Associations Between Exercise Capacity and Psychological Functioning in Children and Adolescents with Fontan Circulation

Abstract

AbstractBackgroundPediatric patients with Fontan circulation (FC) often have diminished exercise capacity. They are also at risk for psychological problems, including anxiety, depression, and inattention. The current study examines associations between exercise capacity and psychological functioning in a clinical sample of pediatric patients with FC.MethodsA multidisciplinary team evaluated participants in a dedicated clinic for pediatric patients with FC. Patients completed cardiopulmonary exercise testing (CPET); metrics selected for analyses included peak oxygen consumption (VO2), maximum achieved heart rate (HR), oxygen saturation at peak exercise, ventilatory anaerobic threshold, work rate, respiratory exchange ratio, and HR recovery at 1-, 3-, and 8-minutes after exercise. Parent and child were administered a standardized questionnaire to measure depression, anxiety, and inattention symptoms. Patients who completed CPET with adequate effort and a psychological measure were eligible for inclusion. Clinical data were extracted from medical records and analyzed using Pearson correlations.ResultsClinical sample (n = 51) was 55% male with a mean age of 13.6 years (SD=2.5). A majority had hypoplastic left heart syndrome (51%). There was a significant negative correlation between parent-report of inattention and peak VO2 (R= -.307, 95% CI -.549/-.018,P= 0.038). Self-report of anxiety was positively correlated with HR recovery at 3 (R= .438, 95% CI .155/.655,P= 0.004) and 8 (R= .432, 95% CI .147/.651,P= 0.004) minutes post exercise. Depression was positively correlated with HR recovery at 3 minutes for parent report (R= .294, 95% CI .004/.538,P= 0.047) and 8 minutes for self-report (R= .410, 95% CI .122/.635,P= 0.007).ConclusionsInattention, depression, and anxiety symptoms were correlated with some CPET metrics in our clinical sample of pediatric patients with FC. Greater inattention symptoms were associated with lower peak VO2. Those with greater depression and anxiety symptoms showed a more rapid decline from max HR to recovery period.What is KnownMany patients with Fontan circulation (FC) have some degree of diminished exercise capacity.The risk for mental health problems in pediatric patients with FC is very high, with an estimated lifetime prevalence of 65%.What the Study AddsThere may be a link between mental health symptoms and exercise capacity metrics obtained during CPET for children and adolescents with FC.Our study found that greater inattention symptoms were linked to lower observed peak VO2 during CPET.Participants with higher levels of depression and anxiety symptoms exhibited a more dramatic decline in HR after exercise, contrary to findings in other cardiac patient samples that report an attenuated HR response for those with depression and anxiety.