Exercise With Congenital Heart Disease: What's Allowed

• Exercise With Congenital Heart Disease: What Current Guidance Actually Allows

Many adults with congenital heart disease grew up on the sidelines. "No contact sports." "Don't push yourself." "Sit this one out." That advice was given with care, often at a time when less was known. For many people, it's still quietly shaping how they move decades later.

The guidance has changed, and for most people, it's changed in favour of moving more.

Here is the short answer. Most adults with congenital heart disease can and should exercise regularly. Current guidance has moved away from blanket restrictions toward individual exercise prescriptions, often guided by a cardiopulmonary exercise test. A few conditions, such as pulmonary hypertension, a dilated aorta or certain rhythm problems, need specific limits, which is why the plan should come from your ACHD team.

Movement also works on the shared root that congenital hearts have in common with heart attack survivors: oxidative stress and chronic low-grade inflammation (see one inflammation, three hearts).

简短的答案： 很多先心病成人是在场边长大的：「不能做对抗性运动」「别太拼」「这次你就坐着吧」。这些建议出于关心，而且往往来自了解较少的年代，但几十年后它们仍在悄悄影响很多人的活动方式。指南已经改变，对大多数人来说，是朝着多运动的方向改变。大多数先心病成人可以、也应该规律运动；现行指南从一刀切的限制转向个体化运动处方，常以心肺运动试验为依据；少数情况——肺动脉高压、主动脉扩张或某些心律问题——需要特定限制，所以计划应由 ACHD 团队制定。运动也作用于先天性心脏与心梗幸存者共有的根源：氧化应激与慢性低度炎症。

Why exercise matters with congenital heart disease

Exercise capacity is often lower than it should be. In a landmark study, peak oxygen uptake was reduced across every major type of adult congenital heart disease, including in many people who reported no symptoms, and lower capacity predicted a higher risk of hospitalisation or death (Diller et al., Circulation, 2005).

Part of that gap is the heart itself. Part is years of inactivity, which is something that can change. In a systematic review, exercise training programmes in children and young adults with congenital heart disease improved exercise capacity without reported serious adverse events (Duppen et al., International Journal of Cardiology, 2013). Regular activity also helps with the acquired risks that come with age, such as blood pressure, weight, blood sugar and mood, and with the fatigue many adults live with (see fatigue in congenital heart disease).

The American Heart Association encourages physical activity for most children and adults with congenital heart disease (Longmuir et al., Circulation, 2013).

为什么先心病成人需要运动： 运动能力往往低于应有水平：一项里程碑研究中，各主要类型成人先心病的峰值摄氧量都下降，包括很多自述无症状的人，且运动能力越低，住院或死亡风险越高（Circulation 2005）。部分差距来自心脏本身，部分来自多年的少动，而后者是可以改变的：系统综述显示，儿童和年轻成人先心病患者的运动训练改善了运动能力，未报告严重不良事件（Int J Cardiol 2013）。规律活动也有助于应对随年龄而来的获得性风险——血压、体重、血糖和情绪——以及很多人长期面对的疲劳。美国心脏协会鼓励大多数先心病儿童和成人进行体育活动（Circulation 2013）。

From blanket restrictions to individual prescriptions

Modern guidance treats exercise like any other part of congenital heart care: individualised. A European Society of Cardiology consensus document recommends basing exercise and sports participation on an assessment of five things (Budts et al., European Heart Journal, 2020):

• Ventricular function: how well the pumping chambers work.

• Pulmonary artery pressure: whether pulmonary hypertension is present.

• Aortic size: whether the aorta is enlarged.

• Arrhythmia: current rhythm problems and their risk with exertion.

• Oxygen saturation: at rest and during exercise.

A cardiopulmonary exercise test (CPET) brings much of this together, measuring how heart, lungs and muscles work under effort. It helps your team set a safe intensity and often shows people they can do far more than they were told as children.

