PHYSICAL ACTIVITY

The benefit of physical activity in children is often promoted. It helps develop coordination, builds strength, increases energy level, and improves mental well-being. While there are lifelong benefits to exercising, children with cardiomyopathy are typically told that they must restrict their physical activities to prevent excess strain on their heart.

The level of restriction will depend on several factors such as the type of cardiomyopathy, family history, presence of symptoms, and severity of the disease. It is recommended to have a shared discussion with your child’s pediatric cardiologist to determine the risks versus the benefits of specific physical activities and the level of acceptable activity as it relates to your child.

Exercise Restrictions

Physical activity recommendations are individualized based on a child's type of cardiomyopathy. Some children with mild cardiomyopathy may not have activity restrictions and be allowed to exercise with few restrictions. Other children with certain forms of cardiomyopathy may be at an increased risk of sudden cardiac arrest and have more restrictions. Your child's cardiologist will work with you and your child to recommend the appropriate level of activity and exercise adaptations.

It is possible to safely exercise and engage in physical activity with these recommendations:

  • Regular cardiology evaluations
  • Follow your cardiologist's activity recommendations
  • Listen to your body and be aware of warning signs
  • Have an accessible AED (automatic external defibrilator) on site
  • Stay hydrated
  • Avoid excessive heat
  • Take breaks

Regular cardiac follow up will allow your child's pediatric cardiologist to monitor changes in your child's heart function and tailor an exercise plan specific to your child's cardiac threshold.

Sports Participation

Based on the American Heart Association and American College of Cardiology joint scientific statement, Recommendations for Competitive Athletes with Cardiovascular Abnormalities, it is recommended that all individuals with cardiomyopathy refrain from participating in competitive sports. This includes isometric exercise (weightlifting), competitive team sports (football, soccer, basketball), high impact sports (skiing, boxing, racquetball), and strenuous water sports.

The risk of sudden cardiac arrest is higher for hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy patients. While the recommendation is to refrain from intense physical activity, there is still a great deal of uncertainty as to whether sports participation increases the risk of sudden cardiac death and to what magnitude.

In certain cases, non-competitive or recreational sports that allow for self-pacing may be approved by your child’s cardiologist. According to published guidelines for young patients with heart disease, examples of moderate to low intensity sports include: swimming, doubles tennis, cycling, golf, skating, and horseback riding. Recreational exercises would include walking, jogging, bike riding, pilates, or yoga.

If your child is cleared for any type of sports or recreational activity, it is advised to:

  • Ensure your child is supervised during physical activity
  • Use a buddy system where a friend, who is familiar with your child’s condition, can participate in the activity with your child
  • Have an AED and someone (coach), who is trained in AED use and CPR, onsite in case of a cardiac emergency

Exercise Training and Cardiac Rehabilitation

For teens, exercise restrictions may be an issue when they their appearance takes on more importance and they want to stay in shape. Cardiac exercise rehabilitation is a relatively new resource that combines aerobic activity to benefit heart and lung function, resistance exercise using weight machines to increase muscle strength, and stretching to increase flexibility. Children can work with a cardiac exercise physiologist at a cardiac rehabilitation facility to develop aerobic and strength training recommendations based on the child’s heart condition. During the session, a baseline exercise stress test is done on a treadmill or bicycle to assess a child’s cardiovascular function and metabolic rate. The test checks for abnormal heart rhythm, assess for symptoms, and identifies specific levels of exertion or heart rates that are within a safe range.

The exercise plan can then be performed at a cardiac rehabilitation center, at home, at the gym, or at school with the child monitoring his/her own level of exertion. Studies have shown that exercise rehabilitation can enhance daily activity levels, heart function, and quality of life. It can also reduce the risk for acquired cardiovascular problems (obesity, high blood pressure, high cholesterol) caused by a sedentary lifestyle.

Additional Considerations

Restricting sports participation during adolescence can put patients at risk for obesity, social isolation, and depression. It can be especially disappointing if competitive sports played a large role in your child’s life before diagnosis. It is important for them to still maintain their relationships with former team members and be involved in sports in a non-competitive manner, such as managing the team or assisting the coach. Your child should also be encouraged to develop new interests and participate in other recreational activities.

For more information about balancing the risks of exercising and participating in organized sports, review the "Exercise and Sports in Children with Cardiomyopathy" fact sheet on CCF's online community, CCF Connect.

Webinar recordings from sessions on “Living with Pediatric Cardiomyopathy: Exercise & Sports Guidelines” and “Exercise and Sports in the Cardiomyopathy Patient” can be viewed on CCF’s webinar page.