Exercise, physical activity, and congenital heart disease

Exercise testing in adult cardiac patients has mainly focused on ischaemic heart disease. The results of exercise testing with ECG monitoring are often helpful in diagnosing the presence of significant coronary artery disease. In children with heart disease, the type of pathology is different. Ischaemic heart disease is very rare. The majority of patients will present with congenital heart defects that will affect exercise capacity. In patients with congenital heart disease, exercise tests are frequently performed to measure exercise function or to assess abnormalities of cardiac rhythm. The risk of exercise testing is very low in the paediatric age group.1 Findings from exercise testing show a reduced exercise capacity in many children with congenital heart disease and exercise responses differ between patients with different underlying heart defects. Results from exercise testing can provide insight into the clinical condition of the child and help decision making regarding patient management. However, exercise testing not only provides information about the heart, but also about the level of daily physical activity (PA). In general, PA has been found to be reduced in children with congenital heart disease, and below recommended guidelines. This has resulted in a shift in research attention from evaluating exercise responses of children with congenital heart disease towards investigating means to improve PA and exercise capacity for health.