Exercise Testing and Prescription in Children and Young Adults with Congenital Heart Disease

The survival of children with congenital heart disease (CHD) has improved dramatically over the last two decades, and most young patients will now reach adulthood. Adults with CHD might have increased rates of obesity, low fitness, cardiovascular risk factors and events, and even mortality, compared with the general healthy population.

Exercise training programs for patients with CHD may help them in maintaining a healthy lifestyle and decreasing their risks for adulthood morbidity. When prescribing exercise to a patient with CHD, several factors should be taken into account: the type of exercise to be performed, its intensity and duration; the type of heart malformation and the corrective procedures performed; the presence or lack of anatomical residua; ventricular function; pulmonary arterial pressure; oxygen saturation in rest and exercise; the initial fitness level; and any electrocardiographic changes during exercise.

Cardiopulmonary exercise testing (CPET) can evaluate maximal aerobic performance and cardiac function, and can provide important information on prognosis, functional outcomes and the safety of exercise. For these reasons, clinical guidelines support the routine use of CPET in the periodic evaluation of children and adults with CHD. Further, CPET is of paramount importance in providing a safe and effective exercise prescription in this unique population.

Exercise prescription for patients with CHD should be personalized, as any other medical treatment. In our clinic, exercise recommendations are individually tailored according to the patient’s aspirations and clinical status, CPET findings and available guidelines.