Cardiovascular Rehabilitation Program in Pediatric and Young Adult Patients With Congenital Heart Disease: Single-Center 4-Year Experience

Congenital heart defect (CHD) affect 9 in 1000 live births worldwide. Due to medical advancements, there are more adults than children with CHD in the United States. However, patients with CHD face a 36% lifetime risk of premature cardiovascular disease1,2 and lifestyle-related risks contributing to declining life expectancy.2 Physical activity is a key modifiable factor in cardiovascular disease prevention, but perceived exercise intolerance, clinician-imposed limits, and caregiver overprotection often restrict participation. Cardiovascular rehabilitation (CR), a supervised program combining exercise and education, is well-studied in adults but remains underdeveloped for pediatric patients with CHD. Despite proven safety and long-term benefits for children, few structured CR programs exist for children with CHD in the United States,3,4 with no established standard.5 Established in 2020, our pediatric CR program is a pioneering initiative for patients with CHD. This article outlines its key components, early results, and lessons learned over 4 years. METHODS This retrospective cohort study included pediatric and young adult patients with CHD who completed a CR program at a midwestern academic children’s hospital (2020–2024) with institutional review board approval and waiver of consent (Supplemental Digital Content 1, available at: https://links.lww.com/JCRP/A666). Inclusion criteria were CHD diagnosis, age >6 years, abnormal exercise capacity (1.0 and target heart rate ≥(220 − age)*0.85 beats/min. Borg exertion scores and physiological parameters (V̇O₂, carbon dioxide production, ventilation, oxygen saturation, blood pressure, and heart rate) are continuously monitored. Muscle Endurance Test Patients perform push-ups, squats, crunches, and overhead presses to measure strength in chest, legs, shoulders, and core, with repetitions recorded for individualized baselines. Cardiovascular Rehabilitation Program The program includes 30 structured, 1-hour sessions over 15 weeks, held twice weekly with one-on-one training led by exercise physiologists. Patients commit to attending at least 75% of supervised sessions. The program integrates cardiovascular training, strength exercises, and education, with each session featuring a warm-up, 30 minutes of exercise, a cool-down, and periodic education (Supplemental Digital Content 2, available at: https://links.lww.com/JCRP/A667 and Supplemental Digital Content 3, available at: https://links.lww.com/JCRP/A668). Safety measures include oxygen, pulse oximetry, and an external defibrillator. Training Components Cardiovascular training includes treadmill walking, biking, and stair climbing to improve endurance. Sessions are personalized using cardiopulmonary exercise stress test (CPX) data, with target heart rates (60%–85% of heart rate reserve) set by the Karvonen formula. Intensity progresses from 60% in early weeks to >85% in high-intensity sessions, enhancing circulation, stamina, and heart health. Electrocardiogram monitoring and Borg scale assessments ensure safety. Muscle strength training follows a linear periodization model, using body weight, medicine balls, dumbbells, and bands to increase intensity while reducing volume. Education covers cardiovascular health, nutrition, stress management, and exercise techniques, with dietitian guidance and psychosocial support promoting mental well-being. Patients are encouraged to exercise at home twice weekly after 3 weeks, though adherence is not monitored. Midpoint and completion questionnaires help refine individual programs and guide future improvements. Completion Assessment Final assessments included CPX and muscle endurance tests, following the baseline protocol (Supplemental Digital Content 4, available at: https://links.lww.com/JCRP/A669 and Supplemental Digital Content 5, available at: https://links.lww.com/JCRP/A670). STATISTICAL ANALYSES Continuous variables were tested for normality and reported as mean ± SD or median (IQR). Paired Student t tests compared pre- and post-rehabilitation data, with P