Abstract
Children born with functional single ventricle undergo the Fontan procedure in infancy. This prospective cohort study aimed to identify longitudinal trends in the physical activity levels among adolescents and adults with Fontan circulation to determine factors associated with daily moderate-to-vigorous physical activity (MVPA). Eligible participants included 104 patients (13±3 years) who participated in the Pediatric Heart Network Fontan 2 Follow-up Study at the Hospital for Sick Children. Participants completed psychosocial questionnaires, cardiopulmonary exercise testing, and physical activity assessments during the Fontan 2 Follow-up Study. Participants (N=32; 21±3 years, 50% male) from this cohort were recruited to complete a 7-day physical activity re-assessment using tri-axial accelerometers. The most recent cardiopulmonary exercise testing results were also extracted from medical record review. Paired t-test analysis was used to determine changes between study periods for MVPA and exercise capacity. Univariable and multivariable linear regression analysis was used to determine factors associated with MVPA as a young adult. Mean MVPA decreased by 12min/day between study periods (mean ± standard deviation)(39±28 MVPA min/day vs. 27±17 MVPA min/day; p=0.01). Exercise capacity (VO2peak) was unchanged between study periods (28±6 ml/kg/min vs. 28±8 ml/kg/min; p=0.97). Univariable regression analysis demonstrated a significant positive association between adult MVPA and higher childhood VO2peak (parameter estimate[standard error]; p-value) (+1.4[0.7]; p=0.04) and higher childhood daily MVPA (+0.40[0.14]; p=0.004). Adult MVPA showed a modest positive association with higher adult VO2peak (+0.88[0.46]; p=0.06). Multivariable regression analysis demonstrated that higher adult MVPA was associated with higher adult VO2peak (+2.2[0.8]; p=0.01) while adult MVPA was not associated with childhood VO2peak or childhood MVPA (-0.83[1.20]; p=0.50 and +0.25[0.20]; p=0.24, respectively). This study identified reduced daily MVPA and unchanged exercise capacity among patients with Fontan circulation from childhood to early adulthood. Regular physical activity should be encouraged among Fontan patients throughout their clinical care. Additional exercise recommendations among young adults with Fontan circulation may also aim to increase exercise capacity (VO2peak) in response to cardiovascular and physiological changes experienced in adulthood. Future research should explore underlying psychosocial and physiological factors associated with physical activity among the emerging adult Fontan population.
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