兒童及青少年心臟健康﹑心臟病與體能活動

Heart health, heart problems and exercise in children

Cardiology Centre

Hong Kong Children’s Hospital

Hong Kong College of Cardiology

香港心臟專科學院

翁 德 璋 醫 生

Dr TC Yung

兒童及青少年心臟健康﹑心臟病與體能活動

Heart health refers to the health of the heart and blood vessels

= absence of cardiovascular disease:

coronary heart disease, stroke, heart failure, heart rhythm disorders, hypertension

= absence of risks of cardiovascular disease:

• obesity

• high blood cholesterol

• high blood pressure

• tobacco

• physical inactivity

心臟健康 / 心血管健康

無患上心血管病

無心血管病風險因素

肥胖 高血脂 高血壓 吸煙

缺乏運動

Physical Inactivity / Sedentary behaviour

American Heart Association(AHA)

Scientific Position Statement

“Physical inactivity (缺乏運動)is a major risk factor for developing coronary artery disease. It increases the risk of stroke and other major cardiovascular risk factors: obesity, high blood pressure, low HDL cholesterol and diabetes.”

缺乏運動

美國心臟協會科學聲明

Leisure Time Physical Activity and Mortality in Hong Kong:

Case-control Study of All Adult Deaths

TH Lam (2004) Annals of Epidemiology

 In 1998 deaths attributable to physical inactivity (6450) exceeded those due to smoking (5720)

Proportion of all

deaths No. of deaths

Men 35+ 25.3% 4,483

Women 35+ 14.4% 1,968

Total 20.6% 6,450

Mortality attributable to physical inactivity

休閒時間體能活動與死亡率

Physical Fitness Test

for the Community 2012 study

45% of young adults are inactive

⼤約⼀半成年⼈缺乏運動

社區體適能調查

“Children and youth in Hong Kong have low physical activity and

physical fitness levels and high sedentary behaviors”

2018 香港青少年體能活動成績咭

香港兒童及青少年體適能水平偏低，

和缺乏運動

The grade for each indicator is based on the percentage of children and youth meeting a defined benchmark (except for Obesity):

A+ 94-100% A 87-93% A- 80-86%

B + 74-79% B 67-73% B- 60%-66%

C+ 54- 59% C 47- 53% C- 40-46%

D+ 34-39% D 27- 33% D- 20-26%

F <20%

age Expectation of life

female male

15 73 68

16 72 67

17 71 66

18 70 65

19 69 64

20 68 63

61 29 25

62 28 25

63 27 24

64 26 23

65 25 23

Hong Kong Life Table (2020)

Longevity

Diseases / illnesses

↑ medical expense 香港生命表 2020

減少缺乏運動 九項目標

邁向 2025

非傳染病防控策略及行動計劃 (2018年5月)

Reduce premature

mortality from NCD Reduce harmful use of alcohol

Reduce physical inactivity

Reduce salt intake

Reduce tobacco use

Contain the

prevalence of raised blood pressure

Halt the rise in diabetes and obesity

Prevent heart attacks and strokes through

drug therapy and counselling

Improve availability of affordable basic

technologies and essential medicines to treat major

NCD

How much exercise, and what level of intensity ?

運動量與強度

All adults should do

• at least 150 – 300 min of moderate-intensity aerobic PA中等強度帶氧運動,

• at least 75 – 150 min of vigorous-intensity aerobic PA 高強度帶氧運動 ,

• an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week

• muscle-strengthening activities 肌肉強化運動 at moderate or greater intensity on 2 or more days a week

N.B. 2 minutes of a moderate-intensity activity is about equal to 1 minute of a vigorous activity.

or or

Children and adolescents (aged 5–17 years), including those living with disability

• at least an average of 60 min/day of moderate-to-vigorous intensity,

mostly aerobic, physical activity中等至高強度帶氧運動, across the week;

• Vigorous-intensity aerobic activities, as well as those that strengthen muscle and bone should be incorporated at least 3 days a week.

• Children and adolescents should limit the amount of time spent being sedentary, particularly the amount of recreational screen time.

減少坐 / 卧時間,減少電視電腦時間

Intensity of exercise

Intensity Signs Examples

Light Breathing rate and heart rate normal;

able to talk normally

Slow walking

Moderate Slight increase in heart rate and breathing rate; able to talk in short sentences or single words

fast walking, cycling,

paddling, slides, swinging, circuit games

Vigorous Significant increase in heart rate and breathing rate; unable to talk

normally

running, rope skipping, dancing, football,

swimming

Talk test

• A person doing moderate-intensity exercise can talk, but not sing.

• A person doing vigorous-intensityactivity cannot say more than a few words without pausing for a breath.

