Exercise Counseling in Congenital Heart Disease: A Guide for the Pediatric and Congenital Cardiologist

Tracy Curran, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. tracy.curran@cardio.chboston.org.
Katherine Hansen, Heart Center, Division of Cardiology, Department of Pediatrics, Children's Health, UT Southwestern Medical Center, Dallas, TX, USA.
Jennifer Lindsey, Division of Cardiology, Inova L.J. Murphy Children's Hospital, Falls Church, VA, USA.
Adam Powell, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Naomi Gauthier, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Jolie Britt, Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Jennifer Huang, Division of Pediatric Cardiology, Oregon Health and Science University, Portland, OR, USA.
Michael Danduran, Program in Exercise Physiology, Marquette University, Milwaukee, WI, USA.
Jared Hershenson, Division of Cardiology, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Matthew Furst, Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, FL, USA.
Ryan Closson, Division of Cardiology, Inova L.J. Murphy Children's Hospital, Falls Church, VA, USA.
Elisabeth Leong, Division of Pediatric Cardiology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Kendra Ward, Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Document Type

Journal Article

Publication Date

11-6-2025

Journal

Pediatric cardiology

DOI

10.1007/s00246-025-04085-z

Keywords

Congenital heart disease; Exercise cardiology; Exercise counseling; Exercise prescription; Exercise promotion; Pediatric fitness

Abstract

Exercise is a critical determinant of both immediate and long-term health for individuals with congenital heart disease (CHD). While pediatric cardiologists increasingly recognize the importance of promoting physical activity, formal training in exercise counseling remains limited. Exercise cardiology is an evolving subspecialty, with growing educational and training opportunities for congenital cardiologists to develop diagnostic and therapeutic approaches and expand access to exercise resources for patients with CHD. As part of this effort, the Global Coalition for Fitness and CHD (GloCo) convened a multi-institutional Education Working Group to develop practical, evidence- and consensus-based guidance for exercise counseling in children, adolescents, and young adults with CHD. This guide outlines foundational elements of exercise counseling, including strategies for obtaining an exercise history, performing cardiac risk assessments, shared decision-making, and tailoring exercise recommendations to individual patient needs. Exercise counseling in CHD must be personalized, taking into consideration the patient's medical status, psychosocial context, and available resources. Core components include risk assessment through multimodal imaging, rhythm monitoring, and exercise assessment, including but not limited to cardiopulmonary exercise tests. Based on these evaluations, clinicians can provide or recommend general physical activity promotion, formal exercise prescriptions, or structured programs such as cardiac fitness and rehabilitation. Importantly, the aim is not simply meeting physical activity targets but fostering positive attitudes toward lifelong exercise and instilling the confidence to sustain it. By aligning exercise plans with patient and family preferences, motivations, goals, and resources, clinicians can promote sustainable engagement and improved overall fitness. This guide aims to support pediatric and congenital cardiologists in providing safe and effective exercise counseling to their patients with CHD to help them achieve optimal physical and psychosocial well-being.

Department

Pediatrics

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