Ref Number = ASPR0024
Sports and Physical Activity in Children With Heart Disease
Ria Nova 
 Department of Pediatric University of Sriwijaya, Palembang, Indonesia

*E-mail: rialuthfan@yahoo.com
Most patients with heart disease do not perform regular physical exercise. This limited physical activity may be the result of  haemodynamic problems, chronotropic impairment as well as psychosocial factors such as parental overprotection or restraints imposed by patients social surroundings.1,2 However, increasingly there is an understanding that promoting physical activity benefits the health and well-being of children with heart disease. Physical activity is necessary for the optimal physical, emotional, and psychosocial development of healthy children as well as children with heart disease.  The resulting sedentary lifestyle leads to diminished physical work capacity and places them at risk for early development of cardiovascular disease and other illnesses associated with physical inactivity.3 
Sports and physical activity is important for patients with heart disease. Research on patients with congenital heart disease, even complex disease, has shown that routine moderate exercise is safe and can be beneficial.4  It is generally thought that children with heart disease have low level of physical activity. It is important to recognise that many children with CHD do not need to be restricted from participation in sports. These are typically patients with hemodynamically insignificant lesions, such as small ventricular septal defects with tiny left-to-right shunts, minimal pulmonary stenosis, and bicuspid aortic valve without obstructions or insufficiency. Children with CHD are currently encouraged to be normally active and to participate in recreational sport activities, also after corrective cardiac surgery. 
Most studies showed a significant positive effect of physical exercise training.2,3,5,6 Physical activity benefits children both physiologically and psychologically. It is well known from physical activity can improve exercise tolerance. This improved uptake in oxygen is due to both increased circulatory delivery of oxygen to the peripheral tissues and an improved ability of the skeletal muscles to do physical work. Physiological improvement from normal exercise is well recognized. Exercise is useful in relieving the depression and anxiety that have been recognized in children with heart disease.5
Classification of sports for children with heart disease should follow the recommendation established by the Bethesda Conference. In this classification, sports are classified into dynamic and static exercises and each sport is categorized by the level of intensity (low, medium, high).6 Dynamic exercise involves changes in muscle length and joint movement with rhythmic contractions that develop relatively small intramuscular force with little or no change in muscle length or joint movement. Dynamic exercise causes a marked increase in oxygen consumption with a substantial increase in cardiac output, heart rate, stroke volume, and systolic blood pressure and a decrease in diastolic pressure and systemic vascular resistance. Static exercise, in contrast, causes a small increase in oxygen consumption, cardiac output, and heart rate and no change in stroke volume. Thus, dynamic exercise primarily causes a volume load on the left ventricle, whereas static exercise causes a pressure load. Regular exercise at recommended levels can be performed and should be encouraged in all patients with heart disease. There is a consensus on benefits of regular physical activity in children and young adults with heart disease.6 The enthusiasm, however, needs to be balanced with parental and physician considerations related to possible consequences of vigorous physical activity. Special concern should be given to those patients with a significant ventricular dysfunction or recent history or risk of arrhythmia.7
Keywords: Sports; Physical Activity; Children; Heart Disease.
1. Voss C, Duncombe SL, Dean PH, de Souza AM, Harris KC. Physical activity and   sedentary behavior in children with congenital heart disease. J Am Heart Assoc. 2017;6:e004665.DOI:10. 1161/JAHA. 116.004665
2. Duppen N, Takken T, Hopman MTE, ten Harkell ADJ, Dulfer K, Utens EMW, et al. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. Int J of Cardiol 2013;168:1779-87
3. Longmuir PE, Brothers JA, de Ferranti SD, Hayman LL, Van Hare GF, Matheme P, et al. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American heart association. Circulation 2013;127:2147-59
4. TakkenT, Giardini A, Reybrouck T, Geeeewillig M,Hovels-Gurich HH, Longmuir PE, et al. Recommendation 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 pediatric cardiology. Eur J of Prev Cardiol 2011;19(5):1034-65
5. Dulfer K, Helbing WA, Utens EMW. The influence of exercise training on quality of life and psychosocial functioning in children with congenital heart disease: A review of intervention studies.Sports 2017;5(13);doi:10.3390/sports5010013
6. Cantinotti M, Giordano R, Assanta N, Murzi B, Melo M,Franchi E, et al. Strength, limitations, and geographical discrepancies in the eligibility criteria for sport participation in young patients with congenital heart disease. Clin J Sport Med 2017;0:1-21
7. Hirth A, Reybrouck T, Wehrens BB, Lawrenz W, Hoffmann A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. Eur J Cardiovasc Prev Rehabil 2006 (13):292-9
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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