Physical activity and exercise in patients with congenital heart disease (CHD)
- Sarah D de Ferranti, MD, MPH
Sarah D de Ferranti, MD, MPH
- Director, Preventive Cardiology Clinic
- Department of Cardiology
- Boston Children's Hospital
- Eric V Krieger, MD
Eric V Krieger, MD
- Assistant Professor of Medicine
- University of Washington School of Medicine
- Section Editors
- David R Fulton, MD
David R Fulton, MD
- Section Editor — Pediatric Cardiology
- Associate Professor of Pediatrics
- Harvard Medical School
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
In the past, physical activity advice for patients with congenital heart disease (CHD) was centered on restriction because of concerns that increased activity might be detrimental. However, increasingly there is an appreciation that promoting physical activity will benefit the health and well-being of children and adults with CHD. The challenge for clinicians who care for these patients is to ensure safe participation in regular physical activity by tailoring recommendations to the individual's clinical status.
This topic will review the risks and benefits of physical activity, and an approach for assessment and recommendations for regular physical activity in children and adults with CHD.
The following definitions related to physical activity, fitness, exercise, and competitive sports are used in this topic:
●Physical activity – Physical activity is defined as bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above the basal level. It includes recreational and competitive sports, and daily living or transportation activities. In adults, a moderate amount of physical activity is roughly equivalent to physical activity that uses approximately 150 calories (kcal) of energy per day or 1000 calories per week. Examples of moderate physical activity include leisure cycling, moderate effort swimming, playing golf (walking), general cleaning at home, or lawn mowing (figure 1). Vigorous activity includes running, rope jumping, and calisthenics. Of note, individuals can be physically active without demonstrating significant fitness.
●Physical fitness – Physical fitness is a set of physical attributes that enable one to perform daily physical activities. Health-related physical fitness encompasses cardiorespiratory endurance, muscular strength and endurance, flexibility, and body composition.
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- BENEFITS OF PHYSICAL ACTIVITY
- LACK OF EVIDENCE LINKING SCD AND EXERCISE
- NEED FOR INDIVIDUALIZED COUNSELING
- MANAGEMENT APPROACH
- ROUTINE PHYSICAL ACTIVITY ASSESSMENT
- - Conditions with potential risks of exercise
- - Activity history
- Cardiorespiratory assessment
- - Basic cardiac assessment
- - Exercise testing for preparticipation counseling
- Treadmill exercise testing
- Cardiopulmonary exercise testing
- GOAL SETTING FOR ROUTINE PHYSICAL ACTIVITY
- FOLLOW-UP FOR ROUTINE PHYSICAL ACTIVITY
- PATIENTS WHO WISH TO ENGAGE IN COMPETITIVE SPORTS
- General considerations
- Specific CHD defects and conditions
- SUMMARY AND RECOMMENDATIONS