Promotion of physical activity for children and adults with congenital heart disease: A scientific statement from the American Heart Association

Circulation

Volumn 127, Issue 21, 2013, Pages 2147-2159

  Longmuir, Patricia E ^a   Brothers, Julie A ^a   De Ferranti, Sarah D ^a   Hayman, Laura L ^a   Van Hare, George F ^a   Matherne, G Paul ^a   Davis, Christopher K ^a   Joy, Elizabeth A ^a   McCrindle, Brian W ^a  

^a NONE

Author keywords

Aha Scientific Statements; Congenital; Death; Exercise; Heart defects; Lifestyle; Pediatrics; Physical activity; Rehabilitation; Sudden

Indexed keywords

ANGINA PECTORIS; ANTICOAGULATION; AORTA DISSECTION; AORTA ROOT; ARTICLE; ATHLETE; BEHAVIOR; BLEEDING; BLOOD PRESSURE; CARDIOPULMONARY EXERCISE TEST; CARDIOVASCULAR FUNCTION; CLINICAL ASSESSMENT; COGNITION; CONGENITAL HEART DISEASE; CONNECTIVE TISSUE DISEASE; COUNSELING; DIZZINESS; EXERCISE INTENSITY; EXTERNAL PACEMAKER; FAINTNESS; FITNESS; GENETIC ASSOCIATION; HEALTH CARE PERSONNEL; HEALTH CARE POLICY; HEALTH PROMOTION; HEART PALPITATION; HEART RATE; HEART VENTRICLE ARRHYTHMIA; HUMAN; HYPOXIA; IMPLANTABLE CARDIOVERTER DEFIBRILLATOR; INTERPERSONAL COMMUNICATION; LUNG FUNCTION; MEDICAL SOCIETY; MOBILIZATION; MORTALITY; MUSCLE STRENGTH; OXYGEN CONSUMPTION; OXYGEN SATURATION; PATIENT ADVOCACY; PHYSICAL ACTIVITY; PRACTICE GUIDELINE; PRIORITY JOURNAL; RECREATION; RISK FACTOR; SEDENTARY LIFESTYLE; SINUS NODE; SOCIAL ADAPTATION; SPORT; TREADMILL ERGOMETRY; WALL STRESS;

AHA SCIENTIFIC STATEMENTS; DEATH, SUDDEN; EXERCISE; HEART DEFECTS, CONGENITAL; LIFESTYLE; PEDIATRICS; PHYSICAL ACTIVITY; REHABILITATION;

ADULT; AMERICAN HEART ASSOCIATION; CHILD; COUNSELING; HEALTH PROMOTION; HEART DEFECTS, CONGENITAL; HUMANS; LIFE STYLE; MOTOR ACTIVITY; UNITED STATES;

EID: 84878299519     PISSN: 00097322     EISSN: 15244539     Source Type: Journal    
DOI: 10.1161/CIR.0b013e318293688f     Document Type: Article

References (93)

