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Mark A. Stefan, MD; Wilma M. Hopman, MA; John F. Smythe, MD, FRCPC

Arch Pediatr Adolesc Med. 2005;159:477-481.

Objective  To determine whether exercise intolerance and recommended activity restrictions are associated with development of overweight and obesity in children with congenital heart disease.

Design  Retrospective review.

Setting  Pediatric cardiology practice at a teaching hospital.

Participants  A total of 110 pediatric congenital heart disease patients followed up for a mean of 8.4 years.

Main Outcome Measures  Body mass index (BMI), sex-appropriate BMI percentiles, overweight (BMI percentile 85), and obesity (BMI percentile 95) at follow-up.

Results  As a group, the increase in BMI percentiles was close to 10 points, but the increase was 21.6 points for exercise intolerant children and 27.3 points for activity restricted children. Activity restriction was significantly associated with both overweight (risk ratio [RR], 2.60; 95% confidence interval [CI], 1.34-3.54) and obesity at follow-up (RR, 4.08; 95% CI, 1.42-7.38) after adjusting for weight at baseline. For the subset of 92 children at a healthy weight at baseline, activity restriction was again significantly associated with overweight (RR, 2.51; 95% CI, 1.24-3.52) and obesity (RR, 6.14; 95% CI, 2.54-8.82) at follow-up. Exercise intolerance did not attain statistical significance.

Conclusions  Exercise intolerant and activity restricted children experienced larger increases in absolute BMI and BMI percentile than children with neither exercise intolerance nor activity restriction. Activity restriction was the strongest predictor of risk of overweight and obesity at follow-up. Elevated weight and obesity may cause these children significant additional health burdens. Therefore, when patients must be counseled against physical exertion, they also need to be educated about the importance of appropriate physical activity and good dietary practices.

Author Affiliations: Departments of Pediatrics (Drs Stefan and Smythe) and Community Health and Epidemiology (Ms Hopman), Queen’s University, and Clinical Research Centre, Kingston General Hospital (Ms Hopman), Kingston, Ontario.

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