Physical fitness in adults with isolated secundum atrial septal defects

Atrial septal defect (ASD) is one of the most common diagnoses in patients with adult congenital heart disease (ACHD). However, recent studies indicate that ASD is not so benign and may impede physical fitness. We aimed to assess physical fitness in patients with isolated secundum ASD compared with healthy reference values and to evaluate the results according to the absence or presence of repair.

Between April 2009 and March 2025, patients with ACHD performed physical fitness tests comprising five muscular fitness tests and one cardiorespiratory endurance test. Data were stored in a registry at the Physical Therapy Department, Sahlgrenska University Hospital/Östra. In total, 102 adults with isolated secundum ASD were included in this descriptive, register-based cohort study.

Both women and men with ASD showed significantly lower isoinertial muscular fitness test results (heel lifts: p < 0.001 and shoulder flexions: p < 0.001) and maximal exercise capacity (p < 0.001) compared with healthy reference values. The shoulder flexion test revealed the lowest percentage of reference values for women and men with ASD (58.3 % and 53.3 %, respectively). Women who had undergone surgical procedures performed the timed-stands test significantly faster when compared with women who had undergone device procedures (13.0 s [10.2, 16.0] vs. 19.1 s [15.1, 26.2]; p = 0.014).

Patients with less complex ACHD, such as secundum ASD, may have impaired muscular fitness and cardiorespiratory endurance. Therefore, all patients with ACHD could be offered tests of physical fitness. These tests are necessary when prescribing individualized exercise, as suggested by guidelines.