New AHA Statement: Physical Activity May Be Safer for Children with Heart Conditions Than Previously Thought

The American Heart Association released a new scientific statement today in its journal Circulation, indicating that physical activity may be safer for children and adolescents with certain heart conditions than previously believed. The statement focuses on young people with cardiomyopathy—a disease affecting the heart muscle’s structure and function—and those with implantable cardioverter-defibrillators (ICDs), which detect and correct life-threatening arrhythmias.

Traditionally, these children have been discouraged from exercise due to fears that it could worsen heart function or trigger sudden cardiac death. However, the new guidance emphasizes that restricting all physical activity can have negative consequences on heart health, physical fitness, mental well-being, and social development. ‘While safety is always paramount, halting all physical activity among children with cardiomyopathy or ICDs has at times led to unintended consequences,’ said Dr. Jonathan B. Edelson, chair of the statement writing group and associate professor at Children’s Hospital of Philadelphia.

The statement advocates for a personalized approach to physical activity, rather than a one-size-fits-all restriction. Key recommendations include tailored risk assessments using tools like echocardiograms, cardiac imaging, exercise stress tests, genetic testing, and family screening. Shared decision-making among clinicians, families, and patients is crucial to balance risks with patient and family goals. Close follow-up and reassessment are also essential as the child grows and their condition evolves.

For many children, light-to-moderate intensity exercise—such as walking, light cycling, or swimming—may be appropriate to maintain fitness and quality of life. Some carefully selected patients may even participate in competitive sports after expert evaluation and discussion of risks and benefits. Emergency action plans, including access to automated external defibrillators (AEDs) and bystanders trained in CPR, are vital during organized sports.

Dr. Edelson stressed, ‘Children with cardiomyopathy should not automatically be sidelined from participating in physical activity, including recreational or competitive sports.’ He noted that most children should be active with individualized evaluation, monitoring, and planning.

The statement acknowledges that much of the evidence comes from observational studies in adults, so findings should be applied cautiously to children. More research is needed on how exercise affects long-term disease progression and how risk varies among different cardiomyopathies. The statement was prepared by a volunteer writing group on behalf of several AHA councils and committees.

This new guidance marks a significant shift from previous recommendations, potentially improving the lives of many young heart patients by allowing them to enjoy the benefits of physical activity while managing risks. The full statement is available online at Circulation.

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