Exercise prescription in young children with congenital heart disease: time for a change in culture

The outcome for children born with congenital heart disease (CHD) has been transformed over the last 50 years. Largely as a consequence of advances in surgical and transcatheter intervention, the majority of children with even the most severe forms of CHD are likely to reach adult life.1 Indeed, there are now considerably more adults with CHD than children.2 As we witness this rise in the number of adults with CHD we need to turn our attention to improving not just longevity but also quality of life. In the past, most children with CHD were discouraged from taking part in regular exercise. There were many reasons for this. Perhaps the most common was a belief in the family, often mirrored by the supervising clinician, that strenuous exercise was potentially dangerous and could lead to clinical deterioration or even a fatality. Another important reason was the poor understanding of exercise physiology in the cardiology community and the failure to recognise the importance of exercise in maintaining good general and cardiovascular health. Many studies have now demonstrated that a short-term exercise prescription can improve general, cardiovascular and mental health in older children and adults with CHD.3–7 These benefits extend beyond a simple improvement in exercise capacity and include improved feelings of physical self-perception and satisfaction with life.6 Moreover, the risk of clinical deterioration or sudden death during an exercise programme is extremely small.8 In 2013, the American Heart Association recommended that all older children and young adults with CHD receive counselling …