Congenital Heart Defects and Physical Activity

female leaving house with yoga mat

Exercise is for everyone

Physical exercise has many benefits and should be a regular part of almost anyone's life. That includes most people with congenital heart disease. Research on patients with congenital heart disease, even complex disease, has shown that routine moderate exercise is safe and can be beneficial. That's why we recommend that almost all patients do some form of regular physical activity.

There are a few exceptions, so it's good to talk to your physician about your specific situation. Most physicians will advise caution to a patient with an enlarged aorta, which is the major artery in the body. An enlarged aorta can occur in people with Marfan syndrome, Turner syndrome, coarctation of the aorta, or a bicuspid aortic valve. There is no proven link between exercise and harmful outcome from an enlarged aorta, but many physicians feel that such patients shouldn't engage in strenuous exercise, particularly activity that involves straining or grunting like heavy weight lifting.

It's likely that for most patients, the benefits of exercise outweigh the perceived risks. Low-intensity activity is still preferred. If you have any questions about the appropriateness of exercise for you, talk to your doctor.

If you've been inactive for a long time and want to start a regular exercise routine, it's often wise to talk with your doctor about how to get started safely. Your doctor may recommend an exercise test which can provide you with guidelines for exercise.

What types and how much?

The best and safest types of exercise are "aerobic" activities. These increase the heart rate and make you breathe heavily. Examples include brisk walking, swimming, biking, jogging, rowing, cross-country skiing, hiking or stair climbing. Team or court sports such as basketball, soccer, football, tennis, squash and volleyball are also aerobic activities.

A good rule of thumb is to increase your activity so you breathe hard and fast but can still carry on a conversation with someone. If you can speak in full sentences but still feel your heart pounding, you're likely benefiting from a safe level of activity.

Often patients are trained to check their heart rate during or immediately after activity. Their target heart rate is 70-80 percent of their predicted maximal heart rate (defined as 220 minus age).

It's best to avoid activities that cause grunting or straining (medically referred to as a "valsalva maneuver"). This happens when a person bears down against a closed throat to increase the strength of arm or abdominal muscles. There's often a tendency to do this when lifting heavy weights, doing sit-ups, push-ups or chin-ups, etc., but it may be harmful. Straining causes a sudden rise in blood pressure, which adds strain on the heart; it increases the pressure in the lungs, which can affect blood flow from the body into the lungs; and it often means there's more force on the chest wall, and many congenital heart patients have surgical scars in the chest that can be damaged, particularly in the first year after surgery.

Intensely physical sports such as football, boxing or hockey may increase the chance for injury and unnecessary strain on the cardiovascular system.

Any amount of activity is better than none, and the more physically active a person is, the greater the anticipated cardiovascular benefit. Guidelines for the general population suggest at least 150 minutes of moderate intensity aerobic activity per week. This is a good target for congenital heart patients too. If it seems like too much, start with a more modest goal and build from there.

Learn more about the benefits of physical activity and how to get started.