title: Physical activity is associated with improved aerobic exercise capacity over time in adults with congenital heart disease.
abstract: BACKGROUND
  Impaired exercise capacity is common in adults with congenital heart disease (ACHD). This impairment is progressive and is associated with increased morbidity and mortality. We studied the influence of the frequency of at least moderately strenuous physical activity (PhysAct) on changes in exercise capacity of ACHD patients over time.
  
  
  METHODS
  We studied ACHD patients ≥21 years old who had repeated maximal (RER≥1.09) cardiopulmonary exercise tests within 6 to 24 months. On the basis of data extracted from each patient's clinical records, PhysAct frequency was classified as (1) Low: minimal PhysAct, (2) Occasional: moderate PhysAct <2 times/week, or (3) Frequent: moderate PhysAct ≥2 times/week.
  
  
  RESULTS
  PhysAct frequency could be classified for 146 patients. Those who participated in frequent exercise tended to have improved pVO2 (∆pVO2=+1.63±2.67 ml/kg/min) compared to those who had low or occasional activity frequency (∆pVO2=+0.06±2.13 ml/kg/min, p=0.003) over a median follow-up of 13.2 months. This difference was independent of baseline clinical characteristics, time between tests, medication changes, or weight change. Those who engaged in frequent PhysAct were more likely to have an increase of pVO2 of ≥1SD between tests as compared with sedentary patients (multivariable OR=7.4, 95%CI 1.5-35.7). Aerobic exercise capacity also increased for patients who increased activity frequency from baseline to follow-up; 27.3% of those who increased their frequency of moderately strenuous physical activity had a clinically significant (at least +1SD) increase in pVO2 compared to only 11% of those who maintained or decreased activity frequency.
  
  
  CONCLUSIONS
  ACHD patients who engage in frequent physical activity tend to have improved exercise capacity over time.
authors: Department of Cardiology, Boston Children's Hospital. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
authors: Ana Ubeda
authors: AU
authors: Tikkanen
authors: Department of Cardiology, Boston Children's Hospital and Department of Medicine, Brigham and Women's Hospital. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
authors: Alexander R
authors: AR
authors: Opotowsky
authors: Heart Center, Massachusetts General Hospital, Boston, MA. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
authors: Ami B
authors: AB
authors: Bhatt
authors: Department of Cardiology, Boston Children's Hospital and Department of Medicine, Brigham and Women's Hospital. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
authors: Michael J
authors: MJ
authors: Landzberg
authors: Department of Cardiology, Boston Children's Hospital. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
authors: Jonathan
authors: J
authors: Rhodes
mesh_terms: D000328:Adult; D018450:Disease Progression; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D010101:Oxygen Consumption; D012189:Retrospective Studies; D013997:Time Factors
keywords: Adults; Congenital heart disease; Exercise capacity and physical activity
references: JAMA. 1995 Apr 12;273(14):1093-8
references: 7707596
references: JAMA. 1988 Aug 19;260(7):945-50
references: 3398199
references: J Cardiovasc Nurs. 2011 Nov-Dec;26(6):497-503
references: 21372735
references: Int J Cardiol. 2010 Jan 21;138(2):196-205
references: 19217676
references: Diabetologia. 2012 Mar;55(3):542-51
references: 22189486
references: Congenit Heart Dis. 2011 Jul-Aug;6(4):294-303
references: 21418537
references: Int J Cardiol. 2008 Feb 29;124(2):179-82
references: 17399817
references: Circulation. 2007 Jan 16;115(2):163-72
references: 17210844
references: N Engl J Med. 1986 Mar 6;314(10):605-13
references: 3945246
references: Obesity (Silver Spring). 2009 Jan;17(1):136-42
references: 18997669
references: Clin Res Cardiol. 2012 Jan;101(1):55-61
references: 21935655
references: Circulation. 2005 Jan 25;111(3):369-76
references: 15668354
references: Int J Cardiol. 2011 Nov 17;153(1):26-30
references: 20840883
references: Am Heart J. 2012 Feb;163(2):280-7
references: 22305848
references: Can J Cardiol. 2003 May;19(6):685-9
references: 12772019
references: Am Heart J. 2009 May;157(5):853-9
references: 19376311
references: Cardiol Young. 2008 Dec;18 Suppl 2:234-9
references: 19063797
references: Ann Thorac Surg. 2008 Mar;85(3):818-21
references: 18291148
references: Prog Cardiovasc Dis. 2012 Mar-Apr;54(5):387-96
references: 22386289
references: J Am Coll Cardiol. 2010 Nov 30;56(23):1939-46
references: 21109118
references: Heart. 2000 Jun;83(6):685-7
references: 10814630
references: Eur Heart J. 2012 Jun;33(11):1386-96
references: 22199119
references: Eur Heart J. 2012 Jun;33(11):1378-85
references: 22036871
references: JAMA. 2013 Mar 13;309(10):984-986
references: 23471480
references: Am Heart J. 2002 Jul;144(1):23-30
references: 12094184
references: Pediatrics. 2005 Dec;116(6):1339-45
references: 16322156
references: Exerc Sport Sci Rev. 2009 Oct;37(4):196-202
references: 19955869
references: Eur Heart J. 2009 Dec;30(23):2915-20
references: 19692392
references: Cardiol Young. 2008 Dec;18 Suppl 2:215-21
references: 19063794
references: Heart. 2005 Apr;91(4):517-20
references: 15772218
references: Can J Occup Ther. 2004 Jun;71(3):161-72
references: 15366632
references: J Am Coll Cardiol. 2009 Jul 28;54(5):460-7
references: 19628123