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Physical performance, physical activity, body composition and exercise training in adults with congenital heart disease
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Adults with congenital heart disease (CHD) is a growing population and related to advances in surgical and medical treatment, they now outnumber the children with corresponding lesions. Since a congenital heart lesion often results in reduced exercise capacity, this population is a potential target for physiotherapy. To what extent this reduction in exercise capacity is caused by abnormal cardiovascular anatomy and physiology or to what degree insufficient physical activity contributes is not known. To support the advancements in paediatric cardiac care, increased knowledge regarding physical performance, physical activity level, body composition and the effects of exercise training among adults with CHD is required.

Methods In a cross-sectional study skeletal- and respiratory muscle function, physical activity level and exercise self-efficacy was investigated among 85 adults with various forms of CHD and 42 control subjects. A second study was conducted to analyse height, weight and body mass index (BMI) in 538 adults with complex CHD and 1886 adults with simple CHD. Data were extracted from the Swedish registry on congenital heart disease (SWEDCON) and compared to data from a national population survey. In a third study, factors associated with self-reported quality of life (QoL) were analysed using SWEDCON data on 315 adults with congenital aortic valve disease. Finally, a randomised controlled trial was conducted to investigate the effects of interval exercise training among adults with complex CHD.

Results Adults with complex CHD showed impaired muscle function compared to both patients with simple CHD and controls. In addition, patients with complex CHD had a lower exercise self-efficacy compared to controls. Patients with CHD were equally active at moderate-to-vigorous level as the controls. However, approximately 50% of both patients and controls failed to reach the recommended physical activity level. In general patients with CHD had the same height, weight and BMI, as the general population. However, compared to the general population, men with CHD were more commonly underweight and less commonly overweight/obese. Additionally, especially male patients with complex CHD were shorter compared to the general population. Among adults with congenital aortic valve disease, a higher physical activity level was associated with better QoL. Furthermore, interval training increased exercise capacity and endurance among adults with complex CHD.

Conclusion A higher physical activity level was associated with better self-reported QoL in patients with congenital aortic valve disease which implies that QoL might be possible to improve, by adopting a physically active life-style. Adults with CHD were equally active as controls at a moderate-to-vigorous physical activity level. However, approximately half of both groups were insufficiently physically active based on current recommendations. This indicates that low physical activity, on group level, does not explain the lower exercise capacity commonly found among patients with CHD. In addition, this is consistent the finding that the majority of patients followed the same pattern regarding BMI as seen in the general population. However, impaired muscle function in combination with the shorter stature and higher prevalence of underweight found in men, especially with complex CHD, implies an altered body composition in this group. The findings of the present thesis suggests an indication for physiotherapy targeting increased physical activity level and individualized exercise training in this patient population. Moreover, regular evaluation of muscle function, exercise self-efficacy and QoL, in addition to exercise capacity, might be useful for monitoring disease development over time.

Place, publisher, year, edition, pages
Umeå: Print och Media , 2016. , 101 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1758
Keyword [en]
Adult congenital heart disease, physical performance, physical activity, body composition, exercise training
National Category
Physiotherapy Cardiac and Cardiovascular Systems
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:umu:diva-112846ISBN: 978-91-7601-360-1 (print)OAI: oai:DiVA.org:umu-112846DiVA: diva2:883042
Public defence
2016-01-29, Aula, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-12-18 Created: 2015-12-16 Last updated: 2016-01-12Bibliographically approved
List of papers
1. Adults with complex congenital heart disease have impaired skeletal muscle function and reduced confidence in performing exercise training
Open this publication in new window or tab >>Adults with complex congenital heart disease have impaired skeletal muscle function and reduced confidence in performing exercise training
2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 12, 1523-1530 p.Article in journal (Refereed) Published
Abstract [en]

