New concepts in the assessment of exercise capacity among children with congenital heart disease: Looking beyond heart function and mortality

Cardiopulmonary exercise testing is a valuable tool in the diagnosis and management of pediatric congenital heart disease. Parent and child reports of the child’s physical activity relative to peers are also routinely used to monitor heart function. Unfortunately, objective measures of their physical activity indicate that most children with congenital heart disease lead sedentary lives, which increase their risk of secondary morbidities. Current recommendations emphasize
the need to proactively counsel patients to engage in at least 60 minutes of physical activity daily. Information regarding the child’s current capacity for physical activity can be obtained through a
physical literacy assessment and enhanced use of cardiopulmonary exercise results. Physical literacy is the knowledge, motivation, behaviour and physical competence needed to adopt and maintain a physically active lifestyle. Protocols to assess these physical literacy domains are well established, with the Canadian Assessment of Physical Literacy offering the first comprehensive assessment of all domains. Cardiopulmonary exercise protocols that incorporate submaximal stages, and measures of the child’s willingness to perform maximal intensity exercise provide important information about the child’s capacity for physically active play with peers, which
seldom requires a maximal effort. Measures of physical literacy and sub-maximal cardiorespiratory capacity thus provide important information when counselling children with congenital heart defects and their parents regarding the child’s daily physical activity participation.