Remote Lifestyle Counseling Influences Cardiovascular Health Outcomes in Youth with Overweight or Obesity and Congenital Heart Disease

Abstract

Background: Children with overweight/obesity and congenital heart disease (CHD) are at increased cardiovascular risk. A lifestyle intervention may help reduce these risks. We sought to determine the feasibility of a smartphone-based lifestyle intervention to improve cardiovascular health outcomes in children with overweight/obesity and CHD.

Methods: We examined the effect of bi-weekly nutrition and fitness counseling delivered via smartphone over 12 months. Thirty-four youth, previously diagnosed with CHD and with overweight or obesity, participated in the intervention. They were divided into two groups depending on whether the heart disease required surgical correction (operated, n = 19) or not (non-operated, n = 15). Anthropometry, body composition cardiorespiratory exercise capacity, and cardio-metabolic risk factors were assessed at baseline, 6 months, and 12 months.

Results: Statistically significant decreases in waist circumference (WC), body mass index z-score, WC z-score, and waist to height ratio z-score were observed at 6 and 12 months in the operated group. A significant linear increase in lean body mass was observed in both groups. The study also had a high retention rate and a low attrition rate.

Conclusion: The observed changes in anthropometry were positive with significant improvement to some cardiovascular and metabolic risk indicators. However, this was only observed in the operated group suggesting that other factors, such as perception of condition and self-efficacy, may influence lifestyle behaviors. The results from this pilot study clearly demonstrate the feasibility to perform a larger controlled study on remote lifestyle intervention in children with congenital heart defects and overweight or obesity.

Keywords: children; congenital heart disease; lifestyle intervention; obesity; remote counseling; smartphone.

Figure 1

Flow diagram of the Smart Heart Pilot Study procedure from baseline to 12-month measures. The Smart Heart Pilot Study included three assessments and spanned 12 months. Self-report, physical, metabolic, cardiovascular, and body composition outcome measures were collected for each participant at baseline and at 6- and 12-month follow-ups. Nutrition and fitness counseling was performed by smartphone once per week, with the nutrition and fitness counseling support alternating weeks (i.e., 25 counseling sessions for each, for a total of 50 sessions).

Figure 2

Trends in body mass index z-score (BMI-Z) score. The BMI-Z was plotted over time (months) relative to the study start date (month 0) for each of the 34 participants divided into the operated congenital heart disease (CHD) (n = 19) and non-operated CHD (n = 15) groups. The BMI-Z was determined for each of the 34 study participants, when possible, from 42 months to 6 months prior to the study start date (month 0) and during the intervention at 0, 6, and 12 months. Loess was used to generate a smoothed line of fit for the operated (solid black line) and non-operated (solid gray line) groups. Linear regression was performed using data from months −42 to 0 to determine a trajectory for the BMI-Z (dashed lines). For the operated group, n = 14 of 19 had from 2 to 4 BMI-Z measurements prior to the study start; while for the non-operated group, n = 11 of 15 had 1 to 3 BMI-Z measurements prior to the study start. All 34 participants had BMI-Z measurements over the course of the intervention (i.e., at 0, 6, and 12 months) with the exception of one participant in each of the two groups that missed the 6-month follow-up. The study start point (0 months) is indicated by a vertical line.