Exercise in Children with Congenital Heart Disease

Physicians and parents seek ways to maximize the participation of their children with congenital heart disease in sports and to minimize any potential risk. It is fortunate that significant problems with exercise are rare in children born with congenital heart disease. As in every child with this condition, the physical examination and knowledge of the child's particular heart defect and its course over time become particularly important.

Testing for Participation
To determine whether or not a child with a congenital heart defect can exercise vigorously or participate in sports, direct exercise testing is done. When exercising children with congenital heart defects, we are looking for their overall exercise performance and whether or not there are any irregularities of blood pressure, heart rate or physical performance. During the exercise test, we measure the child's heart rate response to the exercise, blood pressure, heart rhythm and their overall exercise performance. The child is encouraged to exercise at his/her peak while he/she is monitored safely and carefully.

Types of Defects
In general, children who were born with holes in their heart, such as a hole in the upper part of the heart (atrial septal defect), or in the lower part between the two pumping chambers (ventricular septal defect), or those children who were born with a connection between the two arteries, namely the pulmonary artery and the aorta (patent ductus arteriosus), can participate in all sports, particularly those who have undergone surgical correction of their defect. The conditions that would limit them are if they have high pressures in the arteries to the lungs or irregularities of their heart rhythm which, fortunately, are extremely rare.

Children with narrowing of the valves from the right-sided pumping chamber to the artery to the lungs can participate in all sports if no symptoms are present and if the narrowing across the valve is mild. Children with a narrowing of the aortic valve need closer supervision. If there is severe narrowing across the aortic valve, children should not participate in competitive sports. Those with mild or medium narrowing of the valve can participate in low to moderate dynamic non-contact sports.

Children who are "blue" with their heart defect, whether it has been corrected surgically or not, usually can participate only in low-intensity competitive sports; and individual exercise prescriptions are recommended.

There are also a group of children with Marfan syndrome, which is an inherited disorder of connective tissue where the children are very tall and have enlargements of their aorta. Those children should engage in only low-intensity competitive sports.

It is important for any congenital cardiac condition to have the child cleared by his/her family physician.

We all want our children with congenital heart disease to be able to participate as fully as they can in life. With a good understanding of their particular defects, we can ensure this is possible.