Understanding the physical literacy development of 8- to 12-year-old children living with chronic medical conditions: A comprehensive, mixed methods inquiry.

BACKGROUND: Physical literacy is a concept used to describe the combined physical, affective and cognitive capacities facilitating an active lifestyle. Physical activity participation is essential for children living with chronic medical conditions, but knowledge of physical literacy among this group is scarce. METHODS: An explanatory, sequential mixed methods design was used to comprehensively describe the physical literacies of children with chronic medical conditions (CMCs). Participants were recruited from paediatric cardiology, respirology/cystic fibrosis, neurology, haematology and endocrinology outpatient clinics. All participants completed the Canadian Assessment of Physical Literacy (2nd Edition), and those with higher and lower scores were invited to a semi-structured interview. A deductive-inductive thematic analysis was applied using Margaret Whitehead's conceptualization of physical literacy. RESULTS: Using normative strata, 80.0% of the 99 children assessed (mean age = 9.97 ± 1.3 years, 48% girls) were considered beginning or progressing in their overall physical literacy (mean score = 56.5 ± 13.8/100). Meanwhile, physical literacy informed participants' approach to new, active experiences and may have contributed to a strong sense of self. There was a significant difference between endocrinology and haematology patients on total physical literacy score (p = 0.03) but not domain scores. Participants scored high on motivation/confidence (mean = 22.9 ± 5.0/30) but obtained low physical competence (mean = 11.8 ± 5.6/30) and daily behaviour scores (n = 72, mean = 15.5 ± 7.1/30). Main themes represent salient experiences of children with CMCs within the domains of physical literacy, including their need to evaluate active contexts, self-regulate activity intensity and manage physical limitations. CONCLUSIONS: Children with CMCs can achieve recommended levels of physical literacy without meeting normative standards for physical competence. Participants would benefit from a physical literacy intervention that targets the development of bodily self-regulation skills and risk evaluation in active settings.

"I really like playing games together": Understanding what influences children with congenital heart disease to participate in physical activity.

BACKGROUND: Participation in physical activity is essential to the long-term health and development of all children. However, children living with cardiac conditions are typically not active enough to sustain positive health outcomes. Understanding the experiences of children living with congenital heart disease in community-based settings could help inform the physical activity counselling practices of clinicians. The current study explored the perceptions of 7- to 10-year-old children with moderate or complex congenital heart disease as they participated in a 10-week multisport programme. METHODS: Detailed field notes recorded the discussions and behaviours of 11 participants (45% female participants) each week during the programme sessions. Among those, four participants (50% female participants) were purposively selected to participate in preprogramme and postprogramme focus groups to gather more detailed accounts of their experiences. RESULTS: Four main themes surrounding physical activity were identified: (a) motivation, (b) self-efficacy, (c) peer influences, and (d) family influences. Although feelings of excitement and enjoyment towards physical activity were prevalent throughout the data ("I'm really excited … because I really like those sports"), participants also often felt frustrated, nervous, and fatigued ("I'm not very good at the skills"). Social inclusion with peers and family influences were meaningful reasons to engage in physical activity ("I really like playing games together"). Following the completion of the programme, participants emphasized their enjoyment of physical activity as a primary source of motivation, demonstrating an important shift from recognizing positive health outcomes ( "… it's good for you") towards more intrinsic sources of motivation ("… because it's fun"). CONCLUSION: Opportunities for physical activity that enhance positive experiences and build intrinsic motivation should be identified and promoted to children with congenital heart disease. Community-based programmes may also be an appropriate context for children with cardiac conditions to engage and maintain participation in physical activity through adolescence.

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility.

OBJECTIVE: Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration. METHOD: The target population was outpatients 6-17 years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records. RESULTS: Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system. CONCLUSIONS: Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

Pedometer Efficacy for Clinical Care in Pediatric Cardiology.

BACKGROUND: Physical activity is essential to the long-term health of children living with cardiac disease. The simplicity and cost of pedometers make them an attractive alternative to accelerometers for monitoring the physical activity behaviors of these children. This study compared measures obtained from commercial-grade pedometers and accelerometers. METHODS: Pediatric cardiology outpatients (n = 41, mean age = 8.4 [3.7] y, 61% female) wore a pedometer and accelerometer daily for 1 week. Step counts and minutes of moderate to vigorous physical activity were compared between devices, accounting for age group, sex, and diagnostic severity, using univariate analysis of variance. RESULTS: While pedometer data were significantly correlated with accelerometers (r > .74, P < .001), measurements obtained were significantly different between devices. Overall, pedometers overestimated physical activity data. The overestimation of moderate to vigorous physical activity was significantly less among adolescents than younger age groups (P < .01, ηp2=.38). For step counts, there was a significant age by sex interaction observed where preschool and adolescent males tended to have greater differences between accelerometer and step count data than females (P < .01, ηp2=.33). Differences between devices were not associated with severity of diagnosis. CONCLUSIONS: The distribution of pedometers in a pediatric outpatient clinic was feasible, yet the data collected significantly overestimated physical activity, especially among younger children. Practitioners who want to introduce objective measurements as part of their physical activity counseling practice should use pedometers to monitor individual changes in physical activity and consider patient age before administering these devices for clinical care.

"Like Any Other Camp": Experiences and lessons learned from an integrated day camp for children with heart disease.

