Abstract
Low levels of habitual physical activity in children and adolescents with congenital
heart disease (CHD) leads to various negative health outcomes, yet review of the literature
indicates that many physicians, caregivers, and patients restrict physical activity
owing to safety concerns. There is no evidence supporting absolute restriction of
physical activity in pediatric patients with CHD; in fact, physically active lifestyles
are as important for pediatric patients living with CHD as for the general population.
To encourage long-term maintenance of physically active lifestyles, physical activity
counselling and exercise prescription should be started early in childhood and be
a core component of every patient encounter. Physical activity counselling should
include clear messaging from physicians about recommended physical activities—not
just restrictions—and a personalised written exercise prescription for the patient
and family. Regular follow-up is essential to ensure adherence to recommendations,
monitor patient responses to the increased physical activity level, and long-term
surveillance. This review discusses the importance of a physically active lifestyle
in children and adolescents with and without surgically repaired CHD and hypertrophic
cardiomyopathy, excluding those with electrical abnormalities and channelopathies.
It outlines gaps in knowledge regarding best practices for physical activity promotion
in these patient populations, and provides recommendations on how to include physical
activity promotion and exercise prescription in clinical practice based on existing
literature. An important role for clinicians is identified, because the type of messaging
they provide regarding physical activity will have a major impact on patients’ and
families’ decisions to adopt an active lifestyle.
Résumé
Le manque d’activité physique régulière chez les enfants et les adolescents présentant
une cardiopathie congénitale nuit de différentes manières à la santé et pourtant,
une revue de la littérature révèle que beaucoup de médecins, d’aidants et de patients
limitent l’activité physique pour des raisons de santé. Rien n’indique pourtant qu’il
soit nécessaire d’interdire l’activité physique chez les enfants présentant une cardiopathie
congénitale; au contraire, un mode de vie physiquement actif est aussi important pour
ces patients que pour la population générale. Pour favoriser l’adoption à long terme
d’un mode de vie actif, il convient de mettre en place un programme de counseling
visant à encourager l’instauration d’un régime d’exercice physique tôt durant l’enfance;
cette intervention devrait faire partie du traitement de tous les patients vus en
consultation. Le counseling sur l’activité physique doit transmettre des messages
clairs quant aux recommandations en matière d’activité physique – et non seulement
quant aux restrictions; le médecin devrait remettre par écrit un plan d’activité physique
personnalisé au patient et à sa famille. Un suivi régulier est essentiel pour assurer
l’adhésion aux recommandations, surveiller les effets de l’augmentation de l’activité
physique et exercer une surveillance à long terme. Nous discutons ici de l’importance
d’un mode de vie physiquement actif pour les enfants et les adolescents atteints d’une
cardiopathie congénitale ou d’une cardiomyopathie hypertrophique (ayant ou non fait
l’objet d’une réparation par voie chirurgicale), exception faite de ceux qui présentent
des anomalies électriques ou une canalopathie. Nous soulignons en outre le manque
de connaissance des pratiques exemplaires en matière de promotion de l’activité physique
auprès de ces populations de patients et, en nous fondant sur la littérature publiée,
nous formulons des recommandations sur la façon d’inclure dans la pratique clinique
la promotion de l’activité physique et la prescription d’un régime d’exercice physique.
Les cliniciens ont un rôle important à jouer à cet égard, parce que la teneur des
messages qu’ils transmettent au sujet de l’activité physique aura une grande incidence
sur les décisions du patient et de sa famille quant à l’adoption d’un mode de vie
actif.
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Article info
Publication history
Published online: July 13, 2020
Accepted:
July 6,
2020
Received:
March 3,
2020
Footnotes
See page 1414 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
