Associations between cardiorespiratory fitness, activity behavior, physical literacy and parental sports participation in children with a critical congenital heart disease

Objective: This study investigated associations between cardiorespiratory fitness (CRF), activity behavior (i.e. physical activity and sports participation), physical literacy (motivation, confidence, knowledge and understanding), and parental sports participation in children with critical congenital heart disease (CCHD), and explore differences in children with a single ventricle physiology (SVP) and children with biventricular physiology (BVP). Methods: Ninety children with CCHD (median age 10.0 [7.0–13.0] years) participated in this prospective observational study. CRF was measured through cardiopulmonary exercise testing (VO₂peak). Activity behavior, physical literacy, and parental sports participation were assessed using validated questionnaires. Results: CRF was moderately associated with physical activity (r = 0.36, p < .001) and weakly associated with motivation and confidence (r = 0.25, p = .019). No association was found between CRF and sports participation. Children's sports participation was positively associated with maternal (r = 0.23, p = .034) and paternal (r = 0.23, p = .042) sports participation, as well as with motivation and confidence (r = 0.28, p = .009). Children with a SVP (n = 11) had significantly lower CRF than those with BVP (n = 79) (p < .001). No other differences were found between children with a SVP and children with a BVP. Conclusion: CRF is positively associated with physical activity, motivation and confidence in children with CCHD. Additionally, parental sports participation is associated with children's sports participation. These findings suggest integrating a physical literacy and family-centered approach in interventions aimed to enhance CRF in children with CCHD.