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Aortic stiffness is an important marker of cardiovascular risk and is elevated in children and adolescents with congenital heart disease (CHD) compared with healthy children; however, in children with CHD, little is known about the interaction between aortic stiffness and physical activity—a key determinant of aortic stiffness.

AbstractIntroduction:Failure of the Fontan circulation is not a well-understood clinical phenomena.For some patients, a gradual increase in pulmonary vascular resistance (PVR) and structural changes in the pulmonary artery may be an important causative factor. To further investigate this issue, we employed optical coherence tomography (OCT) to evaluate structural changes within the pulmonary arteries of Fontan patients and compared to those with a normal pulmonary circulation.Materials and Methods:Pulmonary artery OCT was performed, without complications, in 12 Fontan and 11 control patients. Wall thickness and wall:vessel cross-sectional area (CSA) ratio were calculated after image acquisition, using digital planimetry.Results:There was no difference in wall thickness between both groups. Median wall thickness for Fontan patients was 0.12 mm (IQR, 0.10–0.14) and for controls was 0.11 mm (IQR, 0.10–0.12; p = 0.62). Wall:vessel CSA ratio for Fontan patients was 0.13 (IQR, 0.12–0.16) and for controls was 0.13 (IQR, 0.11–0.15) (p = 0.73). There was no association between wall thickness and ventricle morphology, age at catheterisation, age at Fontan, years since Fontan completion, pulmonary artery pressure, and PVR. The vessel media was more readily visualised in control patients.Discussion:OCT of the pulmonary arteries in Fontan patients is safe and feasible. Our OCT findings suggest that during childhood, pulmonary artery wall dimensions are normal in Fontan children with reassuring hemodynamics. Further evaluation of Fontan patients with abnormal hemodynamics and serial evaluation into adulthood are required to conclude on the utility of OCT for identifying early pulmonary artery structural changes.

ObjectiveConduct a meta-analysis to determine the impact of traumatic spinal cord injury (SCI) on echocardiographic measurements of left ventricular (LV) structure and function.MethodsMEDLINE and Embase were used for primary searches of studies reporting LV echocardiographic data in individuals with SCI. Of 378 unique citations, 36 relevant full-text articles were retrieved, and data from 27 studies were extracted for meta-analyses. Literature searches, article screening and data extraction were completed by two independent reviewers and compared for agreement. Primary analyses compared echocardiographic indices between individuals with SCI and able-bodied individuals, using a random effects model.ResultsData are reported as pooled effect estimates (95% CI). Data from 22 articles (474 participants) were included in the primary meta-analysis. Compared with able-bodied individuals, individuals with SCI had reductions to LV stroke volume of 11.8 mL (95% CI −17.8 to −5.9, p<0.001), end-diastolic volume of 19.6 mL (95% CI −27.2 to −11.9, p<0.001) and LV massindexof −7.7 g/m2(95% CI −11.6 to −3.8, p<0.001), but ejection fraction was not different between the groups (95% CI −2.6% to 0.6%, p=0.236). Individuals with SCI also had altered indices of diastolic function, specifically a lowered ratio of early-to-late filling velocities (p=0.039), and augmented ratio of early diastolic flow-to-tissue velocities (p=0.021).ConclusionsIndividuals with SCI have smaller LV volumes and mass, and altered systolic and diastolic function. While this meta-analysis demonstrates important alterations to echocardiographic measures of cardiac structure and function at rest, future work should consider the impacts of SCI on the heart’s capacity or ‘reserve’ to respond to physiological challenges.PROSPERO registration numberCRD42017072333.

Pediatric heart transplant recipients are at risk of posttransplant coronary artery disease known as cardiac allograft vasculopathy (CAV), and also may develop diastolic dysfunction. As CAV begins with a process of progressive intimal thickening, these occult diffuse changes may be detected using optical coherence tomography (OCT). We hypothesized that the development of CAV, as identified via OCT, may be a mechanism of declining ventricular function. Accordingly, the purpose of this study was to assess coronary artery intimal thickening and LV strain in children who have undergone heart transplantation. In 17 children, we analyzed OCT images for coronary intima and media thickness, and cross‐sectional area (CSA). We also performed speckle tracking imaging (STI) of the LV to determine longitudinal strain and strain rate, in addition to standard echocardiographic measures. Longitudinal diastolic strain rate was associated with maximum intima thickness (r =−.497, P =.042), intima CSA, (r =−.489, P =.047), maximum media thickness (r =−.503, P =.039), and media CSA (r =−.614, P =.009). The intima maximum thickness, intima/media, and intima/lumen ratios were associated with stroke volume index (Std. β = −0.487, P =.023 and Std. β = −0.488, P =.022, respectively). These findings suggest coronary artery intimal thickening may be mechanistically linked to changes in ventricular function following cardiac transplantation.

