Physical activity and competitive sport safety for children affected by inherited cardiac conditions and selected acquired cardiomyopathies: emerging evidence and areas for further inquiry
Physicians tasked with caring for children with inherited cardiac conditions (ICCs) face complex decisions regarding safe participation in physical activity and competitive sport. Historically, concerns over sudden cardiac death (SCD) and disease progression led to widespread exercise restrictions. However, emerging evidence and evolving guidelines now support a more nuanced, risk-based approach. This narrative review explores current recommendations for exercise in children with major ICCs-including channelopathies, cardiomyopathies, and aortopathies. It highlights advances in risk stratification, the use of exercise testing, cardiac imaging, and genetic information to guide individualised recommendations. Shared decision-making (SDM) is emphasised as central to balancing arrhythmic and disease progression risk with the substantial physical, psychological, and social benefits of exercise. The review also discusses non-inherited conditions like anthracycline-induced cardiomyopathy and myocarditis. Despite progress, substantial variation exists in international guidelines, and there remains a paucity of paediatric-specific data. This poses a significant challenge and often necessitates utilising adult data when making decisions for children. Conclusion: Further research, including registries and multi-centre studies, is essential to improve evidence-based recommendations and empower clinicians, patients, and families in decision-making. A personalised approach-grounded in expertise, communication, and longitudinal follow-up-is critical to safely supporting children with ICCs in leading active, fulfilling lives.
Authors
- Iulia Rodoman (ORCID: https://orcid.org/0000-0003-0982-2281)
- Andreia Duarte Constante (ORCID: https://orcid.org/0000-0003-3677-8212)
- Nicoletta Cantarutti (ORCID: https://orcid.org/0000-0001-9888-2395)
- Christophe Vô
- Wannes Renders
- Sara Moscatelli (ORCID: https://orcid.org/0000-0002-7370-1057)
- Roger Esmel-Vilomara (ORCID: https://orcid.org/0000-0003-4449-3217)
- Simon D’hulst (ORCID: https://orcid.org/0000-0001-8447-0576)
- Scott Kendall
- Frank A. Casey
- Terrence Prendiville
- Daniel Díaz-Gil
- José Luis López-Guillén
- Georgia Sarquella-Brugada
- Pascal McKeown
- Katarzyna Luczak-Wozniak
- Andrea Greco
Institutions
- University of Siena (IT)
- Universitat Autònoma de Barcelona (ES)
- Queen's University Belfast (GB)
- Boston Children's Hospital (US)
- Hospital Sant Joan de Déu Barcelona (ES)
- Cliniques Universitaires Saint-Luc (BE)
- Harvard University (US)
- University of Toronto (CA)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Medical University of Warsaw (PL)
- Royal Brompton & Harefield NHS Foundation Trust (GB)
- Great Ormond Street Hospital (GB)
- Ghent University Hospital (BE)
- Hospital for Sick Children (CA)
- Hospital de Sant Pau (ES)
- Children's Health Ireland at Crumlin (IE)
- Hospital de São José (PT)
- Sociedade Portuguesa de Cardiologia (PT)
- Bambino Gesù Children's Hospital (IT)
- Sant Joan de Déu Research Foundation (ES)
- Vall d'Hebron Hospital Universitari (ES)
- Mother and Child Foundation (GB)
- ERN GUARD-Heart (NL)
- Hospital de Santa Marta (PT)
- Institute of Child and Mother Health (BD)
- Institut de Recerca Sant Joan de Déu
- University College London (GB)
- University of Warsaw (PL)
- Universitat de Barcelona (ES)
Publication Details
- Journal
- European Journal of Pediatrics
- Published
- 2026-03-04
- DOI
- https://doi.org/10.1007/s00431-026-06768-y
- Primary Topic
- Cardiovascular Effects of Exercise
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Centres de Recerca de Catalunya
- European Commission
- Generalitat de Catalunya
- Hospital for Sick Children
- Instituto de Salud Carlos III