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Which factors determine if an activity is suitable?

Depending on the exact nature of the heart condition, some activities may be recommended, whilst other activities are best avoided. There are many factors to consider when deciding if a particular activity is suitable for someone with a congenital heart condition. Obviously, the exact nature of the heart condition is a key consideration. Age and current fitness level may also affect recommendations.

Make sure that your cardiologist has completed a Physical Activity Recommendations Form for your child. This will let them, their school and you know what activities they should and shouldn’t be doing. You can download and print a copy of this form to give to your cardiologist/nurse specialist/specialist physio below. 

When deciding whether an activity is suitable it is very important to consider the following factors:

Intensity (how hard you are working during an activity)

Some people with a congenital heart condition can safely take part in sports and exercise at a vigorous intensity. However, some heart conditions limit the intensity of physical activity that should be undertaken. For these people, being physically active at too high an intensity could make them feel unwell, cause dizziness or fainting, and make their heart condition worse. Make sure to ask your cardiologist what level of exercise intensity is recommended for you/your child.

Duration

The National Guidelines recommend that young people are physically active for at least 60 minutes every day. This does not have to be done all in one go! Often people with a heart condition find that they need to stop and rest during physical activity, usually because they are not getting enough oxygen to their muscles. This may be due directly to the heart condition, or it may be that they are simply unfit. It’s important to stop and take a break if they are feeling unwell, are struggling to catch their breath or feel dizzy and faint.

Type of activity (static vs dynamic)

The National Guidelines recommend that young people are physically active for at least 60 minutes every day. This does not have to be done all in one go! Often people with a heart condition find that they need to stop and rest during physical activity, usually because they are not getting enough oxygen to their muscles. This may be due directly to the heart condition, or it may be that they are simply unfit. It’s important to stop and take a break if they are feeling unwell, are struggling to catch their breath or feel dizzy and faint.

Most activities are not entirely static or dynamic, but a mixture of the two. When thinking about the suitability of an activity, you should consider if it is mainly static or dynamic. If there is not much movement involved, but a lot of muscular force is used, then it is probably a very static activity and may not be suitable.

Competitive or recreational participation

Most sporting activities can be enjoyed either at a recreational or a competitive level. Recreational means that there is no pressure to play for a long time or at a high intensity. It is not important to keep score or time, whilst competitive means that it is important to win or do better than other people.

Competitive sport is usually much more demanding than taking part at a recreational level. In a competitive situation people are likely to push themselves to a very high intensity. During competition there may be pressure from other participants, coaches or spectators. Often a competitor will put pressure on themselves; this can worsen in team sports, when they may worry about letting down team-mates.

Training plays an important role in most competitive sports. Training often involves exercising at increasingly high intensities or for longer amounts of time, with the aim of increasing strength and/or cardiovascular fitness. However, care should be taken to avoid exceeding safe limits recommended by your cardiologist.

As well as being physically demanding, competition can also be emotionally stressful. This will have an additional effect on our breathing and heart rate.

Often the desire to be successful can make competitors ignore physical discomfort. This is potentially hazardous for some people with a heart condition. For this reason it is important to discuss with your cardiologist, doctor or clinical nurse specialist whether you/ your child can take part in competitive sport.

Medication (are you / your child on drugs to reduce blood pressure or prevent blood clots?)

People taking anticoagulant drugs such as warfarin and aspirin may bleed for a longer time following cuts and scrapes, and may also bruise more easily. For this reason, they are often advised to avoid contact sports. Precautions should be taken to reduce the likelihood of cuts and bruises, such as wearing protective clothing, such as elbow/knee pads, helmet and gloves when skateboarding.

Implanted devices to control or restore heart rhythm

ICDs (implantable cardioverter defibrillators) and pacemakers are fitted to control abnormal heart rhythms (arrhythmia). Which physical activities are appropriate for you depends upon the cause of the arrhythmia. It is therefore very important to get clear advice from your cardiologist.

It usually takes 4-6 weeks for the body to heal after an ICD or pacemaker has been implanted. You / your child will be advised to avoid certain activities during this time, to ensure that the device’s leads are not moved from their correct position. Contact sports, where there is a likelihood of physical impacts, should be avoided if you/your child have an ICD or pacemaker. This is to avoid damage or movement of the device’s leads and to prevent injury to the area around the device. For some activities these risks may be reduced or eliminated by wearing appropriate clothing or padding. This must be discussed with your cardiologist first!

If you/ your child have an ICD card, make sure that it is carried with you/them at all times, but especially when taking part in physical activities.

It is also a good idea for you/them to be accompanied by someone who knows about the heart condition and is able to help in the unlikely event that the ICD delivers a shock.

What’s the difference between an ICD and a pacemaker?

A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart. Pacemakers can relieve some symptoms related to arrhythmias, such as fatigue or fainting. They can help a person who has an abnormal heart rhythm resume a more active lifestyle.

An ICD (implantable cardioverter defibrillator) monitors heart rhythms. It sends electrical pulses or shocks to the heart when it senses any abnormalities in heartbeat. For example, if a patient with an ICD has an irregular heartbeat or goes into sudden cardiac arrest, the device will send a shock to the heart to restore normal heart rhythm. This treatment is called defibrillation. Most new ICDs can act as both a pacemaker and a defibrillator. Many ICDs also record the heart’s electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment.

If you / your child has been diagnosed with an abnormal heart rhythm it is very important to make sure that you/they do a proper warm-up and cool-down to reduce the risk of arrhythmia.

Recent surgical procedures

During open heart surgery the breastbone (sternum) is divided to allow the surgeon access to the heart. This procedure is called a sternotomy. It takes approximately 12 weeks for the sternum to completely heal; however, this can vary between individuals. For the first few weeks following the operation, you / your child will be advised to avoid activities that place any strain on the sternum. Gradually, over a period of about 3 months, you/ your child will be able to return to normal life. However, contact sports, where there is a likelihood of physical impacts, should be avoided for at least 3 months following surgery.

Risk of injury

Assessing risk is all about using good judgement. Consideration should be given to how likely an incident is to happen and how serious the consequences might be. Often it is possible to take extra precautions or adapt activities to reduce the risk.

Many activities have a risk of physical impact. These include ‘contact sports’, such as rugby and judo, where contact with other participants is expected. In other activities, a physical impact may not be intended, but might be quite likely, for example; football, skiing and cricket.

Danny Care playing rugby
Horse Riding

Some heart conditions can cause people to feel dizzy, or even to fall unconscious (loss of consciousness is sometimes referred to as ‘syncope’). Some activities are particularly dangerous if the participant becomes dizzy or unconscious. These include: swimming, climbing, kayaking, horse riding and cycling. If there is a history of dizziness or fainting then it is important to think carefully about whether a particular activity is suitable.

Physical impacts may be harmful if:

  • You / your child has a pacemaker or ICD. This is because the device may be damaged or the leads may be moved. In some activities these risks may be sufficiently reduced by wearing appropriate protective clothing
  • You / your child has recently had surgery or a catheter-based procedure
  • You / your child is being prescribed anticoagulant drugs
  • You / your child has a particular condition, such as mitral valve stenosis or Marfan syndrome
Last Updated: September 8, 2016