Safety of physical sports and exercise in ACHD

An active lifestyle, including regular physical activity, is an important component of long-term health and wellbeing, including in patients with adult congenital heart disease (ACHD). In the past, however, safety concerns regarding ACHD patients engaging in exercise have led to overly restrictive advice from specialists. Over the past few decades, it has become clear that the vast majority of patients with ACHD can exercise safely within their own limits; moreover, exercise capacity is highly variable between patients and should be measured objectively when possible.Cardiopulmonary exercise testing (CPET) is an essential part of ACHD surveillance and provides an integrative assessment of the cardiovascular, respiratory and muscular response to exercise. It allows an objective assessment of exercise tolerance, identification of the extent and mechanisms of exercise limitations, monitoring of disease progression and forms the basis of exercise prescription. Exercise prescription in ACHD patients ideally follows evaluation in an expert center, incorporating clinical assessment and exercise testing, to identify specific risk factors for adverse events during exercise and allow individualized recommendations of safe limits for exercise. In cases where specific risks exist, the intensity of exercise should be adjusted with respect to its dynamic and static components. The exercise prescription should then be reviewed regularly and amended as risk factors emerge or are successfully treated.This review highlights the benefits of physical activity in ACHD patients and discusses the main parameters that influence the risk of certain forms of exercise in some patients. CPET and exercise prescription for noncompetitive sports are also discussed.