Physical Activity Levels in Children with Esophageal Atresia and Congenital Heart Disease: A Comparative Multicenter Study

Abstract

Aim of the Study Esophageal atresia (EA) is associated with impaired motor development, cardiopulmonary function, and physical activity (PA). Despite missing scientific evidence, this fact is often attributed to associated congenital heart disease (CHD). The aim of this study was to investigate PA in EA patients without CHD compared with CHD patients and healthy controls.

Methods In this multicenter study, EA patients aged 6 through 17 years were included. Moderate-to-vigorous PA (MVPA, minutes per week) was assessed using the standardized and validated questionnaire Motorik-Modul Physical Activity Questionnaire. EA patients were randomly matched 1:4 for gender and age with patients with CHD (n = 1,262) and healthy controls (n = 6,233). Patients born with both EA and CHD were excluded. Means and 95% confidence intervals (95% CIs) were calculated. To identify associated factors, Spearman's correlation was performed.

Main Results Overall, 69 EA patients were matched with 276 CHD patients and 276 controls (57% male, 43% female, mean age 10,3 years, 95% CI: 9.5–11.1). Mean MVPA was reduced in EA (492 minutes, 95% CI: 387–598) and CHD patients (463 minutes, 95% CI: 416–511) compared with controls (613 minutes, 95% CI: 548–679). In subgroup analysis, MVPA was reduced further in females and older age groups with EA and CHD. For EA patients, there was no statistical association between Gross type, current symptoms, surgical approaches, and MVPA.

Conclusion Isolated EA and CHD were associated with reduced PA, especially in females and teenagers. To avoid additional morbidity associated with sedentary behavior, PA should be promoted during follow-up.

Keywords

youth - sports - congenital malformation - physical exercise - fitness

Note

This paper is part of Luisa Maria Frankenbach's dissertation at the Johannes Gutenberg University in Mainz.

