The spectrum of different heart defects and especially the severity of one and the same heart defect can be very variable. In addition, there are currently only guidelines for competitive sports for adults. Physical activities in the different age groups are very complex and different: they range from baby swimming, children's gymnastics, recreational sports to school sports and competitive sports.
Environmental conditions (heat, cold, wind) can also have a significant impact on the physical strain of sports. Accordingly, general guidelines and recommendations can only be offered as an orientation guide and in no way replace the individual consultation with the paediatric cardiologist.
A rough distinction is made between dynamic and static sports.
Dynamic movement involves repeated tensing and relaxing of the muscle with relatively low contraction force. An example of this would be running. In contrast to this, static strain - such as weight-lifting - involves a very high application of force with a significant increase in intramuscular pressure, usually together with a significant increase in blood pressure.
In general, dynamic strains are preferable to static ones.
Children with heart defects that can lead to syncope (rhythm disturbance, severe aortic valve stenosis) should not participate in sports where a short-term loss of consciousness poses a risk (e.g. swimming, climbing).
Furthermore, it may be necessary to introduce Marcoumar to thin the blood. In this case contact sports and sports with a high risk of injury should be avoided.
Contact sports should also be avoided in the case of implanted Pacemakers.
The risk of sudden cardiac death from congenital heart defects during sport is often overestimated by doctors.
A study from Norway reported that over a 15-year observation period, not a single child with a congenital heart defect died of sudden cardiac death as a result of Sport.
SPORT ist gesund - nicht nur für den Körper, sondern auch für die Seele! Es gibt zahlreiche Studien, die zeigen, dass Sport gerade bei Kindern nicht nur für die körperliche Entwicklung, sondern auch für die psychische, soziale und neuromotorische Entwicklung ganz wesentlich ist. Und Bewegungsmangel stellt außerdem neben Bluthochdruck, Blutzucker und Cholesterin ein erhebliches kardiovaskuläres Risiko dar.
Doch wie sieht das genau für Kinder mit einem Schrittmacher aus? Kinder mit Herzerkrankungen werden immer wieder aus den verschiedensten Gründen von körperlichen Belastungen und sportlichen Aktivitäten ganz oder teilweise ausgeschlossen. In einigen Fällen kann es natürlich berechtigte, medizinisch indizierte Beschränkungen geben – aber meistens entsteht das Sportverbot durch die Sorge: „Es könnte etwas passieren...“
Gleich vorweg: Das Risiko für Kindern mit einem Schrittmacher bei Sport ist extrem gering. Es gibt nur sehr wenige Fallbeispiele, bei denen es im Rahmen einer sportlichen Aktivität zu einer Beschädigung eines Schrittmachersystems gekommen ist. Dagegen ist der Schaden, der durch ein Sportverbot entsteht, um ein Wesentliches höher. Dennoch gibt es aber Aspekte, die man bei Kindern mit Schrittmacher beachten sollte.
Schrittmacherpatienten haben zumeist ein Problem mit dem Herzrhythmus. Das Herz schlägt zu langsam und braucht daher Unterstützung. Diese kann durch das Einsetzen eines Schrittmachers, der das Herz stimuliert gegeben werden. Außerdem sind Kabel, sogenannte Sonden, nötig, um den elektrischen Impuls vom Schrittmacher zum Herzen zu leiten. Durch Erschütterungen, starke Änderung des Umgebungsluftdruckes sowie mechanische Krafteinwirkungen kann die Funktionsweise des Schrittmachers bzw. der Sonden beeinflusst oder beeinträchtigt werden.
Starke Kraftmomente, die auf Sonden oder Schrittmachergeräte wirken, könnten diese verletzen. Somit liegt es auf der Hand, dass Sportarten, bei denen es zu einer starken Krafteinwirkung auf das Gerät oder die Sonden kommen könnte, zu vermeiden sind. Dazu zählen natürlich insbesondere Kontaktsportarten wie Karate, Judo, Boxen und Taekwondo-Do. Auch Mannschaftssportarten wie Rugby oder American Football sind aus diesen Gründen bedenklich. Im Allgemeinen sollten somit Sportarten mit hohem Verletzungsrisiko oder möglichem Sturz aus größerer Höhe vermieden werden (z.B. auch Reiten, Turmspringen) - ein Sprung ins Wasser von einem 1-3 m Brett ist natürlich bedenkenlos möglich.
Natürlich kann es auch bei Fußball, Basketball oder Handball zu heftigerem Körperkontakt kommen. Je älter das Kind, desto stärker kann die Krafteinwirkung sein. Werden diese Sportarten aber im Rahmen des üblichen Freizeit- oder Schulsportes ausgeübt, ist das Risiko sehr gering.
Beim Geräteturnen am Stufenbarren oder am Reck ist allerdings Vorsicht geboten. Beide Sportarten sollten vermieden werden.
