|General Exercise and Training Guidelines on Common Defects
IMPORTANT! Anyone with congenital heart disease, repaired or non-repaired, should consult with their cardiologist about physical activity to review the risks.
Anomalous Pulmonary Venous Return - Total
Moderate levels of activity are usually tolerated well, but careful exercise testing is important before setting limits. This should be done periodically as there may be a decline in tolerance over time. On the whole, exercise should be restricted to moderate levels of intensity and duration, especially if atrial arrhythmias or other conduction anomalies are present.
There are no restrictions for patients with mild stenosis and acceptably low blood pressure. If there are signs of left ventricular hypertrophy (thickening of the ventricle walls) or arrhythmia in conjunction with moderate stenosis, then the patient should be confined to moderate levels of isotonic exercise and should avoid isometric exercise. Severe stenosis precludes participation in athletics or intensive exercise because of the risk of fainting (syncope) or sudden death. Those patients who have moderate stenosis should be carefully monitored as a progression to more severe stenosis, which could be dangerous in competitive sports, can be quite rapid.
People who underwent repair of isolated aortopulmonary window during childhood may expect normal life expectancy and no restrictions in their activities. Safe levels of activity for patients who received treatment later in life will depend on whether pulmonary hypertension, pulmonary vascular obstructive disease (PVOD), or Eisenmenger Complex are present. Safe levels of exercise should be determined by consultation with your cardiologist.
Atrial Septal Defects (Secundum)
After repair, normal physical activity may be pursued as long as pulmonary artery blood pressure remains acceptably low. However, restrictions in exercise will be necessary if the right ventricle is significantly enlarged, if there is pulmonary hypertension, and/or if there is untreated arrhythmia.
Atrioventricular Canal Defect
After repair, normal physical activity may be pursued as long as there are no significant residual problems, such as dysfunctional valves or subaortic stenosis. The patient should receive regular checkups throughout life to monitor any changes. Restrictions in exercise will become necessary if arrhythmias develop. Also, testing is important to ensure that the heart rate remains normal during periods of exertion.
Coarctation of the Aorta
Particularly in cases where this defect is repaired late in life, there may be a reduced elasticity in the aorta between the heart and the site of the coarctation. This may result in increased blood pressure during physical activity, especially with isotonic exercises such as weight lifting. For this reason, it is important for patients to be tested in order to determine safe levels of exercise.
After repair, normal physical activity may be pursued as long as there are no significant residual problems, such as arrhythmias. The patient should receive regular checkups throughout life to monitor any changes. Restrictions in exercise will become necessary if arrhythmias develop. Also, testing is important to ensure that the heart rate remains normal during periods of exertion.
The patient with Eisenmenger Complex will experience some limitations in physical activity because of fatigue and/or breathlessness during exercise (dyspnea). In addition, care should be taken to avoid circumstances that expose the patient to heat for prolonged periods, the risk of dehydration, or high altitudes. Testing will be necessary to determine safe levels of exertion.
Because of the incidence of sudden death during athletic performance, competitive sports or other highly exertive activities are not recommended. Low blood pressure (hypotension) may be dangerous for the patient with this abnormality. Therefore, excessive loss of body fluids from dehydration should be avoided. Hot baths and saunas may also pose risks.
Isometric exercise (load bearing or maintaining a specific posture without very much movement of the limbs) and contact sports should be avoided by the Marfan patient. Rupture of the aorta or aortic root are the main dangers with this defect, so activities that involve pressures on or impacts to the chest could be dangerous.
Patients with mitral stenosis should avoid contact sports and other forms of strenuous activity. It is important that they be tested regularly to determine safe levels of exercise.
Patent Ductus Arteriosus
People with small "silent ductus" PDAs and those who underwent repair during childhood can expect normal life expectancy and no restrictions in their activities. Patients with untreated medium-sized or large PDAs will experience some limitations in physical activity because of fatigue and/or breathlessness during exercise (dyspnea). The development of symptoms from larger PDAs, such as left heart enlargement and arrhythmias or pulmonary hypertension, will impose restrictions on activity. Safe levels of exercise should be determined through testing.
