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Congenital heart disease in adult patients
Cardiopulmonary exercise testing and sports participation in adults with congenital heart disease
  1. Jonathan Buber1,
  2. Keri Shafer2,3
  1. 1 Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
  2. 2 Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
  3. 3 Division of Cardiology, Brigham and Women’s Hospital, Boston, MA, United Startes of America
  1. Correspondence to Dr Jonathan Buber, University of Washington Medical Center, Seattle, WA 98195, USA; bubery{at}

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Learning objectives

  • Describe the key role of objective evaluation of exercise capacity as part of the routine clinical follow-up in adult congenital heart disease (ACHD) patients.

  • List-specific advantages of cardiopulmonary exercise testing in ACHD patients and recognise the unique exercise patterns associated with common congenital heart defects.

  • Outline possible advantages of routine physical activity across the spectrum ACHD patients while recognising potential caveats for specific lesions.

Patient presentation

Malcolm is a 35-year-old patient followed at a safety net hospital. He describes growing up with limited resources both in his family and at his school. As the child of a single mother, his afternoons were often spent hanging out in his neighbourhood. He recalls that there were two options ‘basketball or gangs’. Because of his complex congenital heart disease, he was not allowed to play sports and his exercise capacity was never evaluated. Now, 20 years later, he feels that was a turning point in his life which ultimately resulted in a 5-year incarceration for weapons charges. ‘I loved basketball and not playing made me angry and feel different. I made my own choices, but playing would have made a huge difference’. Malcolm has his life back on track now, but providers have a responsibility to ensure that kids like him have providers who consider their whole lives and the lifelong impact of their recommendations. Restriction is not only a physical limitation. It affects patient’s self-perception, acceptance and psyche. Thus, providers must consider the risks of not playing sports versus that of playing, and recommend level of activity based on objectively obtained data.


The benefits of exercise are well known to most patients and providers. Due to exercise restrictions placed of patients with congenital heart disease (CHD) as well as concerns for exercise-related morbidity and mortality, many providers and patients are uncertain on ways to …

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  • Contributors Both YB and KS contributed to the planning, conduct and reporting of the work described in the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Patient consent for publication Not required.