title: Effect of activity restriction owing to heart disease on obesity.
abstract: OBJECTIVE
  To determine whether exercise intolerance and recommended activity restrictions are associated with development of overweight and obesity in children with congenital heart disease.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Pediatric cardiology practice at a teaching hospital.
  
  
  METHODS
  A total of 110 pediatric congenital heart disease patients followed up for a mean of 8.4 years.
  
  
  METHODS
  Body mass index (BMI), sex-appropriate BMI percentiles, overweight (BMI percentile > or =85), and obesity (BMI percentile > or =95) at follow-up.
  
  
  RESULTS
  As a group, the increase in BMI percentiles was close to 10 points, but the increase was 21.6 points for exercise intolerant children and 27.3 points for activity restricted children. Activity restriction was significantly associated with both overweight (risk ratio [RR], 2.60; 95% confidence interval [CI], 1.34-3.54) and obesity at follow-up (RR, 4.08; 95% CI, 1.42-7.38) after adjusting for weight at baseline. For the subset of 92 children at a healthy weight at baseline, activity restriction was again significantly associated with overweight (RR, 2.51; 95% CI, 1.24-3.52) and obesity (RR, 6.14; 95% CI, 2.54-8.82) at follow-up. Exercise intolerance did not attain statistical significance.
  
  
  CONCLUSIONS
  Exercise intolerant and activity restricted children experienced larger increases in absolute BMI and BMI percentile than children with neither exercise intolerance nor activity restriction. Activity restriction was the strongest predictor of risk of overweight and obesity at follow-up. Elevated weight and obesity may cause these children significant additional health burdens. Therefore, when patients must be counseled against physical exertion, they also need to be educated about the importance of appropriate physical activity and good dietary practices.
authors.affiliation: Departments of Pediatrics and Community Health and Epidemiology, Queen's University, and Clinical Research Centre, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, Canada K7L 2V7.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Stefan
authors.forename: Wilma M
authors.initials: WM
authors.lastname: Hopman
authors.forename: John F
authors.initials: JF
authors.lastname: Smythe
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D002648:Child; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D008297:Male; D008499:Medical Records; D009765:Obesity / Q000209:etiology*; D012189:Retrospective Studies