Empowering congenital heart disease treatment: Physical activity prescription. The Italian proposal

Regular physical activity has emerged as a cornerstone of preventive and therapeutic care in Congenital Heart Diseases (CHDs). Growing evidence demonstrates that structured exercise not only improves both functional capacity and psychological well-being but also exerts favorable cardiovascular and metabolic effects. However, the participation in physical activities of CHDs patients remains limited due to common misconceptions about exercise safety and the absence of standardized guidelines. This document presents the Italian proposal for exercise prescription in CHDs, jointly promoted by the Italian Federation of Sports Medicine (FMSI) and the Italian Society of Sports Cardiology (SIC Sport) with the collaboration of the Italian Association of Hospital Cardiologists (ANMCO) and the Italian Society of Cardiology (SIC). The Italian proposal establishes a structured, evidence-based framework for exercise prescription indicating the approaches to monitoring and to individualizing the physical program according to the disease's complexity and patient's profile. The model integrates a three-step method: (1) the identification of the most appropriate exercise type, (2) the individual program customization, and (3) the longitudinal monitoring of cardiovascular response. Risk stratification is performed using echocardiographic, hemodynamic, and cardiopulmonary exercise testing (CPET) parameters, which allow the safe exercise threshold to be defined. The exercise prescription is based on the FITT principle (Frequency, Intensity, Time, Type) emphasizing progressive aerobic and combined regimens over static exercise.