Background: Children with congenital heart disease ( CHD ) are thought to have low levels of physical activity ( PA ), but few studies have used objective measures of PA in this population. Methods and Results: We recruited patients with mild, moderate, and severe CHD and cardiac transplant recipients, aged 8 to 19 years, from pediatric cardiology clinics throughout British Columbia and Yukon, Canada. Participants were fitted with an ActiGraph accelerometer to be worn over the right hip for 7 days. Daily means were estimated for a variety of accelerometry‐derived metrics, including moderate‐to‐vigorous PA and percentage of sedentary time if they had at least 3 valid days of accelerometry data. Participants also completed a PA questionnaire. We included 90 participants (aged 13.6±2.7 years; 54% male), of which 26 had mild CHD , 26 had moderate CHD , 29 had severe CHD , and 9 were cardiac transplant recipients. Median daily moderate‐to‐vigorous PA was 43 min/day (interquartile range: 28.9–56.9 min/day), and 8% met PA guidelines of 60 minutes of moderate‐to‐vigorous PA at least 6 days a week. There were no significant differences in any accelerometry‐derived metric according to CHD severity. Boys were significantly more active and less sedentary than girls. Activity declined and sedentary behaviors increased with age in both sexes. Sports participation was common, including competitive out‐of‐school clubs (57%). PA restrictions from cardiologists were rare (15%). Conclusions: We found normal age–sex patterns of PA in children with CHD . There were no differences in PA by CHD severity, suggesting that sociocultural factors are likely important determinants of PA in these children.

To assess the criterion validity, internal consistency, reliability and cut-point for the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in children and adolescents with congenital heart disease–a special population at high cardiovascular risk in whom physical activity has not been extensively evaluated. We included 84 participants (13.6±2.9 yrs, 50% female) with simple (37%), moderate (31%), or severe congenital heart disease (27%), as well as cardiac transplant recipients (6%), from BC Children’s Hospital, Canada. They completed the PAQ-C (≤11yrs, n = 28) or–A (≥12yrs, n = 56), and also wore a triaxial accelerometer (GT3X+ or GT9X) over the right hip for 7 days (n = 59 met valid wear time criteria). Median daily moderate-to-vigorous physical activity was 46.9 minutes per day (IQR 31.6–61.8) and 25% met physical activity guidelines defined as ≥60 minutes of moderate-to-vigorous physical activity per day. Median PAQ-score was 2.6 (IQR 1.9–3.0). PAQ-Scores were significantly related to accelerometry-derived metrics of physical activity (rho = 0.44–0.55, all p<0.01) and sedentary behaviour (rho = -0.53, p<0.001). Internal consistency was high (α = 0.837), as was reliability (stability) of PAQ-Scores over a 4-months period (ICC = 0.73, 95%CI 0.55–0.84; p<0.001). We identified that a PAQ-Score cut-point of 2.87 discriminates between those meeting physical guidelines and those that do not in the combined PAQ-C and–A samples (area under the curve = 0.80 (95%CI 0.67–0.92). Validity and reliability of the PAQ in children and adolescents with CHD was comparable to or stronger than previous studies in healthy children. Therefore, the PAQ may be used to estimate general levels of physical activity in children and adolescents with CHD.