Cardiac Rehabilitation in Adults with Congenital Heart Disease

Abstract

Adults with congenital heart disease represent a small but growing population of patients presenting for cardiac rehabilitation. An approach to clinical assessment of these patients prior to commencing cardiac rehabilitation is discussed. Methods to evaluate exercise capacity are reviewed. Aerobic capacity is significantly reduced in adult congenital heart disease patients and is related to prognosis. Exercise prescription based on the FITT principle is discussed. Benefits of moderate continuous aerobic training versus high-intensity interval training are compared. Testing muscular strength and endurance are described, and resistance training in congenital heart disease is discussed. Evidence for exercise training on improving exercise capacity in congenital heart disease is reviewed. Spontaneous physical activity is reduced, with most adult congenital patients not achieving the World Health Organization’s (W.H.O.) recommendations for daily physical activity and correspondingly having excessive sedentary time. Comprehensive cardiac rehabilitation programs should include formal exercise training as well as physical activity counseling to improve exercise capacity, reduce the risk of coronary artery disease, and ultimately reduce morbidity and mortality in patients with congenital heart disease.