1. Canadian Society for Exercise Physiology. Canadian Physical Activity, Fitness & Lifestyle Approach. Ottawa, Canada: Canadian Society for Exercise Physiology; 2003.
2. Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, Yamazaki T, Froelicher V. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004; 117: 912-918.
3. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ. 2006; 174: 801-880.
4. Oguma Y, Shinoda-Tagawa T. Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. Am J Prev Med. 2004; 26: 407-418.
5. Physical activity and health: the benefits of physical activity. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/ physicalactivity/everyone/health/index.html. Accessed November 9, 2008.
6. Canadian Physical Activity Guidelines. Canadian Society for Exercise Physiology Web site. www.csep.ca. Accessed January 7, 2012.
7. US Department of Health & Human Services Web site. 2008 Physical Activity Guidelines for Americans. www.health.gov/paguidelines/guidelines/ default.aspx. Accessed January 3, 2012.
8. How much physical activity do children need? Centers for Disease Control and Prevention Web site. http://www.cdc.gov/physicalactivity/everyone/ guidelines/children.html. Accessed November 10, 2008.
9. Inuzuka R, Diller GP, Borgia F, Benson L, Tay EL, Alonso-Gonzalez R, Silva M, Charalambides M, Swan L, Dimopoulos K, Gatzoulis MA. Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term. Circulation. 2012; 125: 250-259.
10. Graham TP Jr, Driscoll DJ, Gersony WM, Newburger JW, Rocchini A, Towbin JA. Task Force 2: congenital heart disease. J Am Coll Cardiol. 2005; 45: 1326-1333.
11. Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carrè F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goed-koop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Hoffmann E, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G; Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology; Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005; 26: 1422-1445.
12. Takken T, Giardini A, Reybrouck T, Gewillig M, Hövels-Gürich HH, Longmuir PE, McCrindle BW, Paridon SM, Hager A. Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology. Eur J Cardiovasc Prev Rehabil. 2012; 19: 1034-1065.
13. Deanfield J, Thaulow E, Warnes C, Webb G, Kolbel F, Hoffman A, Sorenson K, Kaemmer H, Thilen U, Bink-Boelkens M, Iserin L, Daliento L, Silove E, Redington A, Vouhe P, Priori S, Alonso MA, Blanc JJ, Budaj A, Cowie M, Deckers J, Fernandez Burgos E, Lekakis J, Lindahl B, Mazzotta G, Morais J, Oto A, Smiseth O, Trappe HJ, Klein W, Blömstrom-Lundqvist C, de Backer G, Hradec J, Mazzotta G, Parkhomenko A, Presbitero P, Torbicki A; Task Force on the Management of Grown Up Congenital Heart Disease, European Society of Cardiology; ESC Committee for Practice Guidelines. Management of grown up congenital heart disease. Eur Heart J. 2003; 24: 1035-1084.
14. Maron BJ, Chaitman BR, Ackerman MJ, Bayés de Luna A, Corrado D, Crosson JE, Deal BJ, Driscoll DJ, Estes NA 3rd, Araújo CG, Liang DH, Mitten MJ, Myerburg RJ, Pelliccia A, Thompson PD, Towbin JA, Van Camp SP; on behalf of Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention; Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004; 109: 2807-2816.
15. Heidbuchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Ivarhoff P, Dorwarth U, Pelliccia A; Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions, part I: supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil. 2006; 13: 475-484.
16. Heidbuchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A; Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions: part II: ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil. 2006; 13: 676-686.
17. Ekelund U, Anderssen S, Andersen LB, Riddoch CJ, Sardinha LB, Luan J, Froberg K, Brage S. Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin Nutr. 2009; 89: 90-96.
18. Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults: a systematic review of longitudinal studies, 1996-2011. Am J Prev Med. 2011; 41: 207-215.
19. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010; 7: 40.
20. Booth FW, Chakravarthy MV, Spangenburg EE. Exercise and gene expression: physiological regulation of the human genome through physical activity. J Physiol (Lond). 2002; 543(pt 2): 399-411.
