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2122 LHEARTS 20PP:NewsletterNo2 2009.qxd 05/11/2009 10:06 Page 4MedicalThe article below looks at sport and exercise for children withsingle ventricle heart disease.Written byLynne KendallClinical Specialist Physiotherapist Congenital CardiologyLeeds General InfirmaryIs it safe for children and young people withsingle ventricle heart conditions to exercise?Absolutely Yes! There are very few people who willbe advised not to do any exercise at all. Yourcardiologist will tell you what you can do and if thereis anything you are better to avoid. Everyone isdifferent so you must get individual advice aboutyour own heart problem.How much exercise?Everyone (yes that does mean you too) should tryto do regular physical activity. It may be that youhave symptoms, such as breathlessness, fromyour heart problem that limit the amount of activityyou can do, that is okay, just do what you can but atyour own pace and your own level.A really good guide to how much activity youshould do is the ‘Talk Test’, you should apply this toall activities/sports/play that you do. You shouldalways be able to talk when doing any activity evenwhen you are a bit ‘puffed’.If you have enough breath to sing then you needto put a bit more effort in, but if you are toobreathless to talk you need to STOP and RESTuntil you can speak again! You are much better tostop and rest BEFORE you get to this point thoughas it is not good for your heart to work so hard. Tryto learn to ‘pace’ yourself and recognise when youare exercising at the right level.Current public health guidelines for children 1 ,which apply to everyone including those peoplewith medical conditions, recommend a daily total of60 minutes moderate intensity physical activity onmost days of the week. Now, before you all yell ‘noway!!’ please read on:Y For children with single ventricle (or anycongenital heart disorder) the daily total of 60minutes can be ‘collected’ in 10-15 minuteperiods throughout the day if necessary.Y ‘Moderate intensity’ means enough to makeyou breathe harder (feel a bit ‘puffed’) and feelwarm, this may happen at quite a low level ofactivity but this is okay as long as it is morethan YOU normally do.Y ‘Most days’ means at least five times a week; itis very important to exercise regularly to feelthe benefits; now and again is just not goodenough!What kind of sports/activities are okay andwhat is it better to avoid?You probably need to think about the type ofsports/activity that you do, especially if you are a bitbreathless and/or are taking medicines such asWarfarin, because some activities are better thanothers for people with heart problems.How much you can do depends on your ownheart problem and how well your heart functionsduring exercise (your cardiologist can tell you moreabout this).It is important that you exercise but it is importantto stay safe too; this means choosing activities thatyou enjoy but maybe avoiding some things whichcould make your heart too tired.• It is usually better to avoid the really strenuousteam sports or competitions where you have torace against other people as these will makeyour heart work too hard. For example,activities such as basketball, triathlon,competitive level swimming or cycling,distance running.• Sports where you can get badly knocked orpushed over are generally not a good idea,especially if you take medicines such asWarfarin or if you have a pacemaker, forexample, hockey, rugby, football, judo.• If you have symptoms such as dizziness orfainting then avoid water-based activities;horse riding; motor sports; climbing etc wherea fall could be very harmful.It might help to think about what exercise involves:There are two basic types of exercise calledisotonic and isometric. Most activities will involve abit of both but there are some important points tothink about when choosing an activity/sport:1. Isotonic exercise (may also be called dynamicor cardiovascular exercise).This type of exercise includes things like swimming,cycling, walking and dancing. This type of exerciseis generally better for people with congenital heartproblems as long as you remember to always usethe ‘Talk Test’ as a guide to how much you can doand when to rest.2. Isometric exercise (may also be called static,weight or resistance exercise).This includes exercise often using weights and4REFERENCES1. NICE public health guidance Jan 2009;PH17Promoting physical activity for children andyoung people: www.nice.org.uk /PH172. Pelliccia A, Fagard R, Bjornstad HH,Anastassakis A, Arbustini E, Assanelli D,Biffi A, et al. (2005).Recommendations for competitive sportsparticipation in athletes with cardiovasculardisease: A consensus document from thestudy group of sports cardiology of theworking group of cardiac rehabilitation andexercise physiology and the working group ofmyocardial and pericardial diseases of theeuropean society of cardiology.European Heart Journal 26: 1422-1445.3. Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffman A.(2006).Recommendations for participation incompetitive and leisure sports in patients withcongenital heart disease: a consensusdocument.European Journal of CardiovascularPrevention and Rehabilitation 13:293-299.4. Graham TP, Driscoll DJ, Gersony WM,Newburger JW, Rocchini A, Towbin JA.(2005). 36th Bethesda Conference:Eligibility recommendations for competitiveathletes with cardiovascular abnormalities.Task force 2: Congenital heart disease. JAm Coll Cardiol 45: 1326 - 1333.
