Acta Cardiol 2014; 69: 155160.CrossRefGoogle ScholarPubMed
Diller, GP, Dimopoulos, K, Okonko, D, et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic implication. Circulation 2005; 112: 828835.10.1161/CIRCULATIONAHA.104.529800CrossRefGoogle ScholarPubMed
Longmuir, PE, Corey, M, Faulkner, G, et al. Children after fontan have strength and body composition similar to healthy peers and can successfully participate in daily Moderate-to-Vigorous physical activity. Pediatr Cardiol 2015; 36: 759767.CrossRefGoogle ScholarPubMed
Tran, D, D’Ambrosio, P, Verrall, CE, et al. Body composition in young adults living with a fontan circulation: the myopenic profile. J Am Heart Assoc 2020; 9: e015639.CrossRefGoogle ScholarPubMed
Chung, ST, Hong, B, Patterson, L, et al. High overweight and obesity in fontan patients: a 20-Year history. Pediatr Cardiol 2016; 37: 192200.CrossRefGoogle ScholarPubMed
Wellnitz, K, Harris, IS, Sapru, A, et al. Longitudinal development of obesity in the post-Fontan population. Eur J Clin Nutr 2015; 69: 11051108.CrossRefGoogle ScholarPubMed
Perkins, DF, Jacobs, JE, Barber, BL, et al. Childhood and adolescent sports participation as predictors of participation in sports and physical fitness activities during young adulthood. Youth Soc 2004; 35: 495520.10.1177/0044118X03261619CrossRefGoogle Scholar
Jose, KA, Blizzard, L, Dwyer, T, et al. Childhood and adolescent predictors of leisure time physical activity during the transition from adolescence to adulthood: a population based cohort study. Int J Behav Nutr Phys Act 2011; 8: 19.CrossRefGoogle ScholarPubMed
Batista, MB, Romanzini, CLP, Barbosa, CCL, et al. Participation in sports in childhood and adolescence and physical activity in adulthood: a systematic review. J Sports Sci 2019; 37: 22532262.10.1080/02640414.2019.1627696CrossRefGoogle ScholarPubMed
Tammelin, T, Näyhä, S, Hills, AP, et al. Adolescent participation in sports and adult physical activity. Am J Prev Med 2003; 24: 2228.CrossRefGoogle ScholarPubMed
Minamisawa, S, Nakazawa, M, Momma, K, et al. Effect of aerobic training on exercise performance in patients after the fontan operation. Am J Cardiol 2001; 88: 695698.CrossRefGoogle ScholarPubMed
Longmuir, PE, Tyrrell, PN, Corey, M, et al. Home-based rehabilitation enhances daily physical activity and motor skill in children who have undergone the fontan procedure. Pediatr Cardiol 2013; 34: 11301151.CrossRefGoogle ScholarPubMed
Piercy, KL, Troiano, RP, Ballard, RM, et al. The physical activity guidelines for Americans. JAMA - J Am Med Assoc 2018; 320: 20202028.CrossRefGoogle ScholarPubMed
Defining Childhood Obesity | Overweight & Obesity | CDC. 2021. Retrieved from https://www.cdc.gov/obesity/childhood/defining.html Google Scholar
Van Hare, GF, Ackerman, MJ, Evangelista, JAK, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2015; 132: e281e291.10.1161/CIR.0000000000000240CrossRefGoogle ScholarPubMed
Obesity S of C. State obesity data - the state of childhood obesity 2020; 114.Google Scholar
Martinez, SC, Byku, M, Novak, EL, et al. Increased body mass index is associated with congestive heart failure and mortality in adult fontan patients. Congenit Heart Dis 2016; 11: 7179.CrossRefGoogle ScholarPubMed
Callegari, A, Neidenbach, R, Milanesi, O, et al. A restrictive ventilatory pattern is common in patients with univentricular heart after fontan palliation and associated with a reduced exercise capacity and quality of life. Congenit Heart Dis 2019; 14: 147155.CrossRefGoogle ScholarPubMed
Guenette, JA, Ramsook, AH, Dhillon, SS, et al. Ventilatory and sensory responses to incremental exercise in adults with a fontan circulation. Am J Physiol - Hear Circ Physiol 2019; 316: H335H344.CrossRefGoogle ScholarPubMed
Matthews, IL, Fredriksen, PM, Bjørnstad, PG, et al. Reduced pulmonary function in children with the fontan circulation affects their exercise capacity. Cardiol Young 2006; 16: 261267.CrossRefGoogle ScholarPubMed
Madan, P, Stout, KK, Fitzpatrick, AL. Age at fontan procedure impacts exercise performance in adolescents: results from the pediatric heart network multicenter study. Am Heart J 2013; 166: 365372.e1.CrossRefGoogle ScholarPubMed
Longmuir, PE, Russell, JL, Corey, M, et al. Factors associated with the physical activity level of children who have the Fontan procedure. Am Heart J 2011; 161: 411417.10.1016/j.ahj.2010.11.019CrossRefGoogle ScholarPubMed
Swan, L, Hillis, WS. Exercise prescription in adults with congenital heart disease: a long way to go. Heart 2000; 83: 685687.10.1136/heart.83.6.685CrossRefGoogle ScholarPubMed
Logan, K, Lloyd, RS, Schafer-Kalkhoff, T, et al. Youth sports participation and health status in early adulthood: a 12-year follow-up. Prev Med Reports 2020; 19: 101107. DOI: 10.1016/j.pmedr.2020.101107.CrossRefGoogle ScholarPubMed
Schumacher Dimech, A, Seiler, R. Extra-curricular sport participation: a potential buffer against social anxiety symptoms in primary school children. Psychol Sport Exerc 2011; 12: 347354.10.1016/j.psychsport.2011.03.007CrossRefGoogle Scholar
Howe, LJ, Lukacs, S, Pastor, P, et al. Participation in activities outside of school hours in relation to problem behavior and social skills in middle. J Sch Health 2010; 80: 119125.CrossRefGoogle Scholar
Snyder, AR, Martinez, JC, Bay, RC, et al. Health-related quality of life differs between adolescent athletes and adolescent nonathletes. J Sport Rehabil 2010; 19: 237248.CrossRefGoogle ScholarPubMed
Taliaferro, L, Rienzo, B, M., M, et al. High school youth and suicide risk: exploring protection afforded through physical activity and sport participation. J Sch Health 2008; 78: 545553.CrossRefGoogle ScholarPubMed
Vella, SA, Cliff, DP, Magee, CA, et al. Sports participation and parent-reported health-related quality of life in children: longitudinal associations. J Pediatr 2014; 164: 14691474.10.1016/j.jpeds.2014.01.071CrossRefGoogle ScholarPubMed
Hebert, JJ, Klakk, H, Møller, NC, et al. The prospective association of organized sports participation with cardiovascular disease risk in children (the CHAMPS study-DK). Mayo Clin Proc 2017; 92: 5765.10.1016/j.mayocp.2016.08.013CrossRefGoogle ScholarPubMed