Associations Between Exercise Capacity and Psychological Functioning in Children and Adolescents with Fontan Circulation

Abstract

Background: Pediatric patients with Fontan circulation (FC) often have diminished exercise capacity. They are also at risk for psychological problems, including anxiety, depression, and inattention. The current study examines associations between exercise capacity and psychological functioning in a clinical sample of pediatric patients with FC. Methods: A multidisciplinary team evaluated participants in a dedicated clinic for pediatric patients with FC. Patients completed cardiopulmonary exercise testing (CPET); metrics selected for analyses included peak oxygen consumption (VO2), maximum achieved heart rate (HR), oxygen saturation at peak exercise, ventilatory anaerobic threshold, work rate, respiratory exchange ratio, and HR recovery at 1-, 3-, and 8-minutes after exercise. Parent and child were administered a standardized questionnaire to measure depression, anxiety, and inattention symptoms. Patients who completed CPET with adequate effort and a psychological measure were eligible for inclusion. Clinical data were extracted from medical records and analyzed using Pearson correlations. Results: Clinical sample (n = 51) was 55% male with a mean age of 13.6 years (SD=2.5). A majority had hypoplastic left heart syndrome (51%). There was a significant negative correlation between parent-report of inattention and peak VO2 (R= -.307, 95% CI -.549/-.018, P= 0.038). Self-report of anxiety was positively correlated with HR recovery at 3 (R= .438, 95% CI .155/.655, P= 0.004) and 8 (R= .432, 95% CI .147/.651, P= 0.004) minutes post exercise. Depression was positively correlated with HR recovery at 3 minutes for parent report (R= .294, 95% CI .004/.538, P= 0.047) and 8 minutes for self-report (R= .410, 95% CI .122/.635, P= 0.007). Conclusions: Inattention, depression, and anxiety symptoms were correlated with some CPET metrics in our clinical sample of pediatric patients with FC. Greater inattention symptoms were associated with lower peak VO2. Those with greater depression and anxiety symptoms showed a more rapid decline from max HR to recovery period.