title: Associations between exercise capacity, physical activity, and psychosocial functioning in children with congenital heart disease: a systematic review.
abstract: BACKGROUND
  Children and adolescents operated upon for congenital heart disease (ConHD) may show reduced exercise capacity and physical activity, possibly associated with lowered self-esteem and quality of life (QoL). The studies into associations between these parameters have not been reviewed before.
  
  
  OBJECTIVE
  Review of studies into associations between exercise capacity, physical activity, respectively exercise training, and psychosocial functioning of ConHD youngsters.
  
  
  METHODS
  PubMed, Embase and reference lists of related articles.
  
  
  METHODS
  Articles published between January 2000 and December 2012 into exercise capacity and/or physical activity, and a measure of psychosocial functioning in children with ConHD.
  
  
  METHODS
  Two investigators independently reviewed the identified articles for eligibility, and one author extracted the data.
  
  
  RESULTS
  Although exercise capacity was strongly related to physical domains of parent-reported and self-reported QoL, it was almost never associated with psychosocial domains of QoL. Physical activity was rarely associated with physical or psychosocial domains of QoL. Remarkably, self-reported depressive symptoms were associated with both physical and psychosocial QoL. The few studies into exercise-training programmes showed promising results in QoL and emotional and behavioral problems, but they contained methodological flaws.
  
  
  CONCLUSIONS
  No clear relationships were found between exercise capacity, physical activity, and QoL in children and adolescents with ConHD. Therefore we recommend assessing QoL separately, preferably both self-reported and parent-reported. Since depressive symptoms were associated with reduced physical and psychosocial QoL, screening on these symptoms is also recommended.
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Karolijn
authors.initials: K
authors.lastname: Dulfer
authors.affiliation: Department of Paediatrics, Division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Helbing
authors.affiliation: Department of Paediatrics, Division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Nienke
authors.initials: N
authors.lastname: Duppen
authors.affiliation: Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands e.utens@erasmusmc.nl.
authors.forename: Elisabeth M W J
authors.initials: EM
authors.lastname: Utens
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D002648:Child; D002652:Child Behavior; D017281:Cost of Illness; D003863:Depression / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D004644:Emotions; D017079:Exercise Tolerance; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology*; D006801:Humans; D008297:Male; D009043:Motor Activity; D011788:Quality of Life; D012307:Risk Factors; D012649:Self Concept; D011795:Surveys and Questionnaires
keywords: Congenital heart disease; children; exercise test; physical activity; quality of life