Assessment of cardiovascular fitness for competitive sport in high risk groups
- Cardiothoracic Unit
- Great Ormond Street Hospital for Children
- London WC1N 3JH
Regular exercise has been well established to be of physical and psychological benefit to the growing child. Recently, the issue of sudden death during sport has been brought to public attention after the tragic deaths of a few high profile athletes. The need for screening before participation has been queried and task forces have been established to devise recommendations in this area. Physicians are also being faced with a growing population of children and young adults with complex congenital heart defects who are surviving thanks to advances in medical and surgical treatment. An understanding of the residual haemodynamic lesions in these children is essential in order to make sensible recommendations for their ongoing participation in sport. The role of the physician is to impose sensible restrictions based on an assessment of the patient’s potential risk of sudden death and of deterioration of cardiac haemodynamics as a result of sport while at the same time encouraging participation in sport as much as is safely possible.
Benefits of exercise
In adults, regular exercise retards the development of coronary artery disease, hypertension, and obesity.1 Training improves cardiac output and oxygen extraction at the tissue level in addition to decreasing myocardial oxygen demands for the same level of external work.2 Exercise has also been shown to have psychological benefits and reduce the incidence of stress and depression. These findings are relevant to paediatrics as those who establish regular exercise patterns are more likely to continue these endeavours throughout adulthood.3 Participation in sports is an important part of social development for every child and unnecessary restriction can result in alienation and stigmatisation. Children with congenital heart disease can also benefit from regular exercise with an improvement in cardiac output, oxygen consumption, and treadmill times.4 5
Based on this information, some degree of regular exercise …