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Background: Healthy active lifestyles are critically important for children with complex heart problems (CHP) that affect heart structure, rhythm or function. They are at increased risk for morbidities such as atherosclerosis, obesity, anxiety and depression. Educating children with CHP and their families about the relevance of healthy lifestyles is an important part of clinical care. Design This study used a collaborative approach among six patients/family members and 22 health professionals to develop a series of knowledge‐to‐action tools suitable for counselling children with CHP and their families about their healthy lifestyle needs. Methods: After development of the knowledge‐to‐action tools had been completed, one cardiologist and one research assistant implemented one or more of these new resources during each clinic visit as appropriate for each patient. Thirty‐nine parents and eight children completed post‐clinic interviews to explore their perceptions of the new resources. The nine resources developed included brochures and websites addressing physical activity with a heart condition, body contact restrictions, exercise test results, emotional health, finding community resources, encouragement for asking healthy lifestyle questions and a brief, in‐clinic healthy lifestyle assessment. Results: Families found the resources useful and helpful for clarifying their specific concerns. They also provided suggestions to improve the content and delivery of the resources so that they would be suitable for a variety of settings—schools, community and sports. Conclusion: Future research is required to evaluate the effectiveness of these resources for raising awareness and knowledge about healthy active lifestyles among children with CHP and the impact of these resources for changing healthy lifestyle behaviours. [ABSTRACT FROM AUTHOR]

This study examined gender, disability type, age, and specific diagnostic category in relation to habitual physical activity levels (HPA), perceived fitness (PF), and perceived participation limitations (PPL) of youths, ages 6 to 20 years, in Ontario, Canada. Data collected through a mailed survey (Longmuir & Bar-Or, 1994) were reanalyzed using ANOVA and chi square statistics to provide new information. The 458 girls and 499 boys were classified by disability type: physical, chronic medical, visual, and hearing. Significant differences (p < .01) were between (a) HPA and disability type, specific diagnostic category, and age: (b) PF and disability type; and (c) PPL and disability type. Gender did not influence the results. Youths with cerebral palsy, muscular dystrophy, and visual impairment had the most sedentary lifestyles. [ABSTRACT FROM AUTHOR]

Children with congenital heart disease (CHD) are often restricted from some types of physical activity (PA) despite the lack of evidence regarding the need to restrict recreational PA, apart from those with rhythm disorders. This study retrospectively investigated the associations between parent-reported activity restrictions (on-going need to restrict exertion, body contact or competition) and measures of health-related fitness among 236 children (8.2 ± 2.1 years, range 4−12 years) treated for single ventricle (n = 104), tetralogy of Fallot (n = 48), transposition of the great arteries (n = 47) or atrial septal defect (n = 37). Body mass index (BMI), moderate-to-vigorous physical activity (MVPA; 7 day accelerometry), strength, flexibility, and movement skill assessment results were collected from the baseline assessment research records for two studies completed in Ontario, Canada. A subset of 62 children also had physician-reported activity restrictions. Regression models empirically tested the goodness of fit between the dependent and independent variables. Participants with body contact restrictions from both parents and physicians had significantly higher BMI z-scores (0.23 ± 1.19 vs. −0.32 ± 0.85; t = 2.55; p = 0.04 and 0.66 ± 1.33 vs. −0.02 ± 0.98; t = 2.25; p = 0.02 for CDC and WHO scores, respectively). Otherwise, BMI z-score was not associated with patient variables (p > 0.36; sex, cardiac diagnosis, age, or activity restriction). Children with any type of parent-reported restriction (0.98 ± 2.06 vs. −0.08 ± 1.99; t = 3.77; p = 0.0002) were less flexible. Movement skill (TGMD-2) scores were 50% lower (25.1 ± 31.2 vs. 52.6 ± 28.6; F = 6.93; p = 0.009) among children with parent-reported competitive sport restrictions. Weekly MVPA (p > 0.18) and strength (p > 0.05) were not associated with activity restriction. Children whose parents reported PA restrictions were less flexible, and had decreased movement skill and increased BMI z-scores if the restrictions impacted competitive sport or body contact, respectively. Future research is recommended to confirm these results among larger samples of children who have both parent- and physician-specified PA restrictions.

Background: Participation in physical activity is essential to the long-term health and development of all children. However, children living with cardiac conditions are typically not active enough to sustain positive health outcomes. Understanding the experiences of children living with congenital heart disease in community-based settings could help inform the physical activity counselling practices of clinicians. The current study explored the perceptions of 7- to 10-year-old children with moderate or complex congenital heart disease as they participated in a 10-week multisport programme., Methods: Detailed field notes recorded the discussions and behaviours of 11 participants (45% female participants) each week during the programme sessions. Among those, four participants (50% female participants) were purposively selected to participate in preprogramme and postprogramme focus groups to gather more detailed accounts of their experiences., Results: Four main themes surrounding physical activity were identified: (a) motivation, (b) self-efficacy, (c) peer influences, and (d) family influences. Although feelings of excitement and enjoyment towards physical activity were prevalent throughout the data ("I'm really excited … because I really like those sports"), participants also often felt frustrated, nervous, and fatigued ("I'm not very good at the skills"). Social inclusion with peers and family influences were meaningful reasons to engage in physical activity ("I really like playing games together"). Following the completion of the programme, participants emphasized their enjoyment of physical activity as a primary source of motivation, demonstrating an important shift from recognizing positive health outcomes ( "… it's good for you") towards more intrinsic sources of motivation ("… because it's fun")., Conclusion: Opportunities for physical activity that enhance positive experiences and build intrinsic motivation should be identified and promoted to children with congenital heart disease. Community-based programmes may also be an appropriate context for children with cardiac conditions to engage and maintain participation in physical activity through adolescence., (© 2020 John Wiley & Sons Ltd.)

