Effects of a supervised exercise training programme on functional capacity in adults with congenital heart disease

Background Advances in medical and surgical management have substantially improved survival among patients with congenital heart disease (CHD), resulting in a rapidly expanding adult population. Despite increased longevity, adults with CHD frequently demonstrate reduced exercise tolerance, a recognised predictor of morbidity and mortality. While exercise training is a fundamental component of cardiac rehabilitation in acquired heart disease, evidence supporting its use in adults with CHD remains limited. Purpose To evaluate the impact of a supervised exercise training programme on exercise capacity and to assess its safety in adults with congenital heart disease. Methods This retrospective cohort study included adults (≥18 years) with confirmed CHD who participated in phase II cardiac rehabilitation between 2017 and 2025 (table 1) . Eligible patients were required to have completed baseline and follow-up exercise testing. A supervised exercise programme comprising 20–30 sessions of moderate-intensity aerobic training (Borg scale 12–13), combined with complementary non-aerobic exercises. Exercise capacity was assessed using peak oxygen uptake (VO₂ peak) and metabolic equivalents (METs). Adverse events during training sessions were systematically recorded. Continuous variables are presented as mean (standard deviation) or median (range), as appropriate, and categorical variables as frequencies and percentages. Pre- and post-intervention comparisons were performed using the paired t-test. A p-value <0.05 was considered statistically significant. Results A total of 69 patients were included in the analysis. The mean age of participants was 38.2 ± 15.9 years, and 57% were female. Most patients had acyanotic CHD with moderate anatomical–physiological complexity. Following the exercise programme, significant improvements were observed: peak VO₂ increased from 16.1 to 17.9 mL/kg/min (p<0.05), estimated METs increased from 5.7 to 7.8 (p<0.01), and the VE/VCO₂ slope decreased from 37.8 to 34.3 (p<0.05) (fig. 1). A total of 48 adverse events were recorded, all benign and consisting of supraventricular or ventricular ectopic beats. No major cardiovascular events, hospitalisations, or deaths occurred. Conclusion A supervised exercise training programme significantly improves exercise capacity in adults with congenital heart disease and appears to be safe, with only minor adverse events observed. These findings support the incorporation of structured cardiac rehabilitation programmes into the routine care of adults with CHD.