Regular physical activity is essential for the rehabilitation and long-term recovery of children and adolescents with heart disease. Many studies have shown that low levels of physical activity are associated with poor health outcomes. There is a lack of longitudinal research on the dynamic changes in physical activity and their influencing factors in children and adolescents with heart disease following hospital discharge after cardiac surgery or conservative management. Therefore, this study aimed to compare physical activity levels in children and adolescents with heart disease at discharge and a 3-month follow-up period, and to explore how intention, intention–behavior gap, self-efficacy, kinesiophobia, and parental support affect physical activity and how these effects change at two time points. This study utilized a prospective, two-time-point follow-up design, recruiting 217 children and adolescents (aged 6–18 years) with heart disease. Intentions, intention–behavior gap, self-efficacy, Kinesiophobia, parental support, and physical activity levels were assessed at discharge and 3 months post-discharge. Generalized linear mixed-effects models were fitted to identify the longitudinal effects of these variables on physical activity behavior. The McNemar–Bowker test was used to analyze how intention–behavior quadrants shifted between the two time points. Multinomial logistic regression was also applied to determine if baseline physical activity levels could predict a participant’s quadrant at follow-up. Physical activity levels significantly decreased at 3 months post-discharge (Z = − 9.940, p < 0.001). Model results indicated that intention (β = 0.074, p < 0.001) and self-efficacy (β = 0.223, p < 0.001) significantly and positively predicted physical activity levels. Time (β = − 0.665, p < 0.001), intention–behavior gap (β = − 0.401, p < 0.05), and Kinesiophobia (β = − 0.043, p < 0.001) showed significant negative correlations with physical activity. The interaction term between time and parental support (β = 0.028, p = 0.037) exerted a significant positive influence on physical activity levels. The proportion of the “intention–behavior gap” group increased from 39.2 to 43.3% between the two time points. Although higher baseline physical activity levels helped prevent complete inactivity, they did not effectively predict whether an individual would enter “intention–behavior gap” group at follow-up. Conclusion: Physical activity levels significantly declined within 3 months post-discharge among children and adolescents with heart disease. Factors including intention, intention–behavior gap, self-efficacy, and Kinesiophobia significantly influenced their behavior, while the role of parental support increased after 3 months. Therefore, enhancing intention and self-efficacy while reducing Kinesiophobia is essential to promote physical activity during the early post-discharge period. Family support must be reinforced during home rehabilitation to maintain physical activity continuity and improve long-term outcomes. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> What is Known: • Regular physical activity is essential for the rehabilitation of children and adolescents with heart disease; however, current evidence consistently demonstrates that their physical activity levels are suboptimal, contributing to unfavorable long-term outcomes. • Known determinants of physical activity in this population encompass both familial factors and individual-level factors. Nevertheless, these identified factors account for less than 15% of the variance in physical activity behavior. </entry> </row> <row> <entry nameend="c2" namest="c1"> What is New: • A significant intention–behavior gap exists in this population and represents a distinct barrier to physical activity; however, baseline physical activity is not a significant predictor of whether individuals will enter the intention–behavior gap group. • Kinesiophobia is a prominent and independent barrier to physical activity among children and adolescents with heart disease, whereas parental support serves as a key and stable facilitator, exhibiting a strengthening protective effect against the characteristic post-discharge decline in physical activity. </entry> </row> </tbody> </tgroup> </Table>

Changes in physical activity behaviors and influencing factors among children and adolescents with heart disease after hospital discharge: a 3-month follow-up study

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发表日期：

2026年3月2日

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Xuanxuan Li,
Lin Chen,
Zhizhen Jin,
Zhiming Yang,
Xiaoman Cai,
Fei Li,
Xihao Du,
Wenyi Luo

摘要

Regular physical activity is essential for the rehabilitation and long-term recovery of children and adolescents with heart disease. Many studies have shown that low levels of physical activity are associated with poor health outcomes. There is a lack of longitudinal research on the dynamic changes in physical activity and their influencing factors in children and adolescents with heart disease following hospital discharge after cardiac surgery or conservative management. Therefore, this study aimed to compare physical activity levels in children and adolescents with heart disease at discharge and a 3-month follow-up period, and to explore how intention, intention–behavior gap, self-efficacy, kinesiophobia, and parental support affect physical activity and how these effects change at two time points. This study utilized a prospective, two-time-point follow-up design, recruiting 217 children and adolescents (aged 6–18 years) with heart disease. Intentions, intention–behavior gap, self-efficacy, Kinesiophobia, parental support, and physical activity levels were assessed at discharge and 3 months post-discharge. Generalized linear mixed-effects models were fitted to identify the longitudinal effects of these variables on physical activity behavior. The McNemar–Bowker test was used to analyze how intention–behavior quadrants shifted between the two time points. Multinomial logistic regression was also applied to determine if baseline physical activity levels could predict a participant’s quadrant at follow-up. Physical activity levels significantly decreased at 3 months post-discharge (Z = − 9.940, p < 0.001). Model results indicated that intention (β = 0.074, p < 0.001) and self-efficacy (β = 0.223, p < 0.001) significantly and positively predicted physical activity levels. Time (β = − 0.665, p < 0.001), intention–behavior gap (β = − 0.401, p < 0.05), and Kinesiophobia (β = − 0.043, p < 0.001) showed significant negative correlations with physical activity. The interaction term between time and parental support (β = 0.028, p = 0.037) exerted a significant positive influence on physical activity levels. The proportion of the “intention–behavior gap” group increased from 39.2 to 43.3% between the two time points. Although higher baseline physical activity levels helped prevent complete inactivity, they did not effectively predict whether an individual would enter “intention–behavior gap” group at follow-up. Conclusion: Physical activity levels significantly declined within 3 months post-discharge among children and adolescents with heart disease. Factors including intention, intention–behavior gap, self-efficacy, and Kinesiophobia significantly influenced their behavior, while the role of parental support increased after 3 months. Therefore, enhancing intention and self-efficacy while reducing Kinesiophobia is essential to promote physical activity during the early post-discharge period. Family support must be reinforced during home rehabilitation to maintain physical activity continuity and improve long-term outcomes.

What is Known:

• Regular physical activity is essential for the rehabilitation of children and adolescents with heart disease; however, current evidence consistently demonstrates that their physical activity levels are suboptimal, contributing to unfavorable long-term outcomes.

• Known determinants of physical activity in this population encompass both familial factors and individual-level factors. Nevertheless, these identified factors account for less than 15% of the variance in physical activity behavior.

What is New:

• A significant intention–behavior gap exists in this population and represents a distinct barrier to physical activity; however, baseline physical activity is not a significant predictor of whether individuals will enter the intention–behavior gap group.

• Kinesiophobia is a prominent and independent barrier to physical activity among children and adolescents with heart disease, whereas parental support serves as a key and stable facilitator, exhibiting a strengthening protective effect against the characteristic post-discharge decline in physical activity.