Physical limitations will vary depending on the individual patient and the surgical treatment strategy that was followed. Fatigue and/or breathlessness during exercise (dyspnea) may be experienced, and arrhythmias or other symptoms may develop that will restrict forms and degrees of exertion. As with other cardiac diseases, testing will be necessary to determine safe levels of exercise for the patient with pulmonary atresia.
Testing is imperative for patients with high pulmonary pressure because exercise may lead to fainting (syncope) or sudden death. Mild forms of exercise are usually tolerated, however.
There are no exercise restrictions for patients with mild stenosis, or for those in whom treatment has reduced the obstruction to acceptably low levels. If the stenosis is moderate to severe, then treatment should be obtained before pursuing unrestricted physical activity or engaging in contact sports. Regular testing is necessary to ensure that the obstruction remains low.
Single Ventricle Defects
Moderate levels of activity may be tolerated, but careful exercise testing is important before setting limits and extreme exertion and dehydration should be avoided. The effects of the Fontan operation on the performance of the lungs and on the anatomy of the thorax may also be factors in determining safe levels of exercise. If a patient has been prescribed the anticoagulant warfarin, contact sports should be avoided as they may lead to serious injury.
Tetralogy of Fallot
Those patients with unoperated Tetralogy of Fallot are usually fairly limited in their exercise capacities. The patient who has received effective treatment for this anomaly, in which both ventricles are functioning properly and hemodynamics (blood pressures and saturation of oxygen and other gases) are near normal, may have few exercise restrictions. However, their risk of sudden death needs to be determined before participation in competitive athletics.
Several variables concerning this defect make it imperative that the patient receives regular testing. The presence of residual defects or abnormal hemodynamics will lower the limits of safe exercise. Also, some symptoms may develop over time (e.g. arrhythmias and an increase in the size of the right ventricle) that will affect the tolerance for and safety of strenuous exercise. The age at which the repair operation was performed is a significant factor because the longer the pressure on the right ventricle remained high, the less tolerance for exercise there is likely to be.
Transposition of the Great Arteries D-Type
Tolerance for exercise depends on the type of repair the patient received. Those with arterial switches have a fairly normal heart and therefore should be able to do most forms of exercise. Sometimes during growth, however, the coronary arteries may become kinked or narrowed. Therefore, exercise testing is usually recommended before allowing truly competitive sports.
Those with an atrial baffle (Mustard or Senning) are much more at risk of arrhythmias or hypotension (low blood pressure) during exercise and therefore should be watched much more carefully and perhaps limited to moderate exercise only. Some of these also have pulmonary hypertension.
Transposition of the Great Arteries L-Type
Patients who have received successful surgical treatment can usually lead normally active lives. Safe levels of physical exertion will be determined through exercise testing and regular check-ups to monitor heart function. Strenuous isometric exercise (load bearing or maintaining a specific posture without very much movement of the limbs) is discouraged as it may strain the tricuspid valve and cause regurgitation to occur. Because of the risk of late-developing symptoms, regular medical examination is imperative.
Patients who have received successful surgical treatment can usually lead normally active lives. Safe levels of physical exertion will be determined through exercise testing and regular check-ups to monitor heart function. Because of the risk of late-developing symptoms, regular medical examination is imperative.
Ventricular Septal Defects
Patients with very small VSDs and those who had VSD repairs in early childhood normally have no exercise restrictions. Those who had VSD closure later in life should be tested to determine safe levels of exercise. Individuals with more significant VSDs and/or secondary pulmonary hypertension (Eisenmenger Complex) should be limited to mild isotonic exercise and should avoid isometric exercise (load bearing or maintaining a specific posture without very much movement of the limbs) completely.