Physical Activity in Pediatric Cardiomyopathies: Moving for Health: A Scientific Statement From the American Heart Association

Abstract

Physical activity (PA) is essential for the cardiovascular, emotional, and social health of all children and adolescents. However, for pediatric patients with cardiomyopathy, decades of risk-averse clinical guidance have resulted in widespread PA restriction due to fears of sudden cardiac death and disease progression. This has contributed to sedentary behavior, poor cardiorespiratory fitness, and increased risk of secondary cardiometabolic conditions in this population. However, emerging data challenge this restrictive paradigm, showing that the risk of sudden cardiac death may not be higher in some patients with cardiomyopathy who exercise than in those who are less active, and that participation in PA may also have a positive effect on reverse remodeling. This American Heart Association scientific statement provides an evidence-based framework for the promotion of PA in pediatric patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, or arrhythmogenic cardiomyopathy, as well as those with implantable cardioverter defibrillators; outlines the physical, social, and emotional benefits of PA for these children and adolescents; and provides updated risk stratification strategies, including the use of advanced imaging, exercise testing, and genotype-specific data. This scientific statement underscores the importance of shared decision-making tailored to developmental maturity and family goals and emphasizes the need for longitudinal surveillance as clinical phenotypes evolve. With individualized assessment and informed shared decision-making, most children and adolescents with cardiomyopathy can safely engage in PA, with important implications for long-term cardiometabolic and psychologic health.