21. Ekblom-Bak E, Hellénius ML, Ekblom B. Are we facing a new paradigm of inactivity physiology? Br J Sports Med. 2010; 44: 834-835.
22. Haskell WL, Leon AS, Caspersen CJ, Froelicher VF, Hagberg JM, Harlan W, Holloszy JO, Regensteiner JG, Thompson PD, Washburn RA. Cardiovascular benefits and assessment of physical activity and physical fitness in adults. Med Sci Sports Exerc. 1992; 24(suppl):S201-S220.
23. Viru A, Smirnova T. Health promotion and exercise training. Sports Med. 1995; 19: 123-136.
24. Sothern MS, Loftin M, Suskind RM, Udall JN, Blecker U. The health benefits of physical activity in children and adolescents: implications for chronic disease prevention. Eur J Pediatr. 1999; 158: 271-274.
25. King AC, Taylor CB, Haskell WL, DeBusk RF. Influence of regular aerobic exercise on psychological health: a randomized, controlled trial of healthy middle-aged adults. Health Psychol. 1989; 8: 305-324.
26. McCrindle BW, Williams RV, Mital S, Clark BJ, Russell JL, Klein G, Eisenmann JC. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child. 2007; 92: 509-514.
27. Reybrouck T, Mertens L. Physical performance and physical activity in grown-up congenital heart disease. Eur J Cardiovasc Prev Rehabil. 2005; 12: 498-502.
28. Rhodes J, Curran TJ, Camil L, Rabideau N, Fulton DR, Gauthier NS, Gauvreau K, Jenkins KJ. Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics. 2005; 116: 1339-1345.
29. Massin MM, Hövels-Gürich HH, Gérard P, Seghaye MC. Physical activity patterns of children after neonatal arterial switch operation. Ann Thorac Surg. 2006; 81: 665-670.
30. Pemberton VL, McCrindle BW, Barkin S, Daniels SR, Barlow SE, Binns HJ, Cohen MS, Economos C, Faith MS, Gidding SS, Goldberg CS, Kavey RE, Longmuir P, Rocchini AP, Van Horn L, Kaltman JR. Report of the National Heart, Lung, and Blood Institute's Working Group on obesity and other cardiovascular risk factors in congenital heart disease. Circulation. 2010; 121: 1153-1159.
31. Tremblay MS, Lloyd M. Physical literacy measurement: the missing piece. Phys Health Educ J. 2010; 76: 26-30.
32. Williams HG, Pfeiffer KA, O'Neill JR, Dowda M, McIver KL, Brown WH, Pate RR. Motor skill performance and physical activity in preschool children. Obesity (Silver Spring). 2008; 16: 1421-1426.
33. Majnemer A, Limperopoulos C, Shevell M, Rohlicek C, Rosenblatt B, Tchervenkov C. Developmental and functional outcomes at school entry in children with congenital heart defects. J Pediatr. 2008; 153: 55-60.
34. Bellinger DC, Bernstein JH, Kirkwood MW, Rappaport LA, Newburger J. Visual-spatial skills in children after open-heart surgery. J Dev Behav Pediatr. 2003; 24: 169-179.
35. Hövels-Gürich HH, Konrad K, Skorzenski D, Nacken C, Minkenberg R, Messmer BJ, Seghaye MC. Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy. Ann Thorac Surg. 2006; 81: 958-966.
36. Ruiz JR, Rizzo NS, Hurtig-Wennlöf A, Ortega FB, Wärnberg J, Sjöström M. Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study [published correction appears in Am J Clin Nutr. 2009; 89: 656].
37. Am J Clin Nutr. 2006; 84: 299-303.
38. Suni JH, Oja P, Miilunpalo SI, Pasanen ME, Vuori IM, Bös K. Healthrelated fitness test battery for adults: associations with perceived health, mobility, and back function and symptoms. Arch Phys Med Rehabil. 1998; 79: 559-569.
39. Warburton DE, Gledhill N, Quinney A. Musculoskeletal fitness and health. Can J Appl Physiol. 2001; 26: 217-237.
40. Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR, Kimball TR, Knilans TK, Nixon PA, Rhodes J, Yetman AT. Clinical stress testing in the pediatric age group: a statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension, and Obesity in Youth. Circulation. 2006; 113: 1905-1920.
41. Holm I, Fredriksen PM, Fosdahl MA, Olstad M, Vøllestad N. Impaired motor competence in school-aged children with complex congenital heart disease. Arch Pediatr Adolesc Med. 2007; 161: 945-950.
42. Stieber NA, Gilmour S, Morra A, Rainbow J, Robitaille S, Van Arsdell G, McCrindle BW, Gibson BE, Longmuir PE. Feasibility of improving the motor development of toddlers with congenital heart defects using a home-based intervention. Pediatr Cardiol. 2012; 33: 521-532.
