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Abstract
Physical activity and health-related quality of life (HRQOL) are associated with overall health outcomes in adolescents with congenital heart disease (CHD). The purpose of this study was to compare the levels of physical activity and HRQOL in adolescents with CHD and healthy controls. In addition, we compared these variables using a propensity score matching to reduce the confounding effects. Participants were divided into three groups with simple CHD (n=55), complex CHD (n=173), and healthy controls (n=181). Self-reported physical activity levels (metabolic equivalent of task [MET]-hr/wk) were obtained using the Global Physical Activity Questionnaire. HRQOL was evaluated using the Pediatric Quality of Life Inventory questionnaire. Total scores of HRQOL in adolescents with complex CHD were significantly lower than those with simple CHD (p=0.022) and healthy controls (p＜0.001), respectively; however, there was no significant difference in total scores of HRQOL between adolescents with simple CHD and healthy controls. Levels of physical activity in adolescents with complex CHD were significantly lower than those with simple CHD (p=0.001) and healthy controls (p＜0.001). After propensity matched analysis (44 pairs), the results were consistent with the above results. In conclusion, HRQOL scores and physical activity levels are significantly lower in adolescents with complex CHD, but not in adolescents with simple CHD, than in healthy adolescents.
References
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Fig. 1.
Proportion of achieved WHO (World Health Organization) physical activity recommendation (60 min/day) for by three groups. CHD: congenital heart disease.
Table 1.
Characteristics of subjects (N=409)
| Variable | Healthy control (n=181) | Simple CHD (n=55) | Complex CHD (n=173) | p-value |
|---|---|---|---|---|
| Age | ＜0.001 | |||
| 13−18 yr | 15.1±1.5 | 15.8±1.8 | 15.9±1.7 | |
| Sex | 0.049 | |||
| Boy | 79 (43.6) | 32 (58.2) | 95 (54.9) | |
| Girl | 102 (56.4) | 23 (41.8) | 78 (45.1) | |
| Body mass index (kg/m2) | 20.64±2.81 | 21.10±2.89 | 20.28±3.48 | 0.209 |
| No. of surgical | ＜0.001 | |||
| 0 | 0 | 23 (41.8) | 6 (3.5) | |
| 1 | 0 | 30 (54.5) | 56 (32.4) | |
| 2−3 | 0 | 2 (3.6) | 48 (27.7) | |
| ≥4 | 0 | – | 63 (36.4) | |
| Cyanosis (yes) | 0 | 0 | 26 (15.0) | ＜0.001 |
| Birth weight (kg) | 3.23±0.39 | 3.07±0.55 | 2.98±0.54 | 0.295 |
| Taking medications (yes) | 0 | 8 (14.5) | 95 (54.3) | ＜0.001 |
| Type of CHD | – | |||
| VSD | – | 35 (63.6) | – | |
| ASD | – | 10 (18.2) | – | |
| PDA | – | 3 (5.5) | – | |
| MR/AR | – | 3 (5.5) | 10 (5.8) | |
| PS | – | 4 (7.3) | – | |
| AS | – | – | 9 (5.2) | |
| AVSD | – | – | 5 (2.9) | |
| COA | – | – | 9 (5.2) | |
| DORV | – | – | 8 (4.6) | |
| FSV | – | – | 38 (22.0) | |
| PA | – | – | 18 (10.4) | |
| TGA | – | – | 7 (4.0) | |
| TOF | – | – | 47 (27.2) | |
| Others∗ | – | – | 22 (12.7) |
CHD: congenital heart disease, VSD: ventricular septal defect, ASD: atrial septal defect, PDA: patent ductus arteriosus, MR/AR: valvar regurgitation, PS: pulmonary stenosis, AS: aortic stenosis, AVSD: atrioventricular septal defect, COA: coarctation of the aorta, DORV: double outlet right ventricle, FSV: functionally single ventricle, PA: pulmonary atresia, TGA: transposition of great arteries, TOF: tetralogy of fallot.