PURPOSE: Summer camps for children living with heart disease can have a profound impact on well-being. However, specialized camps often require extensive resources (i.e., 24-h medical staff supervision) and may be located in far remote settings. Integrating children with heart disease into mainstream day camps may address these barriers. The purpose of this study is to describe the experience of attending an integrated day camp from the perspectives of children with heart disease and their parents. DESIGN AND METHODS: This study used a qualitative descriptive design. Among 25 eligible families, 9 participated in interviews which were held 3 months to 2 years after attending an integrated camp (mean age of children at camp was 7.3 ± 2.25 years). Interviews were audio-recorded and transcribed verbatim for an inductive thematic analysis. RESULTS: Many parents chose the integrated camp as their child's first summer camp experience, citing trust in the local division of Cardiology's approval of the camp activities as an important reason for enrolling. All participants agreed the integrated camp was a valued opportunity which should continue, although not all described positive camp experiences. Participants' descriptions of the integrated camp were organized into two main themes: 1) overall expectations of the camp and 2) important opportunities afforded by the camp experience. Partaking in a typical camp experience, connecting to local children with heart disease, adequate safety precautions and activity adaptations were specific expectations held by participants. Important opportunities included greater independence and confidence, navigating disclosure of their diagnosis to peers on their own terms, and more diverse social connections. Improving communication with parents to ensure expectations match camp objectives would have enhanced the experience. PRACTICE IMPLICATIONS: Practitioners looking for an alternative to specialized camps for their patients with heart disease may use these results to guide the design and promotion of an integrated camp.

Characterization of physical literacy in children with chronic medical conditions compared with healthy controls: a cross-sectional study.

To determine the physical literacy, defined as the capability for a physically active lifestyle, of children with medical conditions compared with healthy peers, this multicenter cross-sectional study recruited children with medical conditions from cardiology, neurology (including concussion), rheumatology, mental health, respirology, oncology, hematology, and rehabilitation (including cerebral palsy) clinics. Participants aged 8-12 years (N = 130; mean age: 10.0 ± 1.44 years; 44% female) were randomly matched to 3 healthy peers from a normative database, based on age, gender, and month of testing. Total physical literacy was assessed by the Canadian Assessment of Physical Literacy, a validated assessment of physical literacy measuring physical competence, daily behaviour, knowledge/understanding, and motivation/confidence. Total physical literacy mean scores (/100) did not differ (t(498) = -0.67; p = 0.44) between participants (61.0 ± 14.2) and matched healthy peers (62.0 ± 10.7). Children with medical conditions had lower mean physical competence scores (/30; -6.5 [-7.44 to -5.51]; p < 0.001) but higher mean motivation/confidence scores (/30; 2.6 [1.67 to 3.63]; p < 0.001). Mean daily behaviour and knowledge/understanding scores did not differ from matches (/30; 1.8 [0.26 to 3.33]; p = 0.02;/10; -0.04 [-0.38 to 0.30]; p = 0.81; respectively). Children with medical conditions are motivated to be physically active but demonstrate impaired movement skills and fitness, suggesting the need for targeted interventions to improve their physical competence. Novelty: Physical literacy in children with diverse chronic medical conditions is similar to healthy peers. Children with medical conditions have lower physical competence than healthy peers, but higher motivation and confidence. Physical competence (motor skill, fitness) interventions, rather than motivation or education, are needed for these youth.

Performance of Fixed Heart Rate Increment Targets of 20 vs 30 Beats per Minute for Exercise Rehabilitation Prescription in Outpatients With Heart Failure.

BACKGROUND: Patients with heart failure (HF) should exercise at 40%-60% heart rate reserve (HRR) during the first 3 weeks of an outpatient cardiac rehabilitation (CR) program and at 50%-80% HRR thereafter. Arbitrary methods to prescribe exercise intensity such as resting HR (RHR) plus 20 or 30 beats per minute (bpm) (RHR + 20 or RHR + 30) are recommended for inpatients after a myocardial infarction or those recovering from heart surgery. This approach has been repurposed by outpatient CR programs to prescribe exercise intensity for patients with HF, yet its efficacy has not been evaluated. METHODS: We examined the appropriateness of RHR + 20/30 for prescribing exercise intensity and improving functional capacity for 55 patients with HF in an outpatient CR program. RHR + 20/30 values were compared to % HRR derived from peak exercise testing in patients with HF. Changes in functional capacity as measured by 6-minute walk test (6MWT) distance, and differences in ratings of perceived exertion (RPE), were examined between patients exercising at RHR + 20-29 and those exercising at RHR + ≥ 30. RESULTS: During weeks 1-3 and exercise at RHR + 20, 26% of participants would exercise at 40%-60% HRR. At RHR + 30, 38% would exercise at 40%-60% HRR. During weeks 4-12 and exercise at RHR + 20, 20% of participants would exercise at 50%-80% HRR. At RHR + 30, 41% would exercise at 50%-80% HRR. A smaller change in 6MWT distance was observed in participants exercising at RHR + 20-29 than in those exercising at RHR + ≥ 30 (Δ86.6 ± 70.3 vs Δ135.8 ± 73.7 m; P = 0.005). No differences in RPE were observed between participants exercising at RHR + 20-29 and those exercising at RHR + ≥ 30 (P > 0.05). CONCLUSIONS: RHR + 30 was more effective than RHR + 20 in assisting outpatients with HF achieve recommended exercise intensities and improve functional capacity.