Objective: The objective of this study was to determine the physical literacy (the motivation, confidence, physical competence, and knowledge contributing to the capacity for physical activity) of children with epilepsy, as compared with that of their healthy peers., Methods: Patients age 8-12 years with epilepsy, without any disabilities interfering with their ability to answer questionnaires and perform vigorous physical activity, were recruited from the Neurology Clinic at the time of visits. They completed the Canadian Assessment of Physical Literacy (CAPL), a comprehensive battery of tests reflecting the primary domains of physical literacy (motivation/confidence, physical competence, knowledge/understanding, and daily behavior). Daily behavior was assessed by pedometer step counts, as well as self-reported moderate-to-vigorous physical activity and screen time. Physical competence included agility and movement skill measures as well as physical fitness. Children with epilepsy were matched with healthy peers from a large research database of over 6000 Canadian children., Results: We tested 35 children with epilepsy, divided into those with presumed self-limiting forms of epilepsy (49%) and those with chronic disease (51%). Only a small proportion of participants (23%) were taking more than one antiepileptic medication, and only one patient was taking three anticonvulsants. Children with epilepsy including those with self-limiting forms had significantly lower total physical literacy scores, lower agility and movement skills, and lower muscular endurance, and reported more screen time than their healthy peers. Only 11% of the children with epilepsy achieved the recommended level of physical literacy. However, the children with epilepsy were knowledgeable about and highly motivated to participate in a physically active lifestyle., Conclusions: Children with epilepsy demonstrate poor physical literacy levels, with potential immediate and long-lasting negative impacts on general health and psychosocial well-being. Programs promoting physical literacy in children with epilepsy should be encouraged, specifically interventions decreasing screen time and enhancing muscular endurance and motor skills, thereby facilitating healthier lifestyles., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: After the Fontan procedure, children exhibit reduced peak exercise capacity, yet their submaximal exercise response remains unclear. This study sought to determine the relationship between submaximal and peak exercise capacity and physical activity in Fontan patients., Methods: This cross-sectional study recruited 50 Fontan patients (59% males) with a median age of 9 yr (range = 6-12 yr). The median age at Fontan procedure was 2.9 yr (range = 1.6-9.1 yr). Study assessments included medical history, exercise testing, and accelerometry., Results: Significantly lower submaximal oxygen consumption (V˙O2) and HR in response to a standardized workload than published values for healthy children (mean ± SD) of -1.72 ± 5.24 (P < 0.001) and -1.45 ± 1.98 (P < 0.001), respectively, suggest enhanced submaximal work efficiency in this group of patients after Fontan. Higher submaximal V˙O2 z-score was associated with higher submaximal HR z-score (P = 0.02) and lower body mass index z-score (P = 0.01). Higher V˙O2peak was associated with higher submaximal V˙O2 z-score (P < 0.01), male sex (P = 0.03), higher RER (P = 0.02), lower submaximal HR z-score (P < 0.01), and higher chronotropic responsiveness (P < 0.0001). Exercise test duration z-score was associated with lower submaximal HR z-score (P = 0.02) and higher chronotropic responsiveness (P = 0.02)., Conclusions: Fontan patients exhibited a lower submaximal V˙O2 and HR responsiveness at a given workload than healthy controls did during standardized exercise testing. Thus, they may be better adapted to perform submaximal exercise. Although peak exercise capacity is limited, Fontan patients are able to perform submaximal physical activities at the same level as their healthy peers.

Background: Physical activity is important for the health of children after the Fontan procedure. Parents uncertain about physical activity have children who are more sedentary. To understand parent uncertainty, we examined agreement regarding activity restrictions from parents, cardiologists, and medical charts., Methods: Activity restriction information for 64 children (25 female), 6 to 11 years, with a Fontan circulation was obtained via cardiologist and parent questionnaire. Each child's medical chart was reviewed for relevant physical activity information. kappa Statistics calculated agreement between sources beyond chance., Results: Cardiologist, parent, and medical chart reports of the child's activity restrictions often disagree. Regardless of the cardiologist reported restrictions, 70% of parents reported that their child's activity was restricted (kappa = 0.04, P = .25). Parents and cardiologists report the same body contact restrictions (kappa = 0.16) but differ for exertion and competition (kappa < .05) restrictions. Medical charts reflect competitive sport (kappa = 0.26) but not body contact or exertion restrictions., Conclusions: Parent feelings of uncertainty about physical activity are supported by these results indicating that reports of activity restrictions after the Fontan procedure vary significantly by source. Parent and cardiologist reports agree only for body contact restrictions due to anticoagulation therapy. Exertion and body contact restrictions are not reflected in clinic letters to primary care providers. Ensuring that activity restrictions are accurately conveyed will enable parents and primary care providers to confidently encourage the active lifestyles that are so important for these children.