Table 2.
Physical activity and HRQOL between CHD adolescents and healthy controls
| Variable | Healthy control (n=181) | Simple CHD (n=55) | Complex CHD (n=173) | p-value |
|---|---|---|---|---|
| Physical activity (MET-hr/wk) | ||||
| Total | 32.6 (19.6−62.9)∗ | 28.6 (18.0−50.0)∗ | 16.6 (10.0−33.6) | ＜0.001 |
| Vigorous | 0 (0−12.0)∗ | 0 (0−16.0) | 0 | ＜0.001 |
| Moderate | 10.0 (0−26.6) | 11.0 (4.0−20.0)∗ | 8.0 (2.8−13.6) | 0.101 |
| Transport | 13.3 (8.1−20.0)∗ | 8.0 (3.3−14.0)∗ | 6.6 (3.3−12.6) | ＜0.001 |
| HRQOL (score) | ||||
| Total | 86.8±11.0∗ | 87.1±14.1∗ | 79.1±15.3 | ＜0.001 |
| Physical | 89.2±12.2∗ | 89.0±14.7∗ | 78.4±17.7 | ＜0.001 |
| Emotional | 82.4±16.7 | 85.2±18.4 | 79.3±20.1 | 0.078 |
| Social | 89.9±14.0 | 89.0±16.1 | 85.9±17.2 | 0.051 |
| School | 84.3±13.5∗ | 84.1±16.0∗ | 73.2±18.1 | ＜0.001 |
Table 3.
Age, sex variables propensity score matching (N=132)
| Variable | Healthy control (n=44) | Simple CHD (n=44) | Complex CHD (n=44) | p-value |
|---|---|---|---|---|
| Age | 1 | |||
| 13−18 yr | 15.3±1.7 | 15.3±1.7 | 15.3±1.7 | |
| Sex | 1 | |||
| Boy | 21 (47.7) | 21 (47.7) | 21 (47.7) | |
| Girl | 23 (52.3) | 23 (52.3) | 23 (52.3) | |
| Body mass index (kg/m2) | 19.99±2.56 | 20.90±2.89 | 18.95±2.66 | 0.040 |
| No. of surgical | 0.001 | |||
| 0 | 0 | 21 (47.7) | 2 (4.5) | |
| 1−2 | 0 | 22 (50) | 10 (22.7) | |
| 3 | 0 | 1 (2.3) | 16 (36.4) | |
| ≥4 | 0 | 0 | 8 (18.2) | |
| Cyanosis (yes) | 0 | 0 | 8 (18.2) | ＜0.001 |
| Birth weight (kg) | 3.18±0.38 | 3.08±0.55 | 2.95±0.54 | 0.141 |
| Physical activity (MET-hr/day) | ||||
| Total | 34.3 (20.0−76.5)∗ | 26.6 (18.0−48.5)∗ | 16.1 (10.0−25.3) | ＜0.001 |
| Vigorous | 0 (0−9.5) | 0 (0−13.3)∗ | 0 (0−0) | 0.004 |
| Moderate | 19.3 (0.6−33.6) | 10.8 (3.5−20.0) | 8.0 (3.0−12.7) | 0.066 |
| Transport | 13.3 (8.0−20.0)∗ | 13.3 (8.0−20.0) | 6.6 (3.5−11.5) | 0.001 |
| HRQOL (score) | ||||
| Total | 85.5±11.7∗ | 86.8±13.7∗ | 77.6±13.8 | 0.003 |
| Physical | 87.2±13.3∗ | 88.4±14.6∗ | 76.4±15.9 | ＜0.001 |
| Emotional | 81.1±19.1 | 85.0±18.4 | 79.3±19.0 | 0.357 |
| Social | 91.0±11.6 | 89.2±15.1 | 84.8±17.2 | 0.143 |
| School | 81.5±17.1∗ | 83.6±16.0∗ | 70.6±17.7 | ＜0.001 |
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