Individuals with congenital heart disease (CHD) may be at higher risk of acquired cardiovascular disease than the general population due to their underlying physiology and/or surgical sequelae. We sought to assess the prevalence of cardiovascular disease risk factors in youth and adults with CHD. We assessed cardiovascular health as per the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) health index in patients with CHD aged 15+ years who attended cardiology outpatient clinics. Participants self‐reported smoking behavior, fruit and vegetable consumption, physical activity, and whether they had diabetes and hypertension. Individual health indices were categorized into ideal/not ideal, and sum of individual health indices was categorized as poor, intermediate or ideal cardiovascular health as per CANHEART criteria. We included n = 102 adults (35.4 ± 12.9 years, 46% female) and n = 88 youth (17.2 ±1.1 years, 41% female). Most individuals reported to be nonsmokers (88% youth vs 86% adults) and to consume ≥5 servings of fruit and vegetables per day (83% vs 85%, respectively). More adults than youth were overweight/obese (52% vs 22%, p < 0.001) though more adults than youth reported meeting age‐specific physical activity guidelines (84% vs 55%, p < 0.001). According to CANHEART health index criteria, 32% of youth and 27% of adults were in ideal cardiovascular health. A low proportion of individuals with CHD are in ideal cardiovascular health, suggesting a need to promote healthy lifestyles during adolescence and throughout adulthood in these individuals.

Increasing physical activity levels is a high priority to optimize long-term health in children with congenital heart disease (CHD). Commercial activity trackers have been validated in adults and are increasingly used to measure and promote physical activity in pediatric populations, but they have not been validated in children.

Physical activity is strongly correlated with children's health, and increasing rates of active school travel (AST) among children may well enhance their overall physical activity levels. Neighbourhood type may influence children's school travel modes; however, few qualitative studies have examined children's experiences of school travel across neighbourhood types. This paper explores urban and suburban children's experiences with AST and outlines perceived barriers and facilitators.

Significant advances in the management of children with congenital heart disease (CHD) have resulted in marked improvements in survival and life expectancy. Thus, there is an increased emphasis on promoting physical activity to optimise healthy development and long-term cardiovascular health. Evaluation of physical activity levels as part of ongoing clinical care is recommended to facilitate physical activity counselling and/or exercise prescription. Physical activity is a complex health behaviour that is challenging to evaluate. We provide an overview of techniques for measuring physical activity in children with CHD with a focus on how to do this in the clinical context. Accelerometers are devices that objectively assess intensity and duration of physical activity under free living conditions. They enable evaluation against physical activity guidelines, but are costly and require advanced technical expertise. Pedometers are a simple-to-use and cost-effective alternative, but an outcome metric of daily step count limits classification against guidelines. Commercial wearable activity trackers offer an appealing user experience and can provide valid estimates in children. Furthermore, activity trackers enable remote monitoring of physical activity levels, which may facilitate exercise prescription and activity counselling. Questionnaires are the most cost-effective and time-effective method, but recall error in younger children is a consideration. Routine exercise testing in children with CHD provides important insight into functional status but should not be viewed as a proxy measure of habitual physical activity. Understanding the spectrum and role of physical activity measurement tools is important for clinicians focused on optimising cardiovascular health in children with CHD.

Emerging evidence shows that public transit use is associated with greater physical activity levels in adults through higher levels of transportation-related walking. However, little is known about the health benefits of public transit use in older adults.

Active travel to school is a potential source of physical activity for adolescents, but its assessments often rely on assumptions around travel patterns. Global positioning system (GPS) and accelerometry provide an objective assessment of physical activity from school-travel and the context in which it occurs (where, when, how long).