Background Adults with congenital heart disease (ACHD) usually have reduced aerobic exercise capacity compared with controls. However, their skeletal muscle function is less studied. Material and methods In this cross-sectional study, unilateral isotonic shoulder flexion, unilateral isotonic heel-lift, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were tested in 85 patients with ACHD (35 women, mean age 36.814.8 years), classed as either complex' (n=43) or simple' (n=42), and 42 age and gender matched controls (16 women, mean age 36.914.9). Maximum number of shoulder flexions and heel-lifts were measured. MIP/MEP was tested using a handheld respiratory pressure meter. Exercise self-efficacy, measuring confidence in performing exercise training, was evaluated. Results Adults with complex lesions performed fewer shoulder flexions compared with controls and patients with simple lesions (28.2 +/- 11.1 vs. 63.6 +/- 40.4, p<0.001 and 28.2 +/- 11.1 vs. 54.9 +/- 24.9, p<0.001), as well as fewer heel-lifts compared with controls and patients with simple lesions (17.6 +/- 7.7 vs. 26.3 +/- 12.8, p<0.001 and 17.6 +/- 7.7 vs. 23.2 +/- 7.0, p=0.024), lower MIP than controls (80.7 +/- 26.7 vs. 111.1 +/- 29.9cm H2O, p<0.001) and lower MEP compared with controls (110.8 +/- 39.9 vs. 141.8 +/- 39.5, p<0.001). Their exercise self-efficacy was lower than controls (28.0 +/- 8.3 vs. 33.4 +/- 6.1, p=0.002). In a linear regression model complex heart lesions were independently associated with impaired limb muscle function. Conclusion Adults with complex congenital heart disease have impaired skeletal muscle function compared with patients with simple lesions and healthy controls. They also had lower confidence in performing exercise training. Thus, this population might have a potential for rehabilitation focusing on improving muscle function and confidence in performing exercise training.

Keyword
Muscle function, congenital heart disease, exercise self-efficacy
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-112235 (URN)10.1177/2047487314543076 (DOI)000364824400003 ()25038081 (PubMedID)
Available from: 2015-12-10 Created: 2015-12-04 Last updated: 2017-12-01Bibliographically approved
2. Habitual Physical Activity in Adults with Congenital Heart Disease Compared with Age- and Sex- Matched Controls
Open this publication in new window or tab >>Habitual Physical Activity in Adults with Congenital Heart Disease Compared with Age- and Sex- Matched Controls
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2016 (English)In: Canadian Journal of Cardiology, ISSN 0828-282X, E-ISSN 1916-7075, Vol. 32, no 4, 547-553 p.Article in journal (Refereed) Published
Abstract [en]

Background: Most adult patients with congenital heart disease (CHD) have reduced aerobic exercise capacity. Their habitual physical activity (PA) level is, however, less well studied. In this study habitual PA level in a cohort of adults with CHD compared to healthy age and gender matched controls was investigated.

Methods: Eighty adults with CHD, classed as either “complex” (n=40) or “simple” (n=40), and 42 healthy controls were studied with a combined uniaxial accelerometer and heart rate monitor worn during 4 consecutive days. We analysed 1) the time spent during ≥ moderate/vigorous PA, 2) accelerometer counts/day and 3) to what extent the World Health Organization recommendations on PA were reached.

Results: Patients with simple lesions had higher total accelerometer counts/day compared to both patients with complex lesions and controls (simple lesions; median (IQR) 107.7(63.4) vs. complex lesions; 72.8(53.5) and controls; 78.3(49.6), p≤0.001 and p=0.002). Furthermore, no differences in time spent during ≥ moderate-to-vigorous PA was found between patients and controls. In addition 46% of the patients with simple lesions, 55% of the patients with complex lesions and 44% of the controls did not reach the W.H.O.-recommended level of daily PA, but no significant differences between groups were found. There were no differences in achieving recommended PA level between patients in NYHA I vs. NYHA II+III.

Conclusions: Patients with CHD follow the same PA-level pattern as the general population. Broad strategies promoting an active lifestyle are needed across the population and especially for patients with complex CHD and impaired NYHA class.