運動強度

說話測試

Intensity of Ex % HR max

light 50-65 lowest level to improve fitness moderate 60-85 fat burning, aerobic zone

vigorous 85-90 anaerobic training

Percentage of Maximum Heart Rate

Max Heart Rate = (220 – age) beats / minute

Exercise and risks

運動與風險

General advice for exercise

• Warm up

• Stretching

• Cool down

• Prevention of dehydration, sunburn

• Protective gears

Increase physical activity gradually over time

熱身運動 伸展

緩和運動

增加運動量及強度要漸進

Exercise and risks

• muscle ache

• muscle strain

• musculoskeletal injury

• over-use injury

• overtraining

• dehydration

• trauma

• drowning

• wilderness injury

• high altitude illness

• heat illness

• cold exposure

• lightning strike

Worsening of existing diseases:

• heart disease

• lung disease

• diabetes mellitus

Sudden death

肌肉酸痛 肌肉拉傷

肌腱及骨骼創傷 勞損

過度訓練

運動可能令原有的疾病惡化

猝死

“If one has any symptoms (chest pain胸痛 , fainting 頭暈 or undue breathlessness不尋常氣喘 ) or

≥ 2 cardiac risk factors 心臟病風險因素:

male >45 or female >55, smoking, hypertension, diabetes, high cholesterol, overweight, family history,

one should get advice from health care professionals before exercise participation.”

Recommendation from Hong Kong College of Cardiology

Evaluation before exercise

Physical Activity Readiness Questionnaire

(The Canadian Society for Exercise Physiology)

體能活動適應能力問卷

1.

Congenital Heart diseases

2.

Acquired Heart diseases

• Kawasaki disease川崎症 affecting coronary arteries

• Myocarditis 心肌炎

• infective endocarditis 心內膜炎

• Cardiomyopathies 心肌病

3.

Cardiac arrhythmias

Heart Diseases in Children 兒童心臟病

先天性 後天性

心律不正

Congenital Heart Diseases

Septa : Atrial septal defect

Ventricular septal defect Vessels: Ductus arteriosus

Coarctation of Aorta

Valves: Pulmonary valve stenosis Aortic valve stenosis

Chambers: Hypoplastic left ventricle Univentricular heart

Complex: Tetralogy of Fallot

Transposition of great vessels

間隔

血管

心瓣

心腔

複雜

先天性心臟病

心房間隔缺損 心室間隔缺損

動脈導管未閉 大動脈收縮 肺動脈瓣狹窄 大動脈瓣狹窄 左心室發育不全

單心室 四聯症

大血管錯位

Signs and symptoms of heart disease in school age children:

1. Poor exercise tolerance:

• low exertion intensity

• short exercise time

• extreme shortness of breath on mild exertion

2. Symptoms during exercise:

• chest pain

• dizziness

• syncope

• palpitations

3. Palpitations 4. Cyanosis

心臟病的徵狀

運動耐量下降/低

運動時出現病徵

胸痛 頭暈 昏厥 心悸

發紺，面色變紫 心悸

General recommendation of exercise in the presence of heart diseases:

Isotonic exercise (aerobic activities)

• rhythmic muscular contraction that develops small force

Isometric exercise (muscle power)

• generation of large force by muscles, e.g. weight lifting.

Most children with heart diseases should have the opportunity to participate in physical activities.大部份心臟病兒童可以參加中強 度運動及參加體育課

 low to moderate intensity isotonic exercise is desirable.

 short period of high intensity isometric exercise is permissible.

 prolonged high intensity isotonic / isometric Ex should only be approved after detailed assessment.

低至中強度等強運動是合適的 短時間⾼強度等⻑運動是容許的

參加⻑時間⾼強度運動需要詳細評估

 No Restriction

Activities may include endurance training, athletic competition, contact sports.

 Moderate Exercise

Activities include regular physical education classes, tennis, baseball.

 Light Exercise

Activities include non-strenuous team games, recreational swimming, jogging, cycling, golf.

 Moderate Limitation

Activities include attending school, but no participation in physical education classes.

 Total Restriction

Recommendation on Intensity Level of Exercise

運動強度建議

Warning cardiac symptoms during or after exercise:

• syncope

• chest pain

• palpitation

• cyanosis , paleness

• excessive dyspnea

• excessive fatigue

Causes of sudden death / cardiac arrest during exercise

• >30 year old :

coronary artery disease

• <30 year old :

cardiomyopathies / genetic arrhythmias

運動時猝死的原因

冠心病

心肌病 / 心律失常

猝死前可能出現的徵狀

Emergence response in school and sports venue

學校及運動場的緊急事件應變準備

CPR

復蘇法

AED

體外除顫器

Summary:

• Inactivity is a major health hazard 缺乏運動 – 重要健康風險因素

• Inactivity is common in young population 年輕人缺乏運動是常見的

• Inactivity is modifiable 缺乏運動是可以改變

Summary:

• Most children with heart diseases can enjoy moderate intensity exercise and physical education sessions

大部份心臟病兒童可以參加中強度運動及參加體育課

• Risk of exercise (sudden collapse) in children with heart diseases after evaluation and treatment is very low.

兒童心臟病因為運動引起猝死非常罕見

• Preparation for emergency response is very important.

學校應有恆常的應急計劃應付及防止運動產生危險和猝死

tcyung@hku.hk

兒童心臟基金會提供教育活動,醫療講座增加公眾對於心臟健康的認識, 回答有關 心臟健康與心臟疾病的問題

如有查詢，請致電：2553 0331 或電郵至：chf@childheart.org.hk 聯絡基金會職員。

翁 德 璋 醫 生