Physical Activity Levels in Children with Esophageal Atresia and Congenital Heart Disease: A Comparative Multicenter Study

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Aim of the Study Esophageal atresia (EA) is associated with impaired motor development, cardiopulmonary function, and physical activity (PA). Despite missing scientific evidence, this fact is often attributed to associated congenital heart disease (CHD). The aim of this study was to investigate PA in EA patients without CHD compared with CHD patients and healthy controls. Methods In this multicenter study, EA patients aged 6 through 17 years were included. Moderate-to-vigorous PA (MVPA, minutes per week) was assessed using the standardized and validated questionnaire Motorik-Modul Physical Activity Questionnaire. EA patients were randomly matched 1:4 for gender and age with patients with CHD (n = 1,262) and healthy controls (n = 6,233). Patients born with both EA and CHD were excluded. Means and 95% confidence intervals (95% CIs) were calculated. To identify associated factors, Spearman's correlation was performed. Main Results Overall, 69 EA patients were matched with 276 CHD patients and 276 controls (57% male, 43% female, mean age 10,3 years, 95% CI: 9.5–11.1). Mean MVPA was reduced in EA (492 minutes, 95% CI: 387–598) and CHD patients (463 minutes, 95% CI: 416–511) compared with controls (613 minutes, 95% CI: 548–679). In subgroup analysis, MVPA was reduced further in females and older age groups with EA and CHD. For EA patients, there was no statistical association between Gross type, current symptoms, surgical approaches, and MVPA. Conclusion Isolated EA and CHD were associated with reduced PA, especially in females and teenagers. To avoid additional morbidity associated with sedentary behavior, PA should be promoted during follow-up.

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Article · Oct 2024 · 1 min read

In brief

This multicenter study compared physical activity levels in 69 children with isolated esophageal atresia to those with congenital heart disease and healthy controls, finding both surgical groups had significantly reduced moderate-to-vigorous activity, particularly among females and teenagers. The findings challenge the assumption that reduced activity in EA patients is primarily due to associated heart defects, highlighting the need for targeted physical activity promotion during clinical follow-up.

Children with esophageal atresia show reduced physical activity independent of congenital heart disease, challenging the assumption that CHD alone explains activity limitations.
Both EA and CHD patients averaged 120 fewer minutes of moderate-to-vigorous activity weekly compared to healthy controls (492 vs 613 minutes).
Physical activity deficits worsen with age and are more pronounced in females with EA or CHD, identifying key at-risk subgroups.
EA surgical type and current symptoms did not correlate with activity levels, suggesting systemic rather than anatomic factors drive inactivity.
Clinicians should proactively promote physical activity during EA follow-up to prevent sedentary-related morbidity, especially in adolescent females.

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