Health in every movement: Interview with Per Morten Fredriksen

Per Morten Fredriksen (© Unni Grevstad/FFHB)

Physical activity is good for you, all year round. This statement is also true for children and adolescents with congenital heart defects. Daily exercise provides both physical and mental-health benefits. And don't forget that exercise makes your heart stronger as well!

"Most children with heart defects can participate in some form of athletic or physical activity,” explains Dr Per Morten Fredriksen, a physical therapist and researcher in the Physical Therapy Department at the University Hospital Oslo. “There is no reason why these children should be overprotected or shielded. Arrangements need to be made for each individual patient."

Important for motor skills

Fredriksen specialises in physical activity for children and adolescents with congenital heart defects. "Active children are often popular children, which is one reason why getting children with heart problems fit and active is so important,” he says. “We know that children with congenital heart defects are 18 times more likely to have motor-skill difficulties than healthy children – irrespective of the type of heart defect they have. Motor skills are greatly affected by whether or not a person is physically active. Since the human body is built to move about, insufficient exercise affects us both physically and mentally. Inactive children not only miss out on the physical aspects of sport, but they also miss out on the social aspects that are incredibly important when growing up."

Something is better than nothing

He urges children and adolescents with congenital heart defects to be as fit as they possibly can be. “Everyone is able do something,” he says. “And any type of physical activity is better than none at all. We are not talking about top athletic performances, just about being as fit as you can manage to be. Exercise also provides so many benefits for your heart. The type of athletic activity that is good for each individual depends on the type of heart defect that they have. There are some activities that are very good for specific individuals but directly harmful for others. The choices have to be considered in context with the heart defect. For example, doing an exercise that involves a lot of shaking movements is not advisable if you have arrhythmias. The most important thing is, however, that the child or adolescent finds something that he or she enjoys."

Health benefits

Fredriksen has established that getting enough physical activity is important for children in terms of developing their motor skills, strength, self-esteem and sense of accomplishment. Physical activity is often a means of social interaction with other children. Daily physical activity can yield health benefits and reduce mortality attributable to cardiovascular disorders.
"Exercise offers just the same health benefits and positive effects for people with heart disease as it does for those who are healthy,” he says. “Today, children and adolescents with congenital heart defects have better prospects of growing up and reaching an age at which they have the same risk of developing cardiovascular disorders as healthy individuals do. An acquired heart disorder in addition to a congenital one is hardly desirable, which is why we need to monitor the amount of activity that children and adolescents with heart disease do to establish whether to increase that amount and thus increase the health benefits."

Large variations

Fredriksen stresses that no two heart defects are the same and that there are many variations – from defects that are minor and fairly insignificant, to those that are much more serious. "Some defects obviously need to be given more attention than others do,” he says. “Because of the large variation in the types of heart defects and the symptoms that such defects can entail for children, general guidelines for exercise are difficult to set up. As a general rule, children with congenital heart defects need to warm up longer than healthy individuals do; patients with stenosis should avoid strength training, and those with cyanosis should identify the intensity level themselves."

The test

Fredriksen has studied physical performance capacity, activity levels, and many other factors in patients. He has used walking tests, treadmills, ergometer cycles, questionnaires and monitors to measure heart rate. “One of the things I have tried to measure is how much the patient can manage over time,” says Fredriksen. “Those being tested had to keep exercising until they could do no more, which took a lot longer than their mothers or fathers wanted and longer than the children themselves wanted. They continued right until they were so tired that they had nothing left.

“As expected, the comparison between individuals with various heart disease diagnoses and healthy individuals showed that the patients with heart disease had lower physical performance capacities; however, their results were surprisingly good in view of the serious diagnoses that some of the children had. The findings suggest that healthy boys are more active than both girls and boys with congenital heart defects are. But, healthy girls are not more active than girls with heart disease are.”

Everything has an effect

A prospective exercise study highlighted the effects of exercise on children and adolescents with congenital heart defects. The findings suggest that patients with various diagnoses can comfortably engage in physical exercise and it produces many positive effects. "In Norway, we are raised with physical activity being a healthy thing, and children and adolescents with congenital heart defects are far more active than children with similar diagnoses in other countries are,” says Fredriksen. “Generally, the children who we tested exclusively had complicated heart defects – i.e. they represented a select sample of patients with the most severe disease – but they too benefited from some form of physical activity every day.”

Making exercise part of the daily routine

Parents, the health-care system, teachers and patients are unsure about how much exercise people with congenital heart defects can do. Important factors include training methods, intensity, the effects of the exercise and, most importantly, safety.

"Patients with congenital heart defects can engage in physical activity, and most will benefit from it,” says Fredriksen. “Present guidelines in this area are unclear, and parents are mainly left to decide for themselves. The best solution would be a cooperative relationship between parents, physical therapists, schools, athletic teams, and health-care personnel. Incorporating exercise into the daily routine is also a very important factor in the physical performance capacity of children and adolescents with congenital heart defects."

Surgical techniques and medical treatments have improved over the past 15 to 20 years, and an increasing proportion of patients with heart defects are living to adulthood. Today there are about twice as many adults aged 16 to 62 years who are living with congenital heart defects than there are children with such conditions. The exact total number is not known, but estimates suggest that there are 7,000 to 8,000 such children and adolescents and around 14,000 such adults in Norway.

"More and more people are living with congenital heart defects. The challenge now is to follow them into adulthood. Physical activity and exercise increase their prospects for a good life as adults,” concludes Fredriksen.