Exercise Counseling in Congenital Heart Disease: A Guide for the Pediatric and Congenital Cardiologist.

Exercise is a critical determinant of both immediate and long-term health for individuals with congenital heart disease (CHD). While pediatric cardiologists increasingly recognize the importance of promoting physical activity, formal training in exercise counseling remains limited. Exercise cardiology is an evolving subspecialty, with growing educational and training opportunities for congenital cardiologists to develop diagnostic and therapeutic approaches and expand access to exercise resources for patients with CHD. As part of this effort, the Global Coalition for Fitness and CHD (GloCo) convened a multi-institutional Education Working Group to develop practical, evidence- and consensus-based guidance for exercise counseling in children, adolescents, and young adults with CHD. This guide outlines foundational elements of exercise counseling, including strategies for obtaining an exercise history, performing cardiac risk assessments, shared decision-making, and tailoring exercise recommendations to individual patient needs. Exercise counseling in CHD must be personalized, taking into consideration the patient's medical status, psychosocial context, and available resources. Core components include risk assessment through multimodal imaging, rhythm monitoring, and exercise assessment, including but not limited to cardiopulmonary exercise tests. Based on these evaluations, clinicians can provide or recommend general physical activity promotion, formal exercise prescriptions, or structured programs such as cardiac fitness and rehabilitation. Importantly, the aim is not simply meeting physical activity targets but fostering positive attitudes toward lifelong exercise and instilling the confidence to sustain it. By aligning exercise plans with patient and family preferences, motivations, goals, and resources, clinicians can promote sustainable engagement and improved overall fitness. This guide aims to support pediatric and congenital cardiologists in providing safe and effective exercise counseling to their patients with CHD to help them achieve optimal physical and psychosocial well-being.