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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.
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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