43. Ruiz JR, Ortega FB, Gutierrez A, Meusel D, Sjöström M, Castillo MJ. Health-related fitness assessment in childhood and adolescence: a European approach based on the AVENA, EYHS, and HELENA studies. J Public Health. 2006; 14: 269-277.
44. Lubans DR, Morgan P, Callister R, Plotnikoff RC, Eather N, Riley N, Smith CJ. Test-retest reliability of a battery of field-based health-related fitness measures for adolescents. J Sports Sci. 2011; 29: 685-693.
45. Tremblay M, Langlois R, Bryan S, Esliger D, Patterson J. Canadian Health Measures Survey pre-test: design, methods and results. Health Rep. 2007; 18(suppl): 21-30.
46. Freedson P, Pober D, Janz KF. Calibration of accelerometer output for children. Med Sci Sports Exerc. 2005; 37(suppl): S523-S530.
47. Westerterp KR. Assessment of physical activity: a critical appraisal. Eur J Appl Physiol. 2009; 105: 823-828.
48. Bailey RC, Olson J, Pepper SL, Porszasz J, Barstow TJ, Cooper DM. The level and tempo of children's physical activities: an observational study. Med Sci Sports Exerc. 1995; 27: 1033-1041.
49. Matthews CE, Ainsworth BE, Thompson RW, Bassett DR Jr. Sources of variance in daily physical activity levels as measured by an accelerometer. Med Sci Sports Exerc. 2002; 34: 1376-1381.
50. Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC. Using objective physical activity measures with youth: how many days of monitoring are needed? Med Sci Sports Exerc. 2000; 32: 426-431.
51. Fredriksen PM, Ingjer E, Thaulow E. Physical activity in children and adolescents with congenital heart disease: aspects of measurements with an activity monitor. Cardiol Young. 2000; 10: 98-106.
52. Puyau MR, Adolph AL, Vohra FA, Zakeri I, Butte NF. Prediction of activity energy expenditure using accelerometers in children. Med Sci Sports Exerc. 2004; 36: 1625-1631.
53. Dua JS, Cooper AR, Fox KR, Graham Stuart A. Physical activity levels in adults with congenital heart disease. Eur J Cardiovasc Prev Rehabil. 2007; 14: 287-293.
54. Tudor-Locke C, Bassett DR Jr. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004; 34: 1-8.
55. Colley RC, Janssen I, Tremblay MS. Daily step target to measure adherence to physical activity guidelines in children. Med Sci Sports Exerc. 2012; 44: 977-982.
56. Adamo KB, Prince SA, Tricco AC, Connor-Gorber S, Tremblay M. A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. Int J Pediatr Obes. 2009; 4: 2-27.
57. Saunders TJ, Prince SA, Tremblay MS. Clustering of children's activity behaviour: the use of self-report versus direct measures. Int J Behav Nutr Phys Act. 2011; 8: 48.
58. Hay J, Cairney J. Development of the Habitual Activity Estimation Scale for clinical research: a systematic approach. Pediatr Exerc Sci 2006; 18: 193-202.
59. Hay JA. Adequacy in and predilection for physical activity in children. Clin J Sport Med 1992; 2: 192-201.
60. Hay J. Predicting the selection of physical education class in grade ten from self-perceptions reported in grades seven, eight and nine. Brock Educ. 1996; 6: 59-69.
61. Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc. 2000; 32: 963-975.
62. Ackerman E, Falsetti SA, Lewis P, Hawkins AO, Heinschel JA. Motivational interviewing: a behavioral counseling intervention for the family medicine provider. Fam Med. 2011; 43: 582-585.
63. Bull F, Milton K. Let's Get Moving: a systematic pathway for the promotion of physical activity in a primary care setting: Let's Get Moving was developed based on National Guidance on effective interventions on physical activity released in the United Kingdom in 2006. Glob Health Promot. 2011; 18: 59-61.
64. Lin JS, O'Connor E, Whitlock EP, Beil TL. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010; 153: 736-750.
65. McDonagh JE, Southwood TR, Shaw KL; British Paediatric Rheumatology Group. Unmet education and training needs of rheumatology health professionals in adolescent health and transitional care. Rheumatology (Oxford). 2004; 43: 737-743.
66. Lawlor DA, Hanratty B. The effect of physical activity advice given in routine primary care consultations: a systematic review. J Public Health Med. 2001; 23: 219-226.
67. Orrow G, Kinmonth AL, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and metaanalysis of randomised controlled trials. BMJ. 2012; 344:e1389.
68. Tulloch H, Fortier M, Hogg W. Physical activity counseling in primary care: who has and who should be counseling? Patient Educ Couns. 2006; 64: 6-20.
69. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Healthcare: Helping Patients Change Behavior. New York, NY: Guilford Press; 2007.
70. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992; 47: 1102-1114.
71. Ockene IS, Hayman LL, Pasternak RC, Schron E, Dunbar-Jacob J. Task force #4: adherence issues and behavior change: achieving a long-term solution. J Am Coll Cardiol 2002; 40: 630-640.
72. Prochaska JJ, Rodgers MW, Sallis JF. Association of parent and peer support with adolescent physical activity. Res Q Exerc Sport. 2002; 73: 206-210.
73. Longmuir PE. Creating inclusive physical activity opportunities: an abilities-based approach. In: Steadward RD, Watkinson EJ, Wheeler GD, eds. Adapted Physical Activity. Edmonton, Canada: University of Alberta Press; 2003: 363-382.
74. Mitchell JH, Haskell WL, Raven PB. Classification of sports. Med Sci Sports Exerc. 1994; 26(suppl): S242-S245.
75. Maron BJ. Sudden death in young athletes. N Engl J Med. 2003; 349: 1064-1075.
76. Gajewski KK, Saul JP. Sudden cardiac death in children and adolescents (excluding Sudden Infant Death Syndrome). Ann Pediatr Cardiol. 2010; 3: 107-112.
77. Brown DW, Dipilato AE, Chong EC, Gauvreau K, McElhinney DB, Colan SD, Lock JE. Sudden unexpected death after balloon valvuloplasty for congenital aortic stenosis. J Am Coll Cardiol. 2010; 56: 1939-1946.
78. Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol. 2005; 45: 1340-1345.
79. Yetman AT, Graham T. The dilated aorta in patients with congenital cardiac defects. J Am Coll Cardiol. 2009; 53: 461-467.
80. Pelliccia A, Di Paolo FM, De Blasiis E, Quattrini FM, Pisicchio C, Guerra E, Culasso F, Maron BJ. Prevalence and clinical significance of aortic root dilation in highly trained competitive athletes. Circulation. 2010; 122: 698-706.
81. Coady MA, Rizzo JA, Hammond GL, Kopf GS, Elefteriades JA. Surgical intervention criteria for thoracic aortic aneurysms: a study of growth rates and complications. Ann Thorac Surg. 1999; 67: 1922-1926.
82. Ergin MA, Spielvogel D, Apaydin A, Lansman SL, McCullough JN, Galla JD, Griepp RB. Surgical treatment of the dilated ascending aorta: when and how? Ann Thorac Surg. 1999; 67: 1834-1839.
83. Mitchell JH, Haskell W, Snell P, Van Camp SP. Task Force 8: classification of sports. J Am Coll Cardiol. 2005; 45: 1364-1367.
84. Streif W, Andrew M, Marzinotto V, Massicotte P, Chan AK, Julian JA, Mitchell L. Analysis of warfarin therapy in pediatric patients: a prospective cohort study of 319 patients. Blood. 1999; 94: 3007-3014.
85. Zipes DP, Ackerman MJ, Estes NA 3rd, Grant AO, Myerburg RJ, Van Hare G. Task Force 7: arrhythmias. J Am Coll Cardiol. 2005; 45: 1354-1363.
86. Lampert R, Cannom D, Olshansky B. Safety of sports participation in patients with implantable cardioverter defibrillators: a survey of Heart Rhythm Society members. J Cardiovasc Electrophysiol. 2006; 17: 11-15.
87. Freed MD, Rocchini A, Rosenthal A, Nadas AS, Castaneda AR. Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol. 1979; 43: 253-258.
88. Diller GP, Dimopoulos K, Okonko D, Uebing A, Broberg CS, BabuNarayan S, Bayne S, Poole-Wilson PA, Sutton R, Francis DP, Gatzoulis MA. Heart rate response during exercise predicts survival in adults with congenital heart disease. J Am Coll Cardiol. 2006; 48: 1250-1256.
89. Dimopoulos K, Okonko DO, Diller GP, Broberg CS, Salukhe TV, Babu-Narayan SV, Li W, Uebing A, Bayne S, Wensel R, Piepoli MF, Poole-Wilson PA, Francis DP, Gatzoulis MA. Abnormal ventilatory response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival. Circulation. 2006; 113: 2796-2802.
90. Guimarães GV, Bellotti G, Mocelin AO, Camargo PR, Bocchi EA. Cardiopulmonary exercise testing in children with heart failure secondary to idiopathic dilated cardiomyopathy. Chest. 2001; 120: 816-824.
91. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008; 40: 181-188.
92. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian children and youth: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011; 22: 15-23.
93. Tremblay MS, Shields M, Laviolette M, Craig CL, Janssen I, Connor Gorber S. Fitness of Canadian Children and Youth: Results From the 2007-2009 Canadian Health Measures Survey. Ottawa, Canada: Statistics Canada; 2010.