ORIGINAL ARTICLE

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

Brian W McCrindle¹, Richard V Williams², Seema Mital³, Bernard J Clark⁴, Jennifer L Russell¹, Gloria Klein⁵, Joey C Eisenmann⁶

¹ University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
² University of Utah, Salt Lake City, UT, USA
³ Columbia University Medical Center, New York, NY, USA
⁴ Children’s Hospital of Philadelphia, Philadelphia, PA, USA
⁵ New England Research Institutes, Watertown, MA, USA
⁶ Iowa State University, Ames, IA, USA

Correspondence to:
Dr Brian McCrindle
The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; brian.mccrindle{at}sickkids.ca

Objectives: To determine physical activity levels in paediatric patients who underwent the Fontan procedure, and their relationship to functional status and exercise capacity.

Study Design: We studied 147 patients (ages 7–18 years) at a median of 8.1 years after Fontan, as part of the Pediatric Heart Network cross-sectional study of Fontan survivors. Assessment included medical history, self-reported physical activity, parent-completed Child Health Questionnaire (CHQ), cardiopulmonary exercise testing and physical activity level measured by accelerometry (MTI Actigraph).

Results: Measured time spent in moderate and vigorous activity was markedly below normal at all ages, particularly in females, and was not significantly related to self-reported activity levels, or to maximum VO₂, VO₂ at anaerobic threshold or maximum work rate on exercise testing. Lower measured activity levels were significantly related to lower perceived general health but not to self-esteem, physical functioning, social impact of physical limitations or overall physical or psychosocial health summary scores. Reduced exercise capacity was more strongly related than measured activity levels to lower scores in general health, self-esteem and physical functioning.

Conclusions: Physical activity levels are reduced after Fontan, independent of exercise capacity, and are associated with lower perceived general health but not other aspects of functional status.

Abbreviations: BMI, body mass index; CHAT, Congenital Heart Adolescent and Teenage questionnaire; CHQ, Child Health Questionnaire; METS, metabolic equivalent tasks; MPA, moderate physical activity; MVPA, moderate and vigorous physical activity; PHN, Pediatric Heart Network; VAT, ventilatory anaerobic threshold; VCO₂, carbon dioxide production; VO₂, oxygen consumption; VPA, vigorous physical activity

Keywords: congenital heart disease; cardiac surgery; functional status; exercise

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