从一刀切的限制到个体化处方： 现代指南像对待先心病照护的其他部分一样对待运动：个体化。

欧洲心脏病学会的共识文件建议根据五项评估来决定运动和体育参与（Eur Heart J 2020）：心室功能——泵血腔室工作得如何；肺动脉压——是否有肺动脉高压；主动脉大小——是否扩张；心律失常——现有心律问题及运动时的风险；血氧饱和度——静息和运动时。

心肺运动试验（CPET）把其中很多项整合在一起，测量心、肺和肌肉在用力时如何协同工作，帮助团队设定安全强度，也常常让人发现自己能做的远比小时候被告知的多。

Which conditions need extra care?

Some situations call for specific limits or closer supervision. The table below summarises common ones; your ACHD team will tailor the details:

• Pulmonary arterial hypertension or Eisenmenger syndrome: strenuous and competitive exercise is usually avoided; gentle, supervised activity may still be encouraged.

• Dilated aorta (aortopathy), including some bicuspid valves, coarctation and connective tissue conditions: heavy lifting and straining that spike blood pressure are usually limited.

• Arrhythmias, pacemakers or ICDs: activity is often fine, but collision sports may be limited to protect the device, and some rhythms need specific guidance.

• Anticoagulation: contact and collision sports carry bleeding risk.

• Fontan circulation: regular aerobic and strength exercise is often encouraged, with attention to hydration, heat and altitude.

• Cyanosis: oxygen levels may drop with exertion, so intensity needs individual setting.

哪些情况需要额外注意： 一些情况需要特定限制或更密切的监督，下表总结常见情况，细节由 ACHD 团队调整：

• 肺动脉高压或艾森门格综合征——通常避免剧烈和竞技运动，但可能仍鼓励温和、有监督的活动；

• 主动脉扩张（包括部分二叶式主动脉瓣、缩窄和结缔组织疾病）——通常限制让血压骤升的大重量和憋劲动作；

• 心律失常、起搏器或 ICD——活动通常可以，但可能限制碰撞类运动以保护设备，部分心律需要专门指导；抗凝——接触和碰撞类运动有出血风险；

• Fontan 循环——常鼓励规律的有氧和力量运动，注意补水、高温和高原；

• 发绀——运动时血氧可能下降，强度需个体设定。

How to get a safe exercise plan

1. Ask your ACHD team directly: "What kind of exercise, and how hard, is right for my heart?" If the answer is still "take it easy", ask whether a CPET would help set specific targets.

2. Start with aerobic activity most days: walking, cycling, swimming or similar, at a level where you can talk but not sing.

3. Add strength training two days a week with light to moderate weights and steady breathing, unless your team has advised otherwise for your aorta or rhythm (the breathing and effort principles in strength training after a heart attack apply here too).

4. Build gradually and keep a simple log of what you did and how you felt.

5. Know your stop signs: chest pain, fainting or near-fainting, unusual breathlessness, palpitations, or bluer lips or fingers than usual. Stop, and seek urgent care if they're severe.

如何得到安全的运动计划：

① 直接问 ACHD 团队：「什么样的运动、多大强度适合我的心脏？」如果答案仍是「悠着点」，问问做 CPET 能否帮助设定具体目标。

② 大多数日子从有氧活动开始：步行、骑车、游泳等，强度以能说话但不能唱歌为准。

③ 每周两天加入力量训练，轻到中等重量、平稳呼吸，除非团队因主动脉或心律另有建议（呼吸和用力原则与心梗后力量训练相同）。

④ 循序渐进，简单记录做了什么、感觉如何。

⑤ 了解停止信号：胸痛、晕厥或近乎晕厥、异常气短、心悸、嘴唇或手指比平时更发紫——立即停止，严重时紧急就医。

ACHD special considerations

Many adults with a Fontan circulation or heart failure have a fluid limit, so hydration for exercise needs to fit within it, especially in heat. Many take anticoagulants, which changes the safety of contact sports. Endocarditis prevention matters for many repaired hearts. Rhythm problems and cyanosis change what intensity is safe. And pulmonary hypertension changes everything about exercise planning. Your ACHD team's guidance overrides any general advice, including ours.

