The impact of the COVID-19 pandemic on application of European Society of Cardiology (ESC) guidelines for exercise in adults with congenital heart disease: a data-based questionnaire.

INTRODUCTION Regular physical activity is safe and effective therapy for adults with congenital heart disease (ACHD) and is recommended by European Society of Cardiology (ESC) guidelines. The COVID-19 pandemic poses enormous challenges to healthcare teams and patients when ensuring guideline compliance. We explored the implications of COVID-19 on physical activity levels in ACHD patients. MATERIALS AND METHODS A data-based questionnaire was distributed to ACHD patients at a regional tertiary centre from October to November 2020. RESULTS Prior to the COVID-19 pandemic, 96 (79.3%) of 125 respondents reported participating in regular physical activity, with 66 (52.8%) meeting target levels (moderate physical activity for at least 150 minutes per week). Commonest motivations for physical activity were general fitness (53.6%), weight loss (36.0%) and mental health benefits (30.4%). During the pandemic, the proportion that met target levels significantly decreased from 52.8% to 40.8% (p=0.03). The commonest reason was fear of COVID-19 (28.0%), followed by loss of motivation (23.2%) and gym/fitness centre closure (15.2%). DISCUSSION The COVID-19 pandemic has negatively impacted exercise levels of ACHD patients. Most do not meet recommended physical activity levels, mainly attributable to fear of COVID-19. Even before the pandemic, only half of respondents met physical activity guidelines. Availability of online classes can positively impact exercise levels so could enhance guideline compliance. This insight into health perceptions and behaviors of ACHD patients may help develop quality improvement initiatives to improve physical activity levels in this population