Exercise

Exercise is important even in those with heart disease. It improves the heart function and general sense of well being. It is associated with increased life expectancy and a reduced risk of heart disease in later life. In addition physical activity helps with controlling weight and reducing blood pressure.

There are different types of exercise. In static exercise the muscles contract but there is little joint movement eg weight lifting. In dynamic exercise the muscles contract and also move the joints eg running. Each places a different stress on the body and cardiovascular system. In general most types of sports are a mix of the two.

The Bottom Line

Most children with heart conditions (even following surgery) can safely participate in sport at all levels
Some children with complex heart problems should restrict themselves to certain sports only
For a few children competitive sport should not be undertaken
For all a certain level of fitness is healthy and should be encouraged

Children usually take part in more rigorous exercise at school as they grow older. In Singapore physical education (PE) tends to teach games skills rather than competitive sports. However pupils may take sport for their co-curricular activities (CCA) when training is more intense and competitive. Training for the NAPFA test is also intensive and some pupils with heart problems may have difficulty with the 2.4k run as they often perform less well at endurance type activities.

As always parents or patients must seek the advice of their own doctor when deciding how much exercise and to what level is safe - particularly as there are no published guidelines for activity levels in children.

What guidance is available comes from the 26th Bethesda Conference: Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities.

This was published in 1994 by the American College of Cardiology (JACC 1994;24:845-99) and provided recommendations on the eligibility of athletes with cardiac disease wanting to participate in competitive sports. The recommendations are very detailed and vary according to the type of cardiac condition and the choice of competitive sport. Below is a synopsis of the recommendations.

Recommendations

Competitive Sport NOT Recommended

Aortic valve disease if stenosis is significant or severe regurgitation (leak).
Severe mitral regurgitation
Dilated cardiomyopathy
Arrythmogenic right ventricular dysplasia
Long QT syndrome
SVT with symptoms on exercise
High pulmonary vascular resistance
Congenital coronary abnormalities

Restriction to Light Exercise
(eg golf, cricket). These include:

Palliated cyanotic heart disease (cyanosed or blue children) who have usually had a shunt operation or pulmonary artery band
Coarctation and tetralogy of Fallot if there are still residual problems
Following a Senning, Mustard or Fontan operation.
Mitral valve prolapse when associated with rhythm problems, collapse with exercise or a family history of sudden death.
Hypertrophic cardiomyopathy
Kawasaki disease with persistent coronary artery problems
Marfan patients
WPW if heart rate can exceed 240 bpm

High Static Exercises Excluded
(eg weightlifting, body building, wrestling, boxing). These include:

Coarctation
Artificial heart valves,
Arterial switch procedure
Severe hypertension (blood pressure).

Contact Sports Excluded for those

anticoagulation medication (blood thinners - usually warfarin)
Pacemaker (as wire can fracture if there is a collision)
Marfan Syndrome

This page was last edited 16/2/2004

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