Ten Points to Remember: "Physical Fitness and Congenital Heart Disease: Mutually Inclusive"

The benefits, safety, and efficacy of structured exercise programs have been studied for decades, but few are tailored for patients with congenital heart disease (CHD) in the US. The following are ten points to remember, which may aid in establishing a comprehensive pediatric cardiac fitness program for CHD.1

  1. Since CHD is a lifelong condition, "cardiac fitness" is the preferred moniker as it underscores the focus on positive ongoing goals, rather than "rehabilitation" which implies recovery from illness.
  2. A comprehensive fitness program for CHD includes elements of exercise and positive mindset training, as well as a consistent sense of community or "team".
  3. Standardized core competencies in adult cardiac rehabilitation programs could be adapted for patients with CHD.
  4. A risk stratification system based on hemodynamic classification rather than anatomic diagnoses may be used to set exercise training intensity levels.
  5. Positive mindset training protocols paired with progressive exercise training guidelines can improve fitness and encourage independence.
  6. Consistent metrics to assess each program component are important.
  7. A program coordinator to oversee each individual's progress is critical.
  8. Especially in the early development phase, identifying staff roles, leveraging existing staff, maximizing use of available space, and identifying physician champions are all important.
  9. Insurance approval of prior authorization requests is significantly better than expected.
  10. Positive, supportive relationships with exercise staff are key factors in the success of a program.


  1. Gauthier N, Curran T, O'Neill JA, Alexander ME, Rhodes J. Establishing a comprehensive pediatric cardiac fitness and rehabilitation program for congenital heart disease. Pediatr Cardiol 2020;July 17[Epub ahead of print].

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, Congenital Heart Disease, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Exercise

Keywords: Heart Defects, Congenital, Cardiac Rehabilitation, Benchmarking, Prior Authorization, Goals, Exercise, Heart, Hemodynamics, Exercise Therapy, Risk Assessment, Longitudinal Studies

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