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Sport in school & leisure time

Mein Kind hat einen angeborenen Herzfehler – darf es überhaupt Sport betreiben?

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Das Spektrum der unterschiedlichen Herzfehler sowie insbesondere der Schweregrad ein und desselben Herzfehlers kann sehr variabel sein. Außerdem existieren derzeit eigentlich nur Richtlinien für Leistungssport bei Erwachsenen. Körperliche Aktivitäten in den verschiedenen Altersgruppen sind sehr vielschichtig und unterschiedlich: Sie reichen vom Babyschwimmen, Kinderturnen, Freizeitsport über Schulsport bis hin zum leistungsorientierten Wettkampfsport.

Auch Umweltbedingungen (Hitze, Kälte, Wind) können die körperliche Belastung bei Sport deutlich beeinflussen. Dementsprechend können allgemeine Richtlinien & Empfehlungen nur als Orientierungshilfe angeboten werden und ersetzen auf keinen Fall das individuelle Beratungsgespräch beim behandelnden Kinderkardiologen.

In general one can say:

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  • In the case of completely corrected heart defects, corrected heart defects with only minor residual findings (at the earliest 3 - 6 months postoperatively), or in the case of primarily only minor abnormalities - deviating from normal findings - not requiring surgery, sport is possible without restrictions.
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  • In cases of severe restrictions of ventricular function, severe valve narrowing or valve leakage, no major strain/stress should be applied.
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  • In the case of findings requiring re-operation, uncorrectable severe heart disease, or severe pulmonary hypertension, only little or no exercise should be attempted.
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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.

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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.

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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.

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Physical education at school

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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.

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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.

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Sport in your leisure time

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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.

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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.

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