Publication History

Received: 10 July 2024

Accepted: 19 September 2024

Accepted Manuscript online:
23 September 2024

Article published online:
28 October 2024

• References

• 1 Bull FC, Al-Ansari SS, Biddle S. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54 (24) 1451-1462
• 2 World Health Organization. Global recommendations on physical activity for health. 2022 . Accessed September 5, 2024 at: https://www.who.int/publications/i/item/9789241599979
• 3 World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2022 . Accessed September 5, 2024 at: https://www.who.int/publications-detail-redirect/9789240015128
• 4 Dingemann C, Eaton S, Aksnes G. et al. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: diagnostics, preoperative, operative, and postoperative management. Eur J Pediatr Surg 2020; 30 (04) 326-336
• 5 Krishnan U, Mousa H, Dall'Oglio L. et al. ESPGHAN-NASPGHAN guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with esophageal atresia-tracheoesophageal fistula. J Pediatr Gastroenterol Nutr 2016; 63 (05) 550-570
• 6 Koumbourlis AC, Belessis Y, Cataletto M. et al. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr Pulmonol 2020; 55 (10) 2713-2729
• 7 König TT, Stefanescu MC, Wildermuth M, Frankenbach LM, Muensterer OJ, Gianicolo E. Sex-specific percentiles for bodyweight and height in children born with esophageal atresia: a registry-based analysis 2001-2021. BMC Pediatr 2023; 23 (01) 27
• 8 König TT, Muensterer OJ. Physical fitness and locomotor skills in children with esophageal atresia-a case control pilot study. Front Pediatr 2018; 6: 337
• 9 Arneitz C, Windhaber J, Castellani C. et al. Cardiorespiratory performance capacity and airway microbiome in patients following primary repair of esophageal atresia. Pediatr Res 2021; 90 (01) 66-73
• 10 König TT, Frankenbach ML, Gianicolo E. et al. Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age. Eur J Pediatr 2023; 182 (06) 2655-2663
• 11 Williams CA, Wadey C, Pieles G, Stuart G, Taylor RS, Long L. Physical activity interventions for people with congenital heart disease. Cochrane Heart Group, Herausgeber. Cochrane Database Syst Rev [Internet]. 2020 . Accessed September 5, 2024 at: http://doi.wiley.com/10.1002/14651858.CD013400.pub2
• 12 König TT, Gianicolo E, Frankenbach L, Wittenmeier E, Muensterer OJ. Esophageal interventions in infants born with esophageal atresia: a comprehensive analysis of a national database. Eur J Pediatr Surg 2022; 32 (01) 42-49
• 13 Olsen M, Marino B, Kaltman J. et al. Myocardial infarction in adults with congenital heart disease. Am J Cardiol 2017; 120 (12) 2272-2277
• 14 Siaplaouras J, Niessner C, Helm PC. et al. Physical activity among children with congenital heart defects in Germany: a nationwide survey. Front Pediatr 2020; 8: 170
• 15 Sport, Spaß und Spiel für Herzkinder? [Internet]. Accessed September 5, 2024 at: https://kompetenznetz-ahf.de/forscher/forschung/laufende-studien/sport-spass-und-spiel-fuer-herzkinder/
• 16 Projektseite Motorik-Modul-Studie (MoMo) Startseite [Internet]. Accessed September 5, 2024 at: https://www.ifss.kit.edu/MoMo/index.php
• 17 Warnes CA, Williams RG, Bashore TM. et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52 (23) e143-e263
• 18 Jekauc D, Wagner MO, Kahlert D, Woll A. Reliabilität und Validität des MoMo-Aktivitätsfragebogens für Jugendliche (MoMo-AFB). Diagnostica 2013; 59 (02) 100-111
• 19 Lejeune S, Sfeir R, Rousseau V. et al. Esophageal atresia and respiratory morbidity. Pediatrics 2021; 148 (03) e2020049778
• 20 Radtke T, Smith S, Nevitt SJ, Hebestreit H, Kriemler S. Physical activity and exercise training in cystic fibrosis. Cochrane Cystic Fibrosis and Genetic Disorders Group, Herausgeber. Cochrane Database Syst Rev [Internet]. 2022 . Accessed September 5, 2024 at: http://doi.wiley.com/10.1002/14651858.CD002768.pub5
• 21 McLoughlin RF, Clark VL, Urroz PD, Gibson PG, McDonald VM. Increasing physical activity in severe asthma: a systematic review and meta-analysis. Eur Respir J 2022; 60 (06) 2200546
• 22 Borselle D, Grochowski K, Gerus S. et al. Thoracic musculoskeletal deformities following surgical treatment of esophageal atresia - thoracoscopic versus open approach: a retrospective two centers cohort study. J Pediatr Surg 2024; 59 (09) 1719-1724
• 23 Flaherty E, Folaranmi SE. Thoracoscopic versus open repair of esophageal atresia: a systematic review of surgical outcomes. J Laparoendosc Adv Surg Tech A 2023; 33 (11) 1114-1120
• 24 Schmidt SCE, Anedda B, Burchartz A. et al. The physical activity of children and adolescents in Germany 2003-2017: the MoMo-study. PLoS One 2020; 15 (07) e0236117
• 25 Leibovitch L, Zohar I, Maayan-Mazger A, Mazkereth R, Strauss T, Bilik R. Infants born with esophageal atresia with or without tracheo-esophageal fistula: short- and long-term outcomes. Isr Med Assoc J 2018; 20 (03) 161-166
• 26 Donoso F, Hedenström H, Malinovschi A. E Lilja H. Pulmonary function in children and adolescents after esophageal atresia repair. Pediatr Pulmonol 2020; 55 (01) 206-213
• 27 Dreiskämper D, Tietjens M, Schott N. The physical self-concept across childhood: measurement development and meaning for physical activity. Psychol Sport Exerc 2022; 61: 102187
• 28 Lazow SP, Ben-Ishay O, Aribindi VK. et al. Predictors of index admission mortality and morbidity in contemporary esophageal atresia patients. J Pediatr Surg 2020; 55 (11) 2322-2328
• 29 Dellenmark-Blom M, Chaplin JE, Jönsson L, Gatzinsky V, Quitmann JH, Abrahamsson K. Coping strategies used by children and adolescents born with esophageal atresia - a focus group study obtaining the child and parent perspective. Child Care Health Dev 2016; 42 (05) 759-767
• 30 Zamorano-García D, Infantes-Paniagua Á, Cuevas-Campos R, Fernández-Bustos JG. Impact of physical activity-based interventions on children and adolescents' physical self-concept: a meta-analysis. Res Q Exerc Sport 2023; 94 (01) 1-14
• 31 Schmidt SC, Schneider J, Reimers AK, Niessner C, Woll A. Exploratory determined correlates of physical activity in children and adolescents: the MoMo study. Int J Environ Res Public Health 2019; 16 (03) 415
• 32 Svedenkrans J, Ekblom Ö, Domellöf M, Fellman V, Norman M, Bohlin K. Physical activity in 6.5-year-old children born extremely preterm. J Clin Med 2020; 9 (10) 3206
• 33 Aakvik KAD, Benum SD, Tikanmäki M. et al. Physical activity and cognitive function in adults born very preterm or with very low birth weight-an individual participant data meta-analysis. PLoS One 2024; 19 (02) e0298311