Predictive Value of Musculoskeletal Fitness for Cardiovascular Risk Factors in Adolescents with Congenital Heart Disease: A Cross-Sectional Study

Objectives: We aimed to investigate the association between musculoskeletal fitness (MF) and cardiovascular risk factors in adolescents with congenital heart disease (ConHD). Methods: This cross-sectional study included 355 adolescents with ConHD (median age 12.4 years [range: 5.7–21.7]; 43.4% female). Participants completed musculoskeletal fitness (MF) tests, including handgrip strength (HGS), curl-ups, push-ups, and trunk lifts, and underwent an assessment of anthropometric indices, blood pressure, pulse wave velocity (PWV), and carotid intima–media thickness (cIMT). To account for body size, HGS was allometrically scaled to body mass with adjustment for age, sex, and ConHD severity. Clustered MF was derived by calculating z-scores for allometric HGS, curl-ups, push-ups, and trunk lifts. Results: Allometric HGS was inversely associated with anthropometric indices: waist circumference [WC] (β = −4.467, p = 0.014), waist-to-hip ratio [WHR] (β =−0.039, p = 0.005), waist-to-height ratio [WHtR] (β = −0.052, p = 0.001), and BMI (β = −3.115, p = 0.001). Push-ups were inversely related to all anthropometric indices (p < 0.05). Trunk lift showed positive associations with multiple anthropometric indices except WHR (all p < 0.05). Clustered MF was negatively associated with WHR (β = −0.004, p = 0.008) and WHtR (β = −0.006, p = 0.001). HGS (β = 0.18, p = 0.033), push-ups (β = 0.004, p = 0.041), and clustered fitness (β = 0.028, p = 0.006) were inversely associated with PWV. Conclusions: Systematically increasing MF in rehabilitation may provide a feasible strategy to mitigate CVD risk in adolescents with ConHD.