Exercise training in congenital heart disease: should we follow the heart failure paradigm?

Exercise intolerance is common in adults with congenital heart disease (ACHD) and affects their prognosis and quality of life, thus becoming an important target for therapies. While exercise training has been widely studied in chronic heart failure, its safety and efficacy in ACHD remain unknown. The main obstacle in studies involving physical training and when prescribing exercise, is long-term compliance. Lifestyle changes through behaviour modification are difficult and require adequate physician and patient education on the benefits and types of exercise. Individualised counselling regarding physical training, exercise and sports should begin in early adolescence or even earlier, and exercise restriction is rarely indicated. Self-monitoring of physical activity through logs and the use of simple devices such as accelerometers may also enhance awareness and motivation. Physicians and nurses with adequate communication skills should assist ACHD patients in achieving a positive attitude towards physical activity and lifestyle modification.