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Life sciences · Journal article
Quality in Sport · October 2, 2026
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Background: Historical approaches to pediatric congenital heart disease (CHD) favored rigorous physical restrictions to prevent arrhythmias and sudden cardiac death. This clinical overprotection paradoxically drives the epidemic of obesity, physical deconditioning, and the psychosocial isolation of patients. Objective: To synthesize current evidence-based medicine (EBM) guidelines and provide a practical exercise prescription framework for clinicians, physical education teachers, and sports professionals. Methods: A narrative literature review was conducted utilizing PubMed, Scopus, and regional academic databases. The analysis centered on the latest European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines, supplemented by clinical trials detailing exertion hemodynamics and public health reports. Results: The clinical paradigm has shifted from absolute restrictions to individualized, safe activity. Children with mild, uncorrected defects or fully repaired simple anomalies require no limitations. In complex palliative states, such as Fontan circulation, activating the peripheral muscle and respiratory pumps is crucial. Objective risk stratification relies exclusively on cardiopulmonary exercise testing (CPET). EBM refutes the myth of a high risk of exercise-induced sudden cardiac death in stable CHD patients. Conclusion: Medical professionals must transition from issuing routine physical education exemptions. The FITT principle should be routinely applied in children with CHD to bridge the gap between cardiac safety and proper psychosocial development, ultimately improving their quality of life.