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.
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 with a connection between 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 pulmonary artery 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" from their heart defect, whether it has been corrected surgically or not, usually can participate only in low-intensity competitive sports; individual exercise prescriptions are recommended. There is also a group of children with Marfan syndrome, which is an inherited disorder of connective tissue where the children are very tall and have enlargement 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.
Does my child have a congenital heart defect?
The main reason children are seen to determine if they have congenital heart disease is because someone has discovered a heart murmur; namely, a sound coming from the heart. Physicians listen to their hearts and order the basic tests: a chest x-ray, electrocardiogram, and the most specific diagnostic test, the echocardiogram.
If it is determined that the child does have congenital heart disease, tests are done to see how it will affect his/her daily life.
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. During the exercise test, we measure the child’s heart rate response to the exercise, blood pressure, heart rhythm and overall exercise performance. The child is encouraged to exercise at his/her peak while he/she is monitored safely and carefully.
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.