237 - CPCA WORKSHOP - APPROACH TO EXERCISE PRESCRIPTIONS AND INTERVENTIONS IN CHILDREN WITH CONGENITAL AND ACQUIRED HEART DISEASE

Saturday, October 29, 2022

4:30 PM – 5:30 PM EDT

Location: Room 215

Target Audience: Pediatric cardiologists, Echocardiologists, Trainee (clinical)

Co-Chair(s)

Michael Khoury, MD FRCPC

Assistant Professor, Pediatric Cardiology, Department of Pediatrics
Canadian Pediatric Cardiology Association
University of Alberta
Edmonton, Alberta, Canada
LM

Luc Mertens, MD

Section Head, Echocardiography
CCS,CPCA
University of Toronto
Toronto, Ontario, Canada
Carolina Escudero

Pediatric Cardiologist and Electrophysiologist
Stollery Children's Hospital
University of Alberta
Edmonton, Alberta, Canada

Presenter(s)

Patricia Longmuir (she/her/hers)

Senior Scientist and Professor
Children's Hospital of Eastern Ontario Research Institute
University of Ottawa
Ottawa, Ontario, Canada
Barbara Cifra, MD (she/her/hers)

Staff Physician
The Hospital for Sick Children
University of Toronto
Toronto, Ontario, Canada

Planning Committee Member(s)

AJ

Alexandra Jevremovic

Pediatric Cardiologist
Markham, Ontario, Canada

Learning Objectives:

At the conclusion of this session, participants will be able to:

know the indications, contraindications for cardiopulmonary exercise testing and the advantages and disadvantages of treadmill vs. cycle ergometer testing;
interpret cardiopulmonary exercise tests in a systematic fashion;
state the indications and contraindications and the rationale for exercise echocardiography in pediatric patients with congenital or acquired heart disease;
promote or restrict competitive and recreational physical activity in pediatric cardiac patients in an evidence-based manner, with a knowledge of existing evidence/knowledge gaps; and
organize an approach to exercise prescription generation for pediatric patients of various ages and with various forms of congenital or acquired heart disease.

The care of children with congenital and acquired heart disease is typically informed in large part by investigations performed when children are at rest, including electrocardiography, echocardiography, MRI, and hemodynamic assessments. These investigations, however, do not reflect the dynamic state children exist in on a daily basis. Cardiopulmonary exercise testing (CPET), unfortunately, remains an under-utilized tool, despite its utility in evaluating important measures including exercise safety at sub-maximal and maximal exertion, exercise capacity, and ventilatory efficiency. Exercise echo has the added advantage of providing key insights regarding children with lesions who may have adverse and dynamic anatomic and physiologic responses to exercise, including those with hypertrophic cardiomyopathy, for example. Thus, tests such as CPET and exercise echo provide key data that help inform the generation of exercise prescriptions, and, when needed, exercise restrictions. These tests can also serve as a baseline assessment to evaluate cardiorespiratory responses to exercise interventions. Finally, exercise capacity serves as a useful prognostic tool, allowing for the identification of at-risk children who would otherwise be difficult to identify when in a rested state.

This workshop proposal is at the request of the Canadian Pediatric Cardiology Association Educational Committee, as the topic of exercise testing and recommendations in children with cardiac disease has been identified as a high yield topic. In this workshop, we aim to address the following topics:

The rationale, indications, and contraindications for both CPET and exercise echo in children with congenital and acquired heart disease will be provided.
A systematic approach to CPET interpretation will be provided, with a focus on both the electrocardiographic interpretation and assessment of the cardiorespiratory measures.
The evidence basis surrounding exercise restriction in children with various forms of heart disease will be reviewed and the rationale for a shift towards exercise promotion in most circumstances will be highlighted. To this end, the utility of CPET and exercise echo to help inform recommendations will be reviewed.
Participants will be provided with an approach to the generation of exercise prescriptions that can be adapted to children of various ages and with various forms of heart disease.

This interactive workshop will provide tools and resources to help facilitate increased utilization of CPET, exercise echocardiography, and exercise prescription in their routine clinical practice.