With rare exceptions, children should be encouraged to be as physically active as their condition allows. The exceptions are children with ldquo;end-stagerdquo; cardiac disease who are either waiting for a cardiac transplantation or who are terminal with no hope for improvement. Even in these children, low-grade exercise such as walking on level areas is beneficial. Most children with congenital heart disease have had corrective surgery by the time they reach the age when exercise prescription is needed. Most of these children have had excellent surgical results, and no exercise restrictions are necessary. Children at risk for sudden unexpected death or worsening of their cardiopulmonary condition are those with hypertrophic cardiomyopathy, arrhythmias and conduction system abnormalities, depressed ventricular function, residual shunts or obstruction, pulmonary hypertension, and dilated aorta in Marfan's syndrome. In these children, a thorough cardiovascular evaluation is mandatory and should include Holter monitoring, cardiac ultrasonography, and exercise testing. In some cases cardiac catheterization is also necessary for hemodynamic and electrophysiologic evaluation. With this knowledge the physician can then prescribe the appropriate forms of physical activity for a particular cardiac condition.
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