Keyword
Congenital heart disease, Physical activity, Adult, Accelerometer, Heart rate monitor
National Category
Cardiac and Cardiovascular Systems Physiotherapy
Identifiers
urn:nbn:se:umu:diva-112856 (URN)10.1016/j.cjca.2015.08.021 (DOI)000373574900020 ()26777265 (PubMedID)
Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2017-12-01Bibliographically approved
3. Height, weight and body mass index in adults with congenital heart disease
Open this publication in new window or tab >>Height, weight and body mass index in adults with congenital heart disease
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2015 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 187, 219-226 p.Article in journal (Refereed) Published
Abstract [en]

Background: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited. Methods and results: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n = 4605). The prevalence of overweight/obesity (BMI >= 25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p = 0.048 and p < 0.001) (AVD 37.5% vs. 49.3%, p < 0.001). Overt obesity (BMI >= 30) was only more common in women with AVD (12.8% vs. 9.0%, p = 0.005). Underweight (BMI < 18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p < 0.001 and simple lesions 3.2% vs. 0.6%, <0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls. Conclusion: Higher prevalence of underweight in men with CHD combined with a lower prevalence of over-weight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown.

Place, publisher, year, edition, pages
Elsevier, 2015
Keyword
congenital heart disease, body mass index, height, weight, adult
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-105260 (URN)10.1016/j.ijcard.2015.03.153 (DOI)000354905600063 ()25838217 (PubMedID)
Available from: 2015-06-22 Created: 2015-06-22 Last updated: 2017-12-04Bibliographically approved
4. The level of physical exercise is associated with self-reported health status (EQ-5D) in adults with congenital heart disease
Open this publication in new window or tab >>The level of physical exercise is associated with self-reported health status (EQ-5D) in adults with congenital heart disease
Show others...
2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, 240-248 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The prognosis in adults with congenital aortic valve disease is usually favourable; nevertheless, a number of medical and social factors might hamper long-term prognosis and quality of life. With a focus on physical exercise level, data from the Swedish National Registry on Congenital Heart Disease (SWEDCON) were analysed and variables associated with health-related quality of life in adults with congenital aortic valve disease were identified.

METHODS: In this registry study, SWEDCON was searched for adult patients with isolated congenital aortic valve disease and valid EuroQol-5Dimensions health questionnaire (EQ-5D) data.

RESULTS: This study identified 315 patients. The majority (n = 202, 64%) reported best possible health status (EQ-5Dindex = 1) whereas 113 (35%) reported some impairment (EQ-5Dindex < 1) with mean EQ-5Dindex 0.73 ± 0.17. In a multivariate logistic regression model, self-reported physical exercise > 3 h/week was independently associated with best possible health status (EQ-5Dindex = 1; p = 0.013). Moreover presence of cardiovascular symptoms (p < 0.001), active smoking (p = 0.002), history of valve surgery (p = 0.017), low educational level (p = 0.022), and higher systolic blood pressure (p = 0.029) were independently associated with impaired health status (EQ-5Dindex < 1).

CONCLUSIONS: Physical exercise >3 h/week was, as a single variable, associated with best possible health status in adults with congenital aortic valve disease. In contrast, a number of medical and social factors are associated with worse self-reported health status. Among these, symptoms, smoking, and educational level are potential targets for modification and intervention. There is a need for studies investigating the effect of increased level of physical exercise in patients with congenital aortic valve disease.

Keyword
Adult congenital heart disease, aortic regurgitation, aortic stenosis, bicuspid aortic valve, EQ-5D
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-82727 (URN)10.1177/2047487313508665 (DOI)000348115400015 ()24108385 (PubMedID)
Available from: 2013-11-07 Created: 2013-11-07 Last updated: 2017-05-29Bibliographically approved
5. Home-Based Interval Training Increases Endurance Capacity in Adults with Complex Congenital Heart Disease
Open this publication in new window or tab >>Home-Based Interval Training Increases Endurance Capacity in Adults with Complex Congenital Heart Disease
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(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems Physiotherapy
Identifiers
urn:nbn:se:umu:diva-112857 (URN)
Available from: 2015-12-16 Created: 2015-12-16 Last updated: 2015-12-17

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