• Tetralogy of Fallot

It is widely recognised that regular exercise can have a salutary effect on cardiovascular health. Additionally, consistent physical activity can be beneficial for mental health, can ameliorate a variety of chronic diseases and can translate into improved self-esteem.1 However, individuals with congenital heart disease (CHD) may be reluctant to accept an exercise prescription if thought to have uncertain clinical benefit or if perceived to be potentially unsafe for their hearts. Practitioners themselves may be unclear as to how to prescribe or interpret adequacy of exercise results in their CHD patients.

As a whole, patients with complex CHD can be expected to have decreased exercise capacity as compared with the normal population. The CHD population is also at elevated risk of sudden death, malignant arrhythmia and heart failure. There are common anatomical and functional drivers that contribute to decreased exercise capacity and associated risk of adverse outcomes; these factors can be intricately linked and difficult to tease apart. A deeper understanding of the impact of exercise interventions in CHD would be of tremendous clinical benefit to patients and practitioners alike.

Schuermans et al 2 explore the efficacy and safety of exercise training interventions in the repaired tetralogy of Fallot (rTOF) population, the most common form of cyanotic congenital heart disease, and an expanding population with significant risk of late morbidity and mortality. They present a systematic review of 9677 citations and select 10 unique studies, including five randomised controlled trials, spanning 12 articles. They report a meta-analysis of studies that test at least one exercise intervention in participants with rTOF and that report preintervention and postintervention outcome measures related to safety or efficacy of exercise. In total, 208 children and adults are described (n=138 with rTOF and n=78 controls). Cardiopulmonary testing was the exercise approach used in all studies, …