Da große Änderungen des Umgebungsdruckes sich negativ auf die Schrittmacherfunktion auswirken könnten, sollte außerdem auf Flaschentauchen (vorallem ab einer Tiefe von mehr als 10m) verzichtet werden. Auch Höhenbergsteigen über 5000m wird als risikoreich angesehen. (Flugreisen, auch Überseeflüge sind bedenkenlos durchführbar!)
Bei all den aufgezählten Einschränkungen sollte man natürlich stets die individuelle Situation beurteilen. – Nicht alle Schrittmacherpatienten sind gleich: Bei Patienten die ohne Schrittmacher nicht auskommen, also jenen die „schrittmacherabhängig“ sind, sind die Empfehlungen strenger zu interpretieren, als bei Patienten, die auch ohne Schrittmacher leben können.
Die individuelle Beratung und Besprechung mit dem betreuenden Arzt ist hier unersetzlich. Ziel muss es immer sein, den eigenen individuell besten Weg in Abwägung zwischen Lebensqualität, sportlicher Ambition und Risiko in Rücksprache mit dem Kinderkardiologen zu finden.
Any sports teacher/coach who has a child with a congenital heart defect in their class must be aware of how much sporting activity can be expected of the child.
In general, children with a congenital heart defect are not as physically fit as other pupils of the same age. The sports teacher must clarify with the parents or the treating paediatric cardiologist how much exercise is appropriate for the child. The doctor can estimate which physical activities are appropriate and what is to be advised against.
It is also important that teachers know about the child's physical capabilities.
It is important that children with heart disease feel part of the class community despite their physical limitations. The teacher should therefore select activities that are suitable for them. Some of the things that are on the curriculum for physical education are really good for children with heart disease - not only for physical but also for social reasons. For example, coordination exercises, artistic expression or psychomotor exercises have an extremely positive effect. After an operation, the paediatric cardiologist will recommend certain physical exercises. These are just as important as the right medication and a certain diet, to help the child regain its strength quickly.
In the case of severe physical limitations, a child with heart disease can also be integrated into the lessons as an assistant to the teacher. The child should not feel excluded and instead should feel that he or she plays an important role in the class.
Running or jogging over a long period of time is not recommended for children with heart disease. Compared to their classmates, they have a lower physical performance and a reduced lung capacity.
Physical activity should be avoided at low temperatures, because the body heats up when running. If classes take place outdoors, they should be allowed to stay somewhere warm.
Many educators are worried that a child with a heart condition might faint during lessons. However, fainting is rare. Some children have a very low pulse rate, which increases the risk of fainting. If the child faints, he or she must be placed on the floor or seated, whichever is more comfortable.
Close communication between educators, parents and doctor is important, to ensure that everyone involved knows what to do in which particular situation.
If from a medical perspective no major sporting restriction is necessary, it is in principle possible to take part in the ski course or swim training.
In the case of heart defects that could lead to short-term loss of consciousness, swimming should only be allowed under appropriate supervision.
The general Austrian recommendation for physical activity for children states: "For children, physical activity should be about 60 minutes per day. In addition, muscle and bone strengthening training should be carried out about 3 times a day and, if possible, there should also be sport activities to improve coordination and mobility".
But how does that apply to children with congenital heart defects?
For parents, educators and doctors, sport for children with congenital heart defects raises a whole range of questions.
There are only a few studies that deal with the topic of sports in children with congenital heart defects. In general, however, these few studies show only positive effects on both the psychomotor development and the physical resilience of the children.
Unfortunately, children with heart diseases are very often wrongfully excluded from physical exertion, school sports and also from participation in various sports activities, either in whole or in part, for a variety of reasons.
In some cases there may of course be justifiable, medically advised restrictions - but even then it is especially important to point out that a ban on sport is not the same as a ban on exercise and therefore the same applies: "exercise is healthy".
In recent years, enough studies have been published which clearly show that in our highly industrialized world, in addition to the common diseases such as high blood pressure, blood sugar and cholesterol, lack of exercise has become the new "Killer No. 1". Lack of exercise represents a major cardiovascular risk. In addition, exercise and sport in children is also important for their psychological, social and neuro-motoric development.
It is a sad fact that our children get far too little exercise, and unfortunately this especially also applies to children with congenital heart defects.
To sum up, it should again be noted:
SPORT & EXERCISE are especially important for children with congenital heart defects. Unfortunately, often too little attention is paid to this topic in general. Questions regarding sports activities for children with congenital heart defects should always be discussed with their paediatric cardiologist.
Find your own way.
Try out different sports to find out which one you enjoy most. Some people like indoor sports more, others prefer outdoor sports.
Once you find that sports are good for you and you have found some sports that you like and that you feel comfortable with, you will enjoy them even more and can easily incorporate them into your everyday life.
(Source: Herzkinder & Sport, Senior Physician Dr. Christoph Prandstetter, Pediatric Heart Center Linz)
