Tailoring Pediatric Cardiac Rehabilitation to the Underlying Cardiac Disease

Abstract Purpose of Review Pediatric cardiac rehabilitation (PCR) is an increasingly important component of care for children and adolescents with congenital, inherited, and acquired cardiac disease. Advances in medical and surgical therapies have improved survival, creating a growing population with chronic cardiovascular morbidity, including exercise intolerance, frailty, neurodevelopmental challenges, and impaired quality of life. This review summarizes the principles of PCR and highlights disease-specific approaches. Recent Findings Contemporary evidence supports the safety and efficacy of structured exercise interventions in most pediatric cardiac populations when appropriately prescribed and monitored. Exercise training improves cardiovascular fitness, vascular function, skeletal muscle health, metabolic outcomes, and quality of life. Emerging data demonstrate benefits of PCR in congenital heart disease, including single ventricle physiology and repaired tetralogy of Fallot, as well as cardiomyopathy, heart failure, heart transplantation, and pulmonary hypertension. Recent studies have challenged historical exercise restrictions in conditions such as hypertrophic cardiomyopathy and channelopathies, supporting individualized risk assessment and shared decision-making. Increasing recognition of frailty, neurodevelopmental impairment, psychosocial comorbidity, and family influences have expanded the scope of PCR. Hybrid and home-based rehabilitation models may improve access and participation. Summary PCR is a safe, effective, and underutilized therapy that addresses the complex physical, developmental, and psychosocial needs of children with cardiac disease. Programs should be individualized based on cardiac physiology, functional limitations, and developmental stage, incorporating aerobic and resistance training, psychosocial support, family engagement, and lifelong physical activity promotion. Despite growing evidence of improvements in exercise capacity, function, frailty, and quality of life, barriers to implementation remain. Expansion of access, development of disease-specific guidelines, and multicenter outcomes research are needed to establish PCR as a standard component of pediatric cardiovascular care.