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

Individuals with Fontan circulation (FC) often have diminished exercise capacity and are at risk for psychological problems. The current study examines associations between exercise capacity and psychological functioning in children and adolescents with FC. A multidisciplinary team evaluated participants in a clinic for pediatric patients with FC. Participants completed cardiopulmonary exercise testing (CPET). Parent and child were administered a psychological questionnaire (BASC-3) to measure child depression, anxiety, and inattention symptoms. Individuals who completed CPET with adequate effort and a psychological measure were eligible for inclusion. Clinical 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%). Parent-report of inattention was negatively correlated with 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 min for parent-report (R = .294, 95% CI .004/.538, P = 0.047) and 8 min for self-report (R = .410, 95% CI .122/.635, P = 0.007). Greater inattention may have negatively impacted CPET engagement, reflected in lower peak VO2. The more rapid decline from max HR to recovery for those with greater depression and anxiety symptoms was unexpected, perhaps explained by a reduction in anxiety state after exercise or possibly an age effect, as a blunted HR decline has been found in adult cardiac patients with depression/anxiety.