Mediating effects of exercise capacity on the association between physical activity and health‐related quality of life among adolescents with complex congenital heart disease

Abstract

Objectives: There is little evidence on interrelationships between physical activity, sedentary behaviors, and health-related quality of life (HRQOL) among adolescents with congenital heart disease (CHD). We hypothesized that exercise capacity would have a mediating effect on the associations of either physical activity or sedentary behavior with HRQOL. Methods: Adolescents with complex CHD (n = 111) were consecutively recruited from an outpatient clinic in a general hospital in South Korea. Physical activity and sedentary behavior were assessed using the global physical activity questionnaire.Exercise capacity was directly measured by peak oxygen uptake using a symptomlimited maximal treadmill exercise test. HRQOL was evaluated by both adolescents and their parents using the Pediatric Quality of Life Inventory questionnaire. Results: The self-reported and parent proxy-reported HRQOL were positively associated with physical activity (ß = 0.16, P = .003; ß = 0.12, P = .049) and exercise capacity (ß = 0.63, P < .001; ß = 0.66, P < .001), but not with sedentary behavior in adjusted regression models. When both variables were entered in the same regression models, only exercise capacity remained significantly associated with the self-reported (ß = 0.50, P = .008) and parent proxy-reported HRQOL (ß = 0.62, P = .003). Exercise capacity acted as a full mediator variable on the relationship between physical activity and HRQOL (P < .05 for both). Conclusions: The present findings suggest that exercise capacity mediates the association between physical activity and HRQOL, highlighting the importance of improving exercise capacity to potentially enhance HRQOL in adolescents with complex CHD.

Effects of perioperative exercise on cardiorespiratory endurance in children with congenital heart disease in plateau areas after surgical repair

“…Although there is clear evidence of the efficacy and safety of exercise training for pediatric patients, it is not performed as frequently as advisable 8 . No relevant studies have assessed the exercise capacity using an early exercise intervention for children with CHD 28 . There are only five randomized, controlled studies involving exercise therapy for children with CHD, however, all of them were performed in Europe and had small sample sizes, high loss to follow-up rates, and strong subjectivity.…”

Mapping Congenital Heart Disease Transitional Care Interventions to Health-Related Quality of Life Domains: A Scoping Review

“…Interventions addressing HRQOL among individuals with CHD primarily focus on the physical domain, such as improving exercise tolerance (Dua et al, 2007). Adolescents with complex CHD, who regularly engaged in physical activity demonstrated improved exercise capacity which was associated with better physical well-being compared to sedentary control groups (Kim et al, 2019). However, interventions that address the psychological and social domains of HRQOL are limited.…”

Positive mindset and exercise capacity in school-aged children and adolescents with congenital heart disease

“…Peak oxygen consumption (VO 2 ) is the measurement of the ability of the cardiopulmonary system to meet the metabolic needs of the body with the increasing demands of exercise, and is measured by gas exchange analysis on a cardiopulmonary exercise test (1,2). Peak VO 2 is important to measure in patients with congenital heart disease as it has been shown to relate to outcomes, can assess response to treatment, and can aid in medical decision making; associations of peak oxygen consumption with quality of life have been more variable (2)(3)(4)(5)(6)(7). Peak VO 2 is an excellent marker of cardiorespiratory fitness for children with and without congenital heart disease (CHD) and is related to baseline anatomic, hemodynamic, and genetic factors.…”