Although parents, teachers, and sometimes even medical professionals, often restrict the exercise of a child or teenager with congenital heart disease, sporting activities can actually contribute to the child’s general fitness levels, wellbeing and overall quality of life. Insufficient exercise can lead to motor deficiencies and make a child feel marginalised and isolated from its peers. The number of European children prevented from doing sports varies substantially between countries. In Germany, the policy is to apply as few restrictions as possible. Whether or not a child is declared healthy enough to participate in sports should be – based – according to the experiences in Germany – on the results of the postoperative examination and not the severity of the heart defect. In this section you can read why most children can and should do sport.

Sport is important for everyone, but especially for people with congenital heart disease

Sport has an important role in western societies and substantially improves most people’s quality of life. This notion is especially true for children: motor activity is essential for young children, fostering not only their motor development but also cognitive and socio-emotional progress. The term “psychomotor development” describes the strong interaction between different developmental areas. Self confidence in boys is often based on doing well in sports. Therefore, whenever possible, people with congenital heart diseases should be encouraged to exercise during their spare time, and especially during physical-education classes at school.

Recent studies support this idea: in a nationwide Norwegian survey of children with congenital heart defects, these children’s risk of suffering sudden cardiac death related to physical activity tended towards zero (1).

The situation is excellent in Germany; however, that is not the case in the rest of Europe, where a south to north gradient ranging from strict to moderate restrictions seems to be in place. Whereas patients with congenital heart disease are sometimes even forbidden to move in southern European countries, most are allowed to practise nearly any type of sport in northern European countries.

Sport recommendations tailored for each individual

To assess one’s cardiological status, postoperative results seem to be more important than the diagnosis itself. Therefore, a special classification system has been developed and approved by the German Association for Prevention and Rehabilitation (DGPR) and other expert committees. The decision to allow a patient to play sport should not be made on the basis of the heart defect itself, but rather on residual results after treatment. Since diagnosis and residual results vary between children, recommending specific sports types to everyone with a congenital heart disease does not seem appropriate. According to the Cologne working group, every child should be advised what type of exercise (eg, dynamic or static, long term or short term) to avoid, emphasising those that they are allowed to do.

Why are not all children allowed to do sport?

However, not all children and adolescents with congenital heart diseases are allowed to participate fully in sport activities for several reasons.

  • The heart defect is so severe that sport must be forbidden, because physical activity could put their life in danger. This course of action is necessary only in exceptional cases, usually because of the over cautiousness of doctors, parents and teachers.
  • The heart defect allows only partial participation in sport (eg, limited sport or no competitive sport, see table 3) because of the heart’s inability to adapt to physical strain. For example, taking anticoagulant drugs is incompatible with contact sports such as rugby. Additionally, wearing a pacemaker is incompatible with extreme stretching such as exercising on a hanging bar.
  • The heart defect is not so severe, but parents, kindergarten or school teachers are too anxious to allow the child to exercise as much as they want. This creates a vicious circle between restriction and deteriorating ability in sports.

The vicious circle caused by limited physical activity

Parents, educators and teachers often tend to overprotect children with congenital heart disease because of apprehension or lack of information. This might stop children from experiencing physical activities and push them towards (social) isolation. A vicious circle could arise, involving reduced motor activity, motor deficits and psychosocial adaptation issues, such as low self esteem and further social isolation. The limited amount of action that derives could in turn further reduce physical activity. The vicious circle remains closed and hard to break.

Vicious circle
Figure 1: Vicious circle - Reduced physical activity

Whether children and adolescents with congenital heart disease can practise sport is a personal choice. This decision mostly depends on:

  • findings after cardiac surgery (and not the heart defect itself)
  • the type of the strain rather than the type of sport; dynamic strain is generally more advisable than static strain is.

The motto should always be “allow sport as much as possible, restrict sport no more than necessary”.

Specialised and tailor-made sport groups

To offer safe extracurricular sport opportunities for children and adolescents with this disease, specialised sport groups have been established in about twelve German cities (as of October 2015). These groups are led by specialised trainers. Sport is mostly practised in a gym, but sometimes swimming, inline-skating, horse riding, sailing and climbing opportunities are offered. A doctor with an emergency kit is always present.

Such groups are especially helpful if sport classes offered at school have to be restricted because of substantial residual defects. They also have positive effects on children with only small postoperative residual defects, whose parents, teachers (and sometimes also doctors) are overprotective and restrict their physical activities more than is necessary. A multidisciplinary study with six groups including 76 children and adolescents undertaken in Cologne showed the motor and psychosocial benefits for participants of such groups. (1,2) This study highlights that the vicious circle between restricted physical activity and impaired motor coordination can be opened and turned into a positive circle.

Positive circle
Figure 3: Positive circle – Physical activity

The Cologne team noted how sport groups seem to have different functions for different age groups

  • For preschool children, they had a preventive function, whereby emergence of deficits could be averted.
  • For school children, they fulfilled more of a therapeutic function, since a large number of the participants had developmental deficits, particularly affecting motor coordination.

To the best of our knowledge, virtually no sport groups designed for children with congenital heart disease exist in other European countries. In Scandinavia and the Netherlands, several such groups had been established within the scope of studies over a limited period of time (3, 4, 5, 6).

Sport lessons at school

Sport teachers often do not know much about congenital heart disease. Therefore they might be worried and over concerned when a child with a heart condition takes part in their sport class. This could lead children to become excessively restricted, hence the vicious circle proceeds. To reduce the level of apprehension when instructing such children, parents and doctors should provide comprehensive information about the child’s condition. Teachers should try to integrate these children as much as possible during physical education classes to allow their normal psychomotor development.

