Parents of Very Young Children with Congenital Heart Defects Report Good Quality of Life for Their Children and Families Regardless of Defect Severity.

The purpose of this study was to investigate parent reports of quality of life for their very young children with congenital heart defects (CHD) and to compare their scores to previously published data. Parents of children 1-3 years old with CHD or innocent heart murmurs completed the Pediatric Quality of Life Inventory (PedsQL) core, cardiac, and family impact modules. Multivariable regression analyses assessed the impact of age, sex, family income, and CHD treatment history (study group) on PedsQL scores. Correlations between family impact and core/cardiac modules were examined. PedsQL scores were compared to healthy norms. 140 parents of young children participated within four study groups: CHD no treatment (n = 44), CHD treatment without bypass (n = 26), CHD treatment with bypass (n = 42) ,and innocent heart murmurs (n = 28). Male sex was associated with higher core (F = 4.16, p = 0.04, σ2 = .03) and cardiac quality of life (F = 4.41, p = .04, σ2 = 0.04). Higher family income was associated with higher family quality of life (F = 8.89, p < .01, σ2 = 0.13). Parents of children with innocent heart murmurs and children with CHD not requiring treatment had higher core quality of life compared to young healthy children. Cardiac-related quality of life scores were associated with family impact (r = 0.68) and core module (r = 0.63) quality of life scores. Parents of very young children with CHD report good quality of life for their children and families. Quality of life exceeds in children with innocent murmurs or CHD not requiring repair. Parents report a lower quality of life among girls, and lower family quality of life is associated with lower family income.

Childhood physical activity body contact risk: feasibility of a novel technique for objective measurements of impact speed, frequency, and intentionality.

INTRODUCTION: Children at risk for bleeding injuries are restricted from body contact during physical activity but current recommendations are based on expert opinion. AIM: Evaluate high-speed digital video recording as an objective measure of body contact risk during physical activity. METHODS: Observational study of physical activities among healthy children, grouped according to participation in teams (vs. individual) and on their perceived risk of injury (high/low). High speed digital video recordings documented the collision target (floor/ground/ice, people, wall, equipment), estimated speed, and impact rates for team and individual activities, with and without expected body contact. RESULTS: Among 348 participating children (3-16 years, 51% female), 32% to 78% experienced at least one contact. Impact type varied significantly (chi-square, p < 0.001) by activity category. Unstructured and Team high risk activity impacts were primarily with the floor/ground, whereas Individual low risk activities were characterized by equipment impacts. Impact speeds were typically 1.0 to 2.1 m s(-1) . Higher impact speeds occurred during instructional classes (2.1 m s(-1) ), unstructured free swim (1.9 m s(-1) ) and ball hockey (1.7 m s(-1) ). Impact rates were higher during Team high risk and Team low risk sports (3.0 and 1.8 impacts per minute, respectively) compared to Individual (high or low risk) or Unstructured activities (0.2-0.3 impacts per minute). CONCLUSIONS: High speed video recordings of childhood physical activity are a feasible method for characterizing the frequency, type, direction and speed of impacts. Quantifying the impacts that occur during childhood physical activity could inform the guidelines for physical activity participation among children with identified bleeding risks.

Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology.

All children have a natural need to move, play, and perform activities. Physical activity is necessary for optimal physical, emotional, and psychosocial development for healthy children as well as children with congenital heart disease (CHD). In this paper we provide recommendations for physical activity, recreational sport, and exercise training in children and adolescents with CHD. In general, children with CHD should be advised to comply with public health recommendations of daily participation in 60 min or more of moderate-to-vigorous physical activity that is developmentally appropriate and enjoyable and involves a variety of activities. While all patients with CHD can participate and benefit from physical activity and exercise, those with specific lesions or complications may require counselling regarding precautions and recommendations.

Validation of the Actiheart activity monitor for measurement of activity energy expenditure in children and adolescents with chronic disease.

BACKGROUND/OBJECTIVES: The purpose of this study was to develop an activity energy expenditure (AEE) prediction equation for the Actiheart activity monitor for use in children with chronic disease. SUBJECTS/METHODS: In total, 63 children, aged 8-18 years with different types of chronic disease (juvenile arthritis, hemophilia, dermatomyositis, neuromuscular disease, cystic fibrosis or congenital heart disease) participated in an activity testing session, which consisted of a resting protocol, working on the computer, sweeping, hallway walking, steps and treadmill walking at three different speeds. During all activities, actual AEE was measured with indirect calorimetry and the participants wore an Actiheart on the chest. Resting EE and resting heart rate were measured during the resting protocol and heart rate above sleep (HRaS) was calculated. RESULTS: Mixed linear modeling produced the following prediction equation: This equation results in a nonsignificant mean difference of 2.1 J/kg/min (limits of agreement: -144.2 to 148.4 J/kg/min) for the prediction of AEE from the Actiheart compared with actual AEE. CONCLUSIONS: The Actiheart is valid for the use of AEE determination when using the new prediction equation for groups of children with chronic disease. However, the prediction error limits the use of the equation in individual subjects.

