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Cochrane corner: Physical activity interventions for people with congenital heart disease
  1. Curtis A Wadey1,
  2. Guido Pieles2,
  3. Graham Stuart2,
  4. Rod Taylor3,
  5. Linda Long4,
  6. Craig A Williams1
  1. 1 Children's Health and Exercise Research Centre, University of Exeter College of Life and Environmental Sciences, Exeter, Devon, UK
  2. 2 National Institute of Health Research (NIHR) Cardiovascular Biomedical Research Centre, bristol heart Institute, Bristol, UK
  3. 3 MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
  4. 4 Institute of Health Research, University of Exeter Medical School, Exeter, Devon, UK
  1. Correspondence to Professor Craig A Williams, Children's Health and Exercise Research Centre, University of Exeter, Exeter EX1 2LU, UK; C.A.Williams{at}

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Congenital heart disease (ConHD) represents 1% of global births (95% CI 0.86% to 1.02%), and due to improved medical care, long-term survival rates have substantially improved, leading to growing ConHD populations across the life span.1 2 People with ConHD can have reduced cardiorespiratory fitness (CRF), health-related quality of life (HRQoL) and physical activity (PA) levels when compared with healthy populations. This is important because CRF has been significantly associated with future mortality and morbidity in healthy and ConHD populations.3 4


There is currently no high-level evidence evaluating the effect of exercise in patients with ConHD. To inform current practice and policy, we therefore sought to undertake a systematic review and meta-analysis of randomised controlled trials (RCTs) to assess the effectiveness and safety of all types of PA interventions in people with ConHD.5



A search was performed through to September 2019 in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL, AMED, BIOSIS, Web of Science, LILACS and DARE.

Study selection

We included any type of RCT that compared a PA intervention to a usual care (no PA) comparator. We included all types of interventions, all settings (hospital and home) and both paediatric (5–18 years old) and adult (>18) populations. Our outcomes of interest were maximal and submaximal CRF, HRQoL, PA, muscular strength, hospital admissions during follow-up, time off work/education and any adverse events (AEs), although these did not limit study inclusion.

Data extraction and risk of bias (RoB) assessment

Data extraction and RoB assessment were carried out independently by two authors. We used piloted data extraction templates and assessed study RoB using the revised Cochrane RoB 2 tool. Any disagreements were resolved by consensus and decisions were independently checked by a third author.

Data analysis

Where possible, study outcomes were pooled using meta-analysis. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess …

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  • Contributors Abridged version: CAWa wrote the first draft and created the summary figure. Full review: CAWi and CAWa independently completed title and abstract screening, full text review, risk of bias assessments, data extraction and Grading of Recommendations Assessment, Development, and Evaluation. CAWi cowrote the manuscript. CAWa performed statistical analyses, produced the summary of findings table and cowrote the manuscript. GP and GS gave specialist clinical insight into the literature and population with congenital heart disease. RT designed and carried out the statistical analyses and arbitrated any discrepancies. LL was the lead author overseeing the project and arbitrated any discrepancies. All authors contributed to the peer review and agreed on the final version of the manuscript.

  • Funding CAWa was funded by an industrial PhD studentship from the University of Exeter and Canon Medical Systems UK Ltd. GP is lead researcher in a contractual research partnership between the University of Bristol and Canon Medical Systems UK Ltd investigating cardiac function during exercise in children. The authors had full control of the design of the study, methods used, outcome parameters, analysis of the data and production of any manuscripts.

  • Disclaimer This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2020, Issue 10, DOI: (see for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.