Recommendations for teachers

Almost a fifth of all children and adolescents have physical or psychic impairments. Therefore every teacher has to cope with this challenging situation, especially during sport classes.  For children with congenital heart disease, the teacher has to collect precise information for each individual to adjust the physical-education programme to the child’s physical potential. The teacher needs to consider the risks involved with long-term treatment, for example, taking anticoagulant drugs or wearing a pacemaker. Therefore, it is essential to gain enough information about a specific heart disease and particularly on residual defects.

An attempt to defeat this challenge has to be made and to create a beneficial environment for children with heart diseases. Many possibilities exist to integrate them in sport lessons, for example by reducing what is expected from them, so that they can also participate.

Discretion is very important, for example when grading these children. Supported by parents and maybe also by doctors, the teacher should be creative in applying the freedom allowed.

Talk and reason with the whole class about how impaired children can be integrated. This action may enhance the social competence of all children. Considering impaired children as a possible enrichment to academic life enables us to see the bright side of this situation, which could have a positive effect on the child, its family, class mates and teachers in a wide range of situations.


(1) Jortveit J., Eskedal L., Hirth A., Fomina T., Døhlen G., Hagemo P., Tell G.S., Birkeland S., Øyen N., Holmstrøm H (2015). Sudden unexpected death in children with congenital heart defects. European Heart Journal; September 04 [Epub ahead of print].

(2) Sticker, E.J. (2004). Sport macht stark – auch bei angeborenem Herzfehler. Ergebnisse einer interdisziplinären Follow-up Studie zur Entwicklungsoptimierung. Aachen: Shaker-Verlag.

(3) Bjarnason-Wehrens, B. & Dordel., S. (Hrsg.) (2001). Motorische Förderung von Kindern mit angeborenen Herzfehlern. Sankt Augustin: Academia Verlag, S. 89-100.

(4) Fredriksen P.M., Kahrs N., Blaasvaer S., Sigurdsen E., Gundersen O., Roeksund O., Nor gaand G., Vik J.T., Soerbye O., Ingjer F., Thaulow E (2000). Effect of physical training in children and adloescents with congenital heart disease. Cardiology of the Young; 10: 107–14.

(5) Nordqvist, P. (2006). Water activities for children with CHD in Sweden. Poster presented at the AEPC-Working Group meeting on Psychosocial care for congenital heart disease held in Belfast between March 8–13, 2006.

(6) Dulfer K., Duppen N., Blom N.A., van Dijk A.P., Helbing W.A., Verhulst F.C., Utens E.M (2014). Effect of exercise training on sports enjoyment and leisure-time spending in adolescents with complex congenital heart disease: the moderating effect of health behavior and disease knowledge. Congenit Heart Dis;9(5):415-23.

Last updated: 2015-11-13

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Comments on this article

21.01.2009 | Debbie Ware, UK
I think this have been very informative, my son does not do well at sport although he has the ability and strength to so do, he has been encouraged to do all he can sport wise as his heart can cope, but with peer pressure and low self esteem he tends not to, also the school he went too never minded if he didn't do any sport, but the upper school are now helping him.
24.01.2009 | Clare Burgess, UK
My daughter is 27 months old and for the last 6 months has been attending a toddler gym class (Tumbletots). Although she is tired after the class which is about 30 minutes of active exercise, she completely enjoys it and her consultants are happy that she is exercising.
16.04.2009 | Sergio Generoso, Spain
Congratulations for the article. It shows very well how this situation is. Me and my wife are quite happy of our own experience about it. One of our daughters has a congenital heart disease and she’s been enjoying the benefits of doing sports. She has been learning how to swim, and still does, she also rides on her bike, and play games with her twin sister and her friends quite a lot, involving such exercise. All this contributes to make her the happiest girl in the world. I would like to thank the doctors and teachers for they support that, added to ours, as parents, make this world a better world for ALL, no matter if you have a congenital heart disease or not.
Best regards, Sergio.
01.03.2010 | Paloma Sánchez, España
Hola, tengo un hijo de quince años con una cardiopatía congénita al que siempre le ha gustado el deporte. El es portador de marcapasos y no podía realizar deportes como el fútbol de manera federada al ser un deporte de contacto. Sin embargo, ha encontrado en el tenis de mesa su deporte ideal. No es de contacto, no supone un ejercicio extenuante, le permite desarrollar capacidades como el autocontrol, la superación personal, la socialización, la seguridad en sí mismo, la intuición...y además no tiene problema para competir. En su caso, está suponiendo una gran ayuda para su desarrollo global como persona. Por eso animo a todos los padres a buscar junto con su hijo un deporte que pueda practicar. Es muy educativo y existen muchos deportes minoritarios adecuados para personas con cardiopatías y/u otras discapacidades.
08.01.2011 | Franz Hernandez, Mexico
agradesco la informacion redactada en este articulo muchas gracias por ponerla a disposicion del publico, tengo un hijo de 7 años lamentablemente nos han informado que tiene un soplo en el corazon grdo dos y devido a esto hemos estado buscando informacion que nos ayude a entender contra que nos vamos a enfrentar y su articulo es una gran herramienta de corazon muchas gracias por su informacion
06.05.2011 | Jonathan Toze, Australia
There is an article on my daughter which some visitors may wish to read about her involvement in sport. She is the one on the front cover. See the following link,
29.09.2011 | Theresa Theresa, I want to send you an award for most helpful internet weirtr.
I want to send you an award for most helpful internet weirtr.