Considerations for fitness appraisal, programming, and counselling of individuals with sensory impairments.

Providing active living opportunities to all individuals, including people with disabilities, requires supporting each person's ability to participate. Successful inclusion often occurs, despite antiquated, inaccessible facilities, when everyone--leaders and participants alike--believes that each person has an equal right to participate, and programmes are offered that suit the varied interests and abilities of all participants.

Analysis of mechanical and metabolic factors in the gait of congenital below knee amputees. A comparison of the SACH and Seattle feet.

Prosthetic feet have been developed with the intention that they deform during the first half of the stance phase to store energy that can be released at the end of stance and contribute to push-off. The purpose of this study was to examine the three-dimensional kinematics and kinetics of gait and metabolic energy cost in children and adolescents with below-knee amputations using the SACH and Seattle prosthetic feet. The metabolic test consisted of an 8-min walk around an oval track while expired gases were collected and analyzed. The biomechanical test consisted of 10 walking trials: 5 for each of the prosthetic and sound limbs. Stance and swing phase moments and powers were calculated for both the prosthetic and sound limbs. A four-camera VICON system recorded movements of the limb segments to calculate joint kinematics, and these were combined with ground reaction force data in a three-dimensional model to determine moments and powers about the hip, knee and ankle joints. The Seattle foot produced a small increase in stride length, which led to a small increase in walking velocity. Biomechanical data revealed that the Seattle foot was less resistant to passive dorsiflexion in midstance, and although there was no effect on the work done across the prosthetic ankle, a knee flexor moment dominated the stance phase when the SACH foot was tested, whereas the Seattle foot allowed a normal extensor moment. The profile of work was unaffected by the type of foot. On the sound side, the hip produced most of the positive work while the ankle output was below normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in self-concept, cardiovascular endurance and muscular strength of children with spina bifida aged 8 to 13 years in response to a 10-week physical-activity programme: a pilot study.

The purposes of this study were to document the self-concept, cardiovascular endurance and isometric muscular strength of children with spina bifida, and to examine the changes in these variables in response to a structured 10-week exercise programme. Eight children trained for about 1 hour a week for 10 weeks, while the five control-group children did not participate in the physical-activity programme. The exercise group improved significantly on five of eight criterion means, while the control group showed no significant improvements. This programme represents an initial attempt to delineate the essential elements in a physical-activity programme to enhance physical fitness and self-concepts of children with spina bifida, and provides a framework for further study.

Postoperative exercise training develops normal levels of physical activity in a group of children following cardiac surgery.

Children with congenital heart defects often demonstrate a reduced capacity for exercise, even after surgical intervention. Forty subjects, with various heart defects, completed a 5-year study to evaluate the impact of a postoperative training program on their physical exercise capacity. All of the patients were significantly less active than their peers prior to the surgical intervention. Subjects who completed a simple, home exercise program during the first 3 postoperative months achieved a normal level of physical fitness. These benefits were maintained up to 5-years postoperatively without further intervention. Children who did not receive a postoperative training program remained significantly below their healthy peers. Therefore, a simple exercise training program, conducted early in the postoperative period would appear essential to the achievement of appropriate levels of physical activity for children with congenital heart defects.

Comparative assessment of gait after limb-salvage procedures.

We performed metabolic studies of gait in eighteen patients who had had above-the-knee amputation, block resection and arthrodesis of the knee, or block resection and rotationplasty for a malignant tumor of the distal end of the femur or the proximal end of the tibia. According to the measurement of consumption of oxygen, the patients who had had rotationplasty walked most efficiently. Those who had had arthrodesis used more oxygen and walked at a slower rate.

Postoperative exercise rehabilitation benefits children with congenital heart disease.

Physical fitness was assessed in children with congenital heart disease using seven tests designed to measure cardiovascular endurance, strength, flexibility and co-ordination. Test scores for age-matched healthy children were significantly higher than preoperative scores for patients. Postoperatively, the patients were divided into a control group and a physical training group. The training group was subsequently divided into compliant and non-compliant subgroups. Patients who complied with a simple six-week home program of physical activity training after surgery improved their test scores significantly (p less than .001) and were not significantly different from normal children. The scores of the non-compliant group remained below normal (p less than .01). When retested six months postop, the scores of all patient groups had improved; however, while there was no significant difference between the healthy and compliant groups, the scores of the non-compliant and control groups remained significantly below those of the healthy children (p less than .01).