Reduced physical activity levels after the Fontan procedure: Related to exercise capacity or own health perception?

Brian W. McCrindle ^1*, Richard V. Williams ², Seema Mital ³, Bernard J. Clark ⁴, Jennifer L. Russell ⁵, Gloria Klein ⁶ and Joey C. Eisenmann ⁷

¹ The Hospital for Sick Children, Canada
² University of Utah, Salt Lake City, Utah, United States
³ Columbia University Medical Center, New York, New York, United States
⁴ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
⁵ The Hospital for Sick Children, Toronto, Ontario, Canada
⁶ New England Research Institutes, Watertown, Massacheusetts, United States
⁷ Iowa State University, Ames, Iowa, United States

^* To whom correspondence should be addressed. E-mail: brian.mccrindle{at}sickkids.ca.

Accepted 5 February 2007

Abstract

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

Study Design: We studied 147 patients (ages 7 to 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 measured physical activity level 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.

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

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