title: Effects of Exercise Restriction on Patients With Anomalous Aortic Origin of a Coronary Artery.
abstract: Management of young patients with anomalous aortic origin of a coronary artery (AAOCA) may involve exercise restriction. We sought to identify the association of exercise restriction with changes over time in body mass index (BMI) and exercise capacity in this cohort.
  
  
  
  We performed a retrospective review of patients with AAOCA seen at The Children's Hospital of Philadelphia between January 1, 1998, and August 31, 2014. Linear mixed model repeated-measures analysis assessed changes in BMI and exercise capacity.
  
  
  
  We included 72 patients with a median age at presentation of 12.6 years (interquartile range: 10.1-15.8) and mean follow-up of 3.6 ± 3.0 years. The majority had an anomalous right coronary artery (71%) and interarterial ± intramural coronary course (90%). Surgery was performed in 54%, more often in those with interarterial/intramural course ( P < .001) and symptoms ( P = .003). Most patients (82%) were exercise-restricted on presentation, and restricted patients were older than those who were not restricted ( P = .01). There was no significant difference between restricted and nonrestricted patients in initial BMI z scores, percentage of patients with BMI over 85th percentile (26%) or exercise capacity variables. In univariable analysis, exercise restriction over time was not associated with change in BMI z score ( P = .25) or change in exercise variables. Restriction was not associated with significant change in these variables in multivariable analysis.
  
  
  
  Although further investigation is warranted to determine the degree of adherence to exercise restriction, the recommendation of restriction alone is not associated with increasing BMI or decreasing exercise performance in the short-term.
authors.affiliation: 1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Elias
authors.affiliation: 2 Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Meza
authors.affiliation: 2 Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: 1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Brothers
authors.affiliation: 1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Paridon
authors.affiliation: 1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D001013:Aorta, Thoracic / Q000002:abnormalities*; D015992:Body Mass Index; D002648:Child; D003330:Coronary Vessel Anomalies / Q000503:physiopathology* / Q000601:surgery; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures
keywords: congenital heart disease; coronary artery anomaly; obesity; pediatrics