ACHD 特别注意： 很多 Fontan 循环或心衰患者需要限制液体，运动补水也必须控制在限额内，高温时尤其注意；很多人服用抗凝药，这会改变接触类运动的安全性；很多修复后的心脏需要预防心内膜炎；心律问题和发绀会改变安全强度；肺动脉高压则会改变运动计划的一切。你的 ACHD 团队的指导高于任何通用建议，包括我们的。

How Healos™ supports adults with congenital heart disease

Healos™ helps turn an exercise prescription into a habit between appointments. The 91-Day Protocol moves through Clear, Replenish and Repair, three sequenced stages of complementary cellular nutrition and lifestyle support, with check-ins at days 30, 60 and 91 that track activity, energy and sleep in a summary for your ACHD team. Sovereign Monthly · Protect continues that support month to month and can be cancelled any time. Neither replaces your team's exercise prescription.

Healos™ 如何支持先心病成人： Healos™ 帮助把运动处方变成复诊之间的习惯：91 天方案依次经过减负、补给、修复，提供辅助的细胞级营养与生活方式支持，并在第 30、60、91 天追踪活动、精力和睡眠，整理成给 ACHD 团队的摘要；Sovereign Monthly · Protect 按月延续支持，可随时取消。两者都不替代团队的运动处方。

The bottom line

If you were told as a child to sit things out, it's worth asking again. For most adults with congenital heart disease, regular exercise is safe, recommended and one of the best ways to improve energy and long-term heart health. A few conditions need specific limits, and a CPET-guided prescription from your ACHD team is the best way to find yours.

结论： 如果你小时候被告知要坐在场边，值得再问一次。对大多数先心病成人来说，规律运动安全、被推荐，而且是改善精力和长期心脏健康的最佳方式之一。少数情况需要特定限制，而 ACHD 团队基于 CPET 的运动处方，是找到适合你的方式的最好途径。

Frequently asked questions

Can I exercise with congenital heart disease? Most adults with congenital heart disease can and should exercise regularly. Current guidance favours individual exercise prescriptions over blanket restrictions, often guided by a cardiopulmonary exercise test.

Can people with a Fontan circulation exercise? Regular aerobic and strength exercise is often encouraged for people with a Fontan circulation, with attention to hydration within any fluid limit, heat and altitude. Your ACHD team will set the intensity.

Should I avoid weightlifting with a bicuspid valve or dilated aorta? If your aorta is enlarged, heavy lifting and straining that spike blood pressure are usually limited. Lighter weights with steady breathing may be fine; ask your ACHD team about your aortic size and safe limits.

Which conditions need the most caution? Pulmonary arterial hypertension and Eisenmenger syndrome need the most caution, along with significant aortic dilation, some arrhythmias, devices such as ICDs, anticoagulation for contact sports and cyanosis.

How do I get an exercise prescription for ACHD? Ask your ACHD team what type and intensity of exercise is right for you, and whether a cardiopulmonary exercise test could help set specific targets.

常见问题：

1. 先心病成人可以运动吗？大多数可以也应该，现行指南倾向个体化处方，常以 CPET 为依据。

2. Fontan 患者能运动吗？常鼓励规律有氧和力量运动，注意液体限额内补水、高温和高原，强度由团队设定。

3. 二叶瓣或主动脉扩张要避免举重吗？主动脉扩张时通常限制大重量和憋劲动作，轻重量平稳呼吸可能可以，请问团队。

4. 哪些情况最需谨慎？肺动脉高压和艾森门格最需谨慎，还有明显主动脉扩张、部分心律失常、ICD 等设备、抗凝者的接触运动和发绀。

5. 怎么获得运动处方？问 ACHD 团队适合的类型和强度，以及是否需要 CPET。

References

1. Diller GP, et al. Exercise intolerance in adult congenital heart disease: comparative severity, correlates, and prognostic value. Circulation. 2005;112(6):828–835.

2. Budts W, et al. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document from the Exercise, Basic & Translational Research Section of the European Society of Cardiology. European Heart Journal. 2020;41(43):4191–4199.

3. Longmuir PE, et al. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation. 2013;127(21):2147–2159.

4. Duppen N, et al. Systematic review of the effects of physical exercise training programmes in children and young adults with congenital heart disease. International Journal of Cardiology. 2013;168(3):1779–1787.

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