If you're a parent of a child with congenital heart disease (CHD), it's understandable to be afraid of taxing your child's heart.
Historically, doctors and parents have been hesitant to encourage activity and exercise for children who have CHD. But a growing number of pediatric cardiologists are trying to change that, including Katie Hansen, M.D., Pediatric Cardiologist at Children's Health℠ and Assistant Professor at UT Southwestern.
"In pediatric cardiology, we used to think it was best for those with CHD to avoid exercise because we didn't want them to put stress on their heart. We're learning more and more that we don't have great evidence to make broad restrictions and that limiting a child or teen's physical activity doesn't benefit them – in the short term or in the long term," Dr. Hansen says.
Dr. Hansen believes that there are forms of exercise that are safe for everybody and that an individualized approach to promoting exercise is essential. She's on a mission to make sure kids and parents know just how much being active helps kids thrive – including kids with CHD.
Is it safe for a child with CHD to exercise or play sports?
Yes, Dr. Hansen stresses that every child can find a safe way to exercise – and that the benefits generally outweigh the risks. Some children with CHD may have no problem playing a competitive sport. But others may need to set some limits around how much and what types of activity they do. She encourages families to periodically check with their child's cardiologist to make sure they know what's on and off limits for their child.
Here are a few examples of possible heart defects or conditions that may have limitations:
- Children who have pediatric dilated aorta caused by connective tissue disorder may need to avoid strenuous weightlifting.
- Children with certain types of arrhythmias, aortic dilation, coronary artery abnormalities or low oxygen saturations may need to avoid high-intensity activities.
- Children with implanted devices or who take anticoagulants (blood thinners) may need to avoid contact sports.
Call your child's health care provider if they experience any of the following symptoms during exercise or after:
- Chest pain
- Dizziness or lightheadedness during exercise
- Irregular, fast or pounding heartbeats (palpitations)
- Leg swelling
- Nausea or vomiting
- Shortness of breath or fatigue that doesn't go away after exercise
What are the benefits of exercise for kids with CHD?
Whether a child has CHD or not, regular physical activity is an important part of overall health. Being active not only improves a child's physical health, it also offers cognitive and emotional benefits such as improving attention span and mental well-being.
Kids who are active have a greater chance of feeling good day-to-day and being ready for life's inevitable challenges.
Research shows that kids who are active experience:
- Lower risk of overweight and obesity
- Lower risk of type 2 diabetes
- Lower risk of high blood pressure
- Lower risk of depression and anxiety
- Improved mood
- More body confidence
- Lower levels of stress
- Improved self-esteem
- Greater mental strength and resilience
- Better sleep
There are also certain exercises that can offer targeted benefits to kids who have CHD.
Aerobic exercise
Research shows that kids with CHD who engage in regular aerobic exercise – or any exercise that increases your heart rate – have a decreased need for future hospitalizations for heart problems.
Your heart's a muscle just like any other muscle. And it's important to strengthen that muscle – particularly for kids who have CHD.
While medication can play an important role in treating CHD, it's not a substitute for exercise. There have been several studies looking at the effect of medications compared to exercise training on patients' ability to exercise. And they've found that exercise works as well or better than medication to improve fitness.
Muscle-strengthening exercises
Muscle strengthening exercises include activities like weightlifting, pushups, squats and lunges. While these exercises generally help to improve the strength, power and endurance of muscles, they also offer specific benefits that may improve the quality of life for kids with certain health conditions. These benefits include:
- Developing and improving foundational motor skills
- Coordinating different groups of muscles for those who may struggle with everyday activities
- Improving blood flow to the heart and throughout the body (especially helpful for kids who have a single ventricle)
How much exercise should my child with CHD get?
The American Heart Association (AHA) outlines these daily activity recommendations for all kids, which also applies to most kids with CHD:
- Kids ages 3 to 5: 3 hours of active play every day
- Kids age 6 to 17: 1 hour of moderate to vigorous activity every day, plus muscle strengthening 3 times a week
But Dr. Hansen believes that any physical activity is better than none.
"It's okay not to meet the full recommendations. Just taking steps in the right direction is great. Everything counts, including taking the stairs instead of the elevator," Dr. Hansen says.
While younger kids can get a lot of activity through unstructured play, older kids often need more guidelines and structure. Here are a few tips on how to motivate your child to exercise.
Setting exercise goals for kids with CHD
Not every kid with CHD will be like five-time Olympic gold medalist in half-pipe snowboarding, Shaun White, who was born with tetralogy of Fallot. But anyone can set goals and work towards them.
"The end goal may or may not be playing a team sport. What's more important is to develop the skills and habits of being active and to set goals. I encourage kids and families to be open-minded and find something that feels fun or has a social aspect, like a dance or fitness class," Dr. Hansen says.
Goals for children with CHD can widely vary, including:
- Having the strength to open a jar of jam after weeks of being on ECMO
- Being able to climb the two flights of stairs at school without getting winded
- Going on regular walks
- Doing fun at-home exercises together as a family
- Being able to participate in an after-school sports program
- Returning to the swim team after having restrictive cardiomyopathy
Kids who have CHD need the chance to overcome challenges, just like other kids. It's so powerful to see a parent watch their kid work towards and meet their goals, get stronger and be able to do things they never thought they could do. Setting exercise goals and building habits to get to those goals provides kids that opportunity.
How could my child with CHD benefit from an exercise cardiologist?
The field of pediatric exercise cardiology is growing, as more and more people realize just how many ways a child with CHD can benefit from being active. But still, only 1 in 5 children with CHD get medical advice on physical activity.
"General cardiologists have to fit so much into a regular visit. It can be hard for them to really dive into exercise and exercise habits. But during a visit that's focused purely around activity, I can explore exercise history, fears, obstacles, resources – everything that might contribute to a child's ability to develop healthy exercise habits and experience the social, emotional and physical benefits," Dr. Hansen says.
Dr. Hansen is excited about a growing body of research to learn more about certain conditions that could help her further tailor activity recommendations – and help more children with CHD thrive well into adulthood.
"I want to help kids build a narrative about themselves as someone who's been through something incredibly hard and to see that as one of their superpowers. By reaping all the benefits of an active life, I want to help them see themselves as the hero of their own story," Dr. Hansen says.
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As one of the nation's top pediatric cardiology programs, our compassionate experts at The Heart Center at Children's Health care for all children's heart conditions, from congenital heart defects to heart disease.
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