Jesse M. Boyett Anderson, MD, MS; Megan A. Moreno, MD, MSEd, MPH; John S. Hokanson, MD
Introduction
Approximately 7,000 babies with a critical Congenital Heart Defect, requiring surgery or other procedure during their first year of life, are born each year in the United States.[1,2] Following cardiac surgery, these patients are typically placed on post-operative activity restrictions and many are given life-long activity restrictions.
There is scant evidence regarding activity restriction following any pediatric surgery, and none regarding restrictions after cardiac surgery.[3] Current guidelines for children who have had cardiac surgery are extrapolated from adult guidelines, which, themselves are based on limited evidence and are not standardized.[4,5] Both the American Heart Association/American College of Cardiology (AHA/ACC) and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR)/European Congenital Heart and Lung Exercise Group (ECHLEG)/Association for European Paediatric Cardiology (AEPC) have developed guidelines for ongoing participation in sports and other physical activities for older children and young adults with Congenital Heart Disease.[6-8] These recommendations are based on expert opinion and the American guidelines are tailored to the adolescent and young adult competitive athlete, offering no guidance for other types of activity or for children under the age of 12 years.
FIGURE 1 Clinician recommendations regarding optimal interval after cardiac surgery for return to activities of daily living. Lift = lift under arms.
Although exercise and activity restrictions are recommended in the hopes of decreasing postoperative complications and injury or negative health outcomes, the potential adverse effects of these restrictions are not always considered. Mounting evidence demonstrates the benefit of regular physical activity on physical health, mental health, longevity, academic performance, social adjustment, and quality of life for everyone.[9-12] Patterns of physical activity established during childhood often carry over into adult life, the association between physical activity and physical health increases across the lifespan,[13] and early patterns of physical activity impact cognitive functioning during adulthood.[14] Activity restrictions in the immediate post-surgical period and in the long term may limit the early acquisition of healthy activity habits in children who have surgery for Congenital Heart Disease.
There are unique benefits that accrue to patients with Congenital Heart Disease (CHD) who participate in regular physical activity. Adolescents and young adults with CHD who participate in competitive sports (including those restricted by current guidelines) experience marked physical and emotional health benefits, including increased quality of life and exercise capacity.[15] Improved childhood exercise capacity in patients following the Fontan procedure is correlated with better adult prognosis.[16] Additionally, while children who undergo cardiac surgery have a higher risk of poor neurocognitive outcomes, including impaired executive function,[17-19] a recent meta-analysis shows that long-term physical activity can help improve executive function.[20]
To read the full article, please go to the May 2020 Issue of CCT.