Statement Highlights:

• With evaluation and monitoring, some physical activity may be safer than previously believed for children and adolescents with select heart conditions, such as different types of cardiomyopathies (disorders affecting the heart muscle’s structure and function) or those with an implantable cardioverter-defibrillator.
• Personalized guidance about the appropriate amount and type of physical activity for children with heart conditions relies on diagnosis, individual risk profile and personal and family goals. Ongoing follow-up and shared decision-making among patients, families and their health care team are critical.

DALLAS, April 23, 2026 — Physical activity in children and teenagers with cardiomyopathy (conditions that affect the heart muscle’s structure and function, impairing its ability to pump or fill effectively), as well as children with implantable cardioverter-defibrillators (ICDs) may be safer than previous research suggested, according to a new scientific statement from the American Heart Association, published today in the Association’s flagship peer-reviewed journal Circulation.

While physical activity and exercise are essential for childhood development and long-term health, they have been traditionally discouraged among children and adolescents with cardiomyopathies and ICDs (implantable devices that detect life-threatening abnormal heart rhythms and deliver electrical shocks) due to concerns that they could worsen heart function or lead to sudden cardiac death.

“While safety is always paramount, halting all physical activity among children with cardiomyopathy or ICDs has at times led to unintended consequences. The latest research indicates that restricting children’s movement can negatively affect their heart health, physical fitness levels, mental well-being and social development, and quality of life,” said Jonathan B. Edelson, M.D., M.S.C.E., chair of the scientific statement writing group, an associate professor of pediatrics and medical director of the sports cardiology program and heart transplant and ventricular assist device programs in the division of cardiology at Children’s Hospital of Philadelphia.

What do parents and caregivers need to know?

Ensuring safe participation in physical activity requires thoughtful, individualized planning and ongoing collaboration among clinicians, families and patients.

• Personalized approach: Tailored risk assessments based on diagnosis, risk profile, genetic profile and clinical evaluations are critical to better guide decisions about prescribing physical activity for children with different types of cardiomyopathies. Various diagnostic screening tools, such as echocardiograms, cardiac imaging and exercise stress tests, can be used to assess symptoms at rest and with activity. Genetic testing and family screening can also be helpful to assess individual risk.
• Shared decision-making: Clinicians, families and (when developmentally appropriate) children or adolescents with cardiomyopathy and/or ICDs can work together to balance a patient’s risk, patient- and family-tailored goals and values. It is important for clinicians to disclose when risk evidence is based on adult data.
• Close follow-up and reassessment: Ongoing monitoring is important to track potential shifts in risk, assess if symptoms progress and evaluate if heart function improves or deteriorates. The recommendations for safe physical activity must evolve as the child grows, activities change and the disease progresses.

What types of activities can be considered?

The new scientific statement aims to shift from adopting a one-size-fits-all approach to physical activity limitations to considering ways for youth with heart conditions or an ICD to safely participate in physical activities — from low-intensity daily activities to high-intensity training and sports in select cases — after a detailed individualized risk assessment.

Light-to-moderate intensity exercise (such as walking, light cycling or swimming) may be appropriate to maintain physical fitness, social development and quality of life, with regular monitoring of their condition. Structured physical activity, such as fitness classes, strength training, running, biking, hiking or organized sports programs, may be reasonable for some children and adolescents with heart conditions. For some carefully selected pediatric patients with certain cardiomyopathies, participation in physical activity including competitive sports may be reasonable after expert assessment and shared decision-making discussion about the risks and benefits. Emergency action plans, including AED (automated external defibrillator) access and bystanders trained in CPR, are essential during organized sports. Additional guidance for specific types of cardiomyopathies are detailed in the manuscript.

“Children with cardiomyopathy should not automatically be sidelined from participating in physical activity, including recreational or competitive sports,” Edelson said. “Most children should be physically active — with individualized evaluation, monitoring and planning. Physical activity is important for their long-term health, physical and social development.”

The statement notes more research is needed about childhood cardiomyopathies because most of the findings in the statement are based on observational studies in adults; therefore, findings should be applied cautiously to a pediatric population. In addition, outstanding questions remain, such as how moderate or vigorous exercise may affect the long-term progression and how risk varies across different types of cardiomyopathies.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; the Council on Clinical Cardiology; the Council on Lifestyle and Cardiometabolic Health; and the Council on Cardiovascular and Stroke Nursing. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke conditions and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice-Chair Jennifer Conway, M.D.; Carissa Baker-Smith, M.D., FAHA; Barbara Cifra, M.D.; Melissa Cousino, Ph.D.; Sharlene Day, M.D., FAHA; Jonathan A. Drezner, M.D.; Anne M. Dubin, M.D.; Corey Gates, R.N.; and David White, Ph.D. Authors’ disclosures are listed in the manuscript.

The Association receives more than 85% of its revenue from sources other than corporations. These sources include contributions from individuals, foundations and estates, as well as investment earnings and revenue from the sale of our educational materials. Corporations (including pharmaceutical, device manufacturers and other companies) also make donations to the Association. The Association has strict policies to prevent any donations from influencing its science content and policy positions. Overall financial information is available here.