OBJECTIVES:Cross-cultural comparisons in children’s body composition, health-related fitness and physical activity (PA) are rare due to a shortage of comparable data, but such comparisons may help avert worrying global prevalence in childhood obesity, and declining fitness and PA. METHODS:We drew samples of Canadian and English children (10 years, n=1630, 50% boys) and adolescents (15 years, n=1406, 56% boys) from three separate, regional studies that conducted comparable school-based assessments (2006-2011). For each age-sex group, we assessed betweencountry differences for body composition (mass, height, BMI, waist circumference), cardiorespiratory fitness (CRF; 20 m shuttle run test), strength (handgrip) and self-reported PA. We used multiple regression to investigate whether between-country differences in fitness were explained by body composition and PA. RESULTS:At any age, Canadian boys and girls were taller, heavier, and had greater BMIs and waist circumferences. English children had higher CRF than Canadians, which was explained by differences in body composition and PA. Canadian children were significantly stronger, partly due to greater body size. There were no between-country differences in adolescent boys. Canadian adolescent girls reported more PA than their English counterparts, but neither PA nor body size explained why Canadian adolescent girls had greater CRF or strength. CONCLUSION:Future cross-cultural studies of PA should include indices of growth and fitness to better understand the relationship between intricate differences in PA and health outcomes. OBJECTIFS :Rares sont les comparaisons interculturelles de la composition corporelle des enfants, de leur forme physique liée à la santé et de leur activité physique en raison du manque de données comparables, mais de telles comparaisons peuvent aider à éviter la menace de la prévalence mondiale inquiétante de l’obésité juvénile, ainsi que le déclin de la forme physique et de l’activité physique. MÉTHODE :Nous avons extrait des échantillons d’enfants (10 ans, n=1 630, 50 % de garçons) et d’adolescents (15 ans, n=1 406, 56 % de garçons) canadiens et anglais de trois études régionales distinctes ayant mené des évaluations en milieu scolaire comparables (2006-2011). Pour chaque groupe d’âge et de sexe, nous avons évalué les différences entre les deux pays pour ce qui est de la composition corporelle (masse, taille, IMC, périmètre ombilical), de la capacité cardiorespiratoire (CCR; course navette sur 20 mètres), de la force (poigne) et de l’activité physique autodéclarée. Par régression multiple, nous avons cherché à déterminer si les différences entre les deux pays au chapitre de la forme physique s’expliquaient par la composition corporelle et l’activité physique. RÉSULTATS :À tout âge, les garçons et les filles canadiens étaient plus grands, plus lourds, et avaient un IMC et un périmètre ombilical plus élevés. Les enfants anglais avaient une CCR supérieure à celle des Canadiens, ce qui s’expliquait par les différences dans leur composition corporelle et leur activité physique. Les enfants canadiens étaient significativement plus forts, en partie en raison de leur plus grande corpulence. Il n’y avait pas de différences entre les garçons adolescents des deux pays. Chez les filles, les adolescentes canadiennes ont déclaré faire davantage d’activité physique que les Anglaises, mais ni l’activité physique, ni la corpulence n’expliquaient pourquoi les adolescentes canadiennes avaient une CCR ou une force supérieures. CONCLUSION :Les futures études interculturelles de l’activité physique devraient inclure des indices de croissance et de forme physique pour que l’on comprenne mieux le lien entre les différences subtiles des niveaux d’activité physique et les résultats sanitaires.

Introduction:Children with congenital heart disease (CHD) report lower quality of life (QoL) than healthy children. These patients have increased risk of health complications and cognitive deficits. Executive function - higher order cognitive skills needed for planning, organization and flexibility - can be impaired in children with CHD. QoL has been linked to executive function, physical activity, body mass index (BMI) and parental education. This study investigates which personal and behavioural factors are associated with QoL in children with CHD.Hypothesis:We hypothesized that higher levels of physical activity and executive function would be associated with higher QoL in children with CHD.Methods:We recruited participants during routine CHD follow up. Participants? parents rated their child?s QoL (PedsQL) and perceived executive function (Behaviour Rating Inventory of Executive Function [BRIEF]). Seven days of accelerometry objectively measured participants? moderate to vigorous physical activity (MVPA). Multiple linear regression was conducted to assess potential predictors (BRIEF general composite score, mean daily minutes of MVPA, age, sex, BMI percentile and highest level of parental education) of QoL in children with CHD.Results:Forty-three participants (27 male) completed all measures. Participants? mean age was 9.2 ? 2.8 years. All participants had moderate or complex CHD. Mean parent-rated QoL was 74.8 ? 14.9 out of 100. Mean BRIEF general composite score (higher indicates worse executive function) was 52.5 ? 10.1, which was not significantly different from the norm. MVPA varied considerably (mean: 57.3 ? 25.6 min/day, range: 12.5-128.5). Mean BMI percentile was 52.1 ? 32.7. The best model (R2= 0.29) included the BRIEF general composite score (? = -0.67, p = 0.001) and age (? = 1.44, p = 0.047). The remaining explanatory variables were not significantly related and did not explain any additional variance.Conclusions:QoL is associated with age and executive function, but not other factors in children with CHD. Executive function interventions could improve QoL in this population. The positive association of age with QoL may be due to increased time since early childhood interventions for CHD or changing parental perceptions.

Previous studies of forest-dwelling bats have identified physical features of trees and forests that correlate with the presence of bats by comparing roost sites to paired, randomly selected sites. This method may be limited if the absence of bats from random sites cannot be confirmed. Our purpose was to address roosting ecology of female big brown bats (Eptesicus fuscus) using a different approach. We quantified relative use of trees with 3 different types of cavity openings (long crevices, multiple holes, or single holes) and compared the relative use of these potential roosts to the availability of each roost type in the study area. Bats used trees with multiple holes and crevices significantly more often than expected based on their availability and trees with single holes less often than expected. Crevice roosts had significantly larger cavities than did single holes and roosting-group size was positively correlated with cavity volume. No relationship was found between cavity volume and tree height or stem diameter of roost trees, 2 variables that have been reported to correlate with roost selection in other studies of forest bats. Examination of our data suggests that the volume of roost cavities may be an important selection criterion for colonial, forest-living bats and that standard interpretations of the roost versus random-tree approach may not accurately identify patterns of roost selection in some systems.