pediatric and adolescent patients with inherited cardiac arrhythmias or cardiomyopathies may demonstrate lower cardiopulmonary fitness and physical activity levels compared with healthy controls, according to a multicenter, prospective controlled study.
In the study, published in JAMA Network Open, investigators found that maximal oxygen uptake (V̇o2max), a key indicator of cardiopulmonary fitness, was significantly lower in pediatric patients with inherited cardiac disease. The mean V̇o2max z score was −1.49 (standard deviation [SD] = 1.48) in patients vs −0.16 (SD = 0.97) in controls (P < .001), with raw values of 32.2 (SD = 7.9) vs 40.2 (SD = 8.5) mL/kg/min (P < .001). The findings remained significant after adjusting for beta-blocker use and body mass index (BMI).
The study enrolled 100 pediatric patients (mean age = 12.7 years, 52.0% male) diagnosed with inherited cardiac arrhythmias or cardiomyopathies, along with 107 age- and sex-matched controls. Conducted across seven tertiary care centers in France from February 2021 to June 2023, the study used cardiopulmonary exercise testing (CPET) and accelerometry to assess fitness and physical activity levels.
Pediatric patients with inherited cardiac disease engaged in less moderate to vigorous physical activity (MVPA), averaging 42.0 minutes per day compared with 48.2 minutes in the control group (P = .009). They also demonstrated more sedentary time, with a mean of 568.6 (SD = 122.5) vs 524.3 (SD = 101.4) minutes per day (P = .02). Additionally, these patients had a significantly lower ventilatory anaerobic threshold (VAT) (22.4 [SD = 7.1] vs 29.0 [SD = 7.4] mL/kg/minute, P < .001).
A lower V̇o2max was associated with a higher NYHA functional class, ventricular dilatation, and implantable cardioverter-defibrillator use. Behavioral and demographic factors, such as male sex, higher maternal education, and greater motivation for physical activity, were linked to better cardiopulmonary fitness.
"Assessing cardiopulmonary fitness among [pediatric patients] with inherited cardiac disease can contribute to engaging in a shared decision-making process for sports participation and preventive interventions, such as early cardiac rehabilitation programs," said lead study author Luc Souilla, PhD, of PhyMedExp at INSERM at CNRS at the University of Montpellier in France, and colleagues.
While historical concerns about sudden cardiac events have led to physical activity restrictions, emerging evidence supports a more individualized approach. Further research is needed to assess the long-term benefits of targeted exercise interventions in this population.
Full authors' disclosures are available in the study.