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1、Sport, exercise & congenital cardiac conditions,Lynne Kendall Clinical Specialist Physiotherapist June 2009,Is exercising good for everyone?,What do you think re exercise:Who needs to exercise?How much? How often?What type?,How much exercise?,Public health guidelines for children: Recommend 60 minut
2、es (daily total, it can be done in 15” chunks) of moderate level activity on most days of the week (minimum of 5). Moderate level means enough to make you breathe harder (bit puffed out) & feel warmer.,Exercise intolerance common in CHD,Due to individual cardiac anatomy possible overprotection or ap
3、athy in some schools,What do we know? Problems in Adult CHD - lessons to be learned?,Poor exercise tolerance deconditioning long-term consequences on health?,Types of Exercise,Dynamic or isotonic exercise Changes in muscle length & joint movement, rhythmic contractions steady state Static or isometr
4、ic exercise Sudden, large intramuscular force, little/no change in muscle length/joint movement Most activities involve a combination of the two,Exercise and congenital cardiac defects,Problems can be due to 3 main factors: Limitations due to the nature of the cardiac condition Restrictions imposed
5、by clinicians because of the condition (safety) Other restrictions or misconceptions re exercise,Condition (symptom) limited,Many conditions are symptom limited Often complex conditions e.g. Fontan; HLHS; PHTReduced exercise tolerance due to nature of heart condition adapt activitiesPacing during ex
6、ercise; long warm up & cool down (*selflimit*?)Emphasis on what CAN do (at own level),Examples: activity guidelines,REMEMBER INDIVIDUAL! NB: May be able to modify activity to allow some participation level of intensity.Congenital Aortic Stenosis moderate severe advised to avoid at school/home:Maxima
7、l exercise tests - Bleep/Cooper TestsDistance runningSprint running or Burst type exertionWeights or high isometric (static) type effort “Competitive” sport & training sessions,Activity guidelines,Coarctation of Aorta repaired (?BP)Avoid free weight-lifting / intense isometric exercise Marfan syndro
8、me aortic dilatation/mitral valve Avoid weight-lifting / isometric exerciseAvoid sport with risk of bodily collision(contact sport)Some martial arts (direct blow over chest or head)Trampolining, step aerobics etc care re joints Potential Arrhythmias : Cardiomyopathies; Long QT; better to avoid inten
9、se level activity Warfarin avoid contact or rough sports - risks of bodily collision - special care head/abdomen,Key points,Many young people need little or no restriction (& do NOT take enough exercise!) Inclusion not exclusion school & PE Confusion about terms such as recreational, non-competitive
10、, non-contact, normal Underestimation of the need for detailed counselling re sport/leisure/work activities Misunderstanding between cardiac symptoms & lack of fitness Lack of information/understanding re exercise & their cardiac condition Do not know what NEED to Know,What input do congenital heart
11、 patients need?,Regular review in specialist centre Education re cardiac anatomy/physiology acquired heart disease,Proactive exercise: Does it make a difference?,Young people, parents & teachers report benefits: exercise tolerance, confidence, peer integration, contact between appointments, reassura
12、nce, independence / transition / life skills / growing up Possible saving of cardiologists clinic time Increased awareness at all levels Prompted to ASK!,What type of exercise?,Something you enjoy! Remember the Talk Test rule: You should still be able to speak when exercising If you have enough brea
13、th to sing you need to work harder! If you are too breathless to speak you need to stop & rest,Does it HAVE to be sport?!,Encourage outdoor play/activities/picnics Dress for the weather! Visit NT gardens etc many activities for children in school holidays / minibeasts, treasure hunts, pond dipping M
14、usic & Drama clubs Childrens veggie plot, allotments, gardens Wii .?,ANY activity is good,What can families do?,ASK Cardiologist if *ANY* activities to avoid *But be specific about what you want to do! Promote Physical Activity Encourage healthy eating/lifestyle Ensure school fully informed Make a l
15、ist of questions for each clinic appointment,What to do?,Change4Life http:/www.nhs.uk/change4life Green gyms http:/www2.btcv.org.uk/display/greengym Walking http:/www.whi.org.uk/ Get outdoors! http:/www.naturalengland.org.uk/ Cycle http:/www.sustrans.org.uk/,Is exercising good for everyone?,What do
16、you think re exercise:Who needs to exercise?How much? How often?What type?,Summary,Always individual ask cardiologist re current cardiac statusImportant to be physically active adaptIncrease PA awareness as child grows upMonitor changes in conditionTransition to adult services,References,Graham TP,
17、Driscoll DJ, Gersony WM, et al. 36th Bethesda Conference: Eligibility recommendations for competitive athletes with cardiovascular abnormalities. Task Force 2: Congenital heart disease. J Am Coll Cardiol 2005;45:1326-33. Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffman A. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. European Journal of Cardiovascular Prevention 83, 685-687.,
