Pediatric Physical Activity Promotion, Exercise Therapy, and Cardiac Rehabilitation

The field of pediatric cardiology historically focused on exercise restriction due to perceived safety concerns with relatively little attention paid to physical activity promotion. Over time, the care of pediatric patients with congenital, acquired, and arrhythmic heart disease has evolved. With better survival and refined risk stratification, providers now also aim to improve patient quality of life and long-term health. Physical activity can improve both. Regular exercise participation supports physical, mental, and social health throughout the lifespan. Lifestyle habits that impact health develop at a young age. Exercise counseling should be part of every pediatric heart disease patient’s care. Some patients with more complex congenital heart disease, heart failure, arrhythmias and/or additional comorbidities may benefit from formal exercise consultation, evaluation, and prescription with input from appropriate specialists. Pediatric cardiac rehabilitation formalizes the exercise program and has been shown to be safe and effective at improving cardiorespiratory fitness in youth with heart disease. This chapter discusses how to promote safe and appropriate physical activity for all children, adolescents, and young adults with heart disease.