# Physical activity and weight are important predictors of health related quality of life in adults with congenital heart disease

## TL;DR

Regular physical activity and weight are key factors in improving quality of life for adults with congenital heart disease.

## Contribution

Identifies physical activity and weight as the strongest predictors of health-related quality of life in adults with congenital heart disease.

## Key findings

- Physical activity for ≥3 hours per week is the strongest predictor of high health-related quality of life in adults with congenital heart disease.
- Patients with severe congenital heart disease show disproportionately improved quality of life with even minimal exercise.
- Underweight and obese patients are at higher risk for poor quality of life unless they exercise ≥3 hours per week.

## Abstract

Traditional cardiovascular risk factors put patients with congenital heart disease (CHD) at increased risk for acquired cardiovascular disease and mortality – more so than patients without CHD. In the general population, health related quality of life (HRQoL) is associated with regular physical activity. It was the aim of this study to evaluate the most important predictors of HRQoL in adults with CHD (ACHD).

This is a registry study using single center data collected between 2004 and 2022. Data include demographic data such as age and sex, body mass index (BMI) type of CHD, prior surgeries, physical activity and HRQoL using the EQ-5D-3L questionnaire. CHD severity was classified based on European Society of Cardiology (ESC) criteria. The cohort was divided based on self-reported levels of physical activity.

A total of 2469 patients were included in this study. 878 (25.6 %) patients had mild, 1151 (46.9 %) moderate and 329 (13.3 %) severe CHD. Patients with severe CHD had a lower BMI, HRQoL and were less physically active than those with mild-moderate CHD. Conversely, patients who were not doing regular exercise were significantly older, were more likely to be female, had a higher BMI, and had a lower HRQoL than their physically active peers. In a logistic regression model, physical activity was the most important predictor of a perfect HRQoL score in all five domains, especially if performed for ≥3 h/week (Odds ratios (OR) 2.1–7.5, all p < 0.001). In patients with severe CHD, HRQoL was disproportionately increased with even little exercise. Other important predictors of perfect HRQoL were younger age (OR 0.99, p < 0.001), male sex (OR 1.58, p < 0.001), mild-moderate CHD (OR 1.59, p < 0.001) and being of normal/overweight (OR 1.44, p < 0.001). Patients with underweight or obesity had a higher HRQoL only if execrising ≥3 h/week.

Regular physical activity in ACHD patients is associated with better HRQoL. Patients with underweight and obesity alike are also at risk for impaired HRQoL. We suggest that ACHD follow-up visits should include counseling on life-style issues in order to enhance HRQoL and minimize modifiable risk factors for acquired cardiovascular disease.

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•Physical activity is the most important predictor of a perfect HRQoL score in adults with CHD.•In patients severe CHD, HRQoL is disproportionately increased with only some physical, i.e. <3 h/week.•Adult CHD patients with underweight and obesity alike are at increased risk for impaired HRQoL. Execrising ≥3 h/week is associated with HRQoL only in this cohort.•Non-modifiable predictors of HRQoL are younger age, male sex, and mild-moderate CHD.

Physical activity is the most important predictor of a perfect HRQoL score in adults with CHD.

In patients severe CHD, HRQoL is disproportionately increased with only some physical, i.e. <3 h/week.

Adult CHD patients with underweight and obesity alike are at increased risk for impaired HRQoL. Execrising ≥3 h/week is associated with HRQoL only in this cohort.

Non-modifiable predictors of HRQoL are younger age, male sex, and mild-moderate CHD.