2122 LHEARTS 20PP:NewsletterNo2 2009.qxd 05/11/2009 10:06 Page 5machines, such as weight-lifting, some athleticsthrowing events and gym equipment. Othersinclude: rock-climbing, boxing, some martial arts,rowing/canoeing. Some people may be advisedagainst some of this type of exercise because itmay put more of a strain on the heart and bloodvessels; others may be able to do some of thembut at a low level of intensity. Always ask if you arenot sure.Remember, you do not have to be ‘sporty’ orathletic, or join a gym, or play for a school team, inorder to take part in physical activity/exercise.Walking your dog, drama groups, using a Wiisports/fit, or dancing to your favourite music forexample can be excellent exercise. If you do enjoysport that is okay, but if you don’t it really does notmatter, just find another way to keep active doingsomething you enjoy. Any activity is better thannone at all!What about PE and sports at school?Young people should be encouraged to take part inphysical activity at school at their own pace andwithin their own limitations. This may mean theschool making modifications to lesson plans forindividual pupils to allow them for example to takepart fully in skills and rules teaching sessions, butduring strenuous activity finding an alternative foryoung people (maybe help with coaching, orrecording/timekeeping duties) to keep themincluded with their peer group as much as possible.It is important that schools are provided with up-todateinformation about individual’s heart conditionsand given detailed guidance for, or limitations to,physical activity; parents can ask theircardiologist/liaison nurse for help with this.General adviceIf there are any concerns about physical activityand exercise then always ask your cardiologistand/or cardiac liaison nurse or congenital cardiacphysiotherapist for individual guidance and advice;remember everyone is different and heartconditions may change so always ask aboutexercise at clinic appointments and ring or write ifqueries come up in between appointments.Any new or unusual symptoms during, orimmediately following exercise should alwaysprompt you to stop and rest and if they do notresolve then report them to your doctor. It is‘normal’ and indeed recommended to feel warm,breathe harder and feel your heart beat fasterduring exercise. You should stop to rest if you feeldizzy or faint; feel unwell in any way; or becomeunusually breathless.There are both European 2,3 and American 4,5guidelines which are the consensus opinions ofworldwide expert congenital cardiologists. Theymainly refer to competitive sports participation butprovide a useful benchmark for reference; theyhave recently been revisited comparing thedifferent guidelines 6 . However, it is essential thatpatients always discuss their exercise participationwith their own cardiologist as clinicians may havedifferent opinions on patient management.What is becoming increasingly evident fromresearch in the adult congenital cardiac populationis that exercise intolerance is not uncommon in thispatient group. The reasons for this are multifactorialbut some non-clinical problems arising fromchildhood include: fears or misconceptions aboutthe nature/severity of the cardiac defect; lack ofinformation or understanding about the conditionand exercise; relatives/teachers either preventingthe child from doing any, or unnecessarily limitingexercise; some teachers pushing the child to domore exercise than safe/recommended for theircondition; misunderstanding between (perceived)cardiac symptoms and lack of fitness.We should all try to promote ‘healthy living’ forthis patient group and provide timely, detailedindividual information regarding exercise.KEY POINTS• Think about how much effort you put intoyour activity but always listen to your body,use the ‘Talk Test’ and stop to rest whentired.• Remember, mainly dynamic (isotonic) isusually preferable to high static (isometric)exercise.• Being short of breath when you exercisemay be because you are unfit and notanything to do with your heart problem.Most people can do more than they think!Alfie Yeoman5. Maron BJ, Chaitman BR, Ackerman MJ, etal. (2004).Recommendations for physical activity andrecreational sports participation for youngpatients with genetic cardiovasculardiseases. Circulation; 109: 2807-2816.6. Pelliccia A, Zipes DP and Maron BJ. (2008).Bethesda conference #36 and the Europeansociety of cardiology consensusrecommendations revisited.J Am Coll Cardiol 52: 1990 - 1996.Our son Alfie was born withHypoplastic Left HeartSyndrome 11 years ago.Although we have always beenblessed with the fact that hecame through all three stages ofthe Norwood Procedure verywell, as he grew older it becameapparent that he could notparticipate in full with any of thecontact sports that his friendswere playing.It was whilst driving a golfbuggy during a game of golfthat his dad was playing in, thatAlfie showed some interest.From this we decided to letAlfie have group lessons to seeif he enjoyed the game orindeed showed any potential.Over and above anyexpectations we could have hadit became very obvious that Alfiehad some extraordinary naturaltalent.He has progressed to havingtwo lessons a week. Joining hislocal course, Crowlands Heath,and participating in competitionsgenerally held fortnightly.He has participated in theEssex under 12 championshipfor the last two years and morethan held his own with two top15 places.Guided by the professional athis club, Marcus Radmore, weare all hoping he can fulfil hispotential and hopefully becomea professional in the future.We have found that the sportoffers Alfie a very healthyexercise and surroundings andobviously a sport that he canparticipate in despite hiscondition.Janet Yeoman5
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