COR LOE Recommendations I C-LD Clinicians should assess activity levels at regular intervals and counsel patients with ACHD about the types and intensity of exercise appropriate to their clinical IIa C-LD CPET can be useful to guide activity recommendations for patients with IIa B-NR Cardiac rehabilitation can be useful to increase exercise capacity in patients with Synopsis Historically, guidelines for physical activity among pa- tients with CHD have focused on restriction, rather than promotion of activity.S3.6-14,S3.6-15 Because of fears of adverse events such as SCD or aortic dissection, rec- ommendations derived from those that apply to com- have been applied to recreational activities despite the absence of evidence on the risk or safety of moderate activity. The 2015 Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force does work toward encouraging participation and shared decision-mak- ing with patients regarding competitive sports partic- ipation. Most patients with ACHD can safely engage in regular, moderate physical activity. A few conditions, such as systemic ventricular systolic dysfunction, sys- temic ventricular outflow tract obstruction, hemody- namically significant arrhythmias, or aortic dilation, warrant more cautious recommendations.S3.6-17 Recommendation-Specific Supportive Text 1. Physical activity is widely recognized as being ben- eficial to the physical and mental health of those There is conflicting evi- dence regarding physical activity levels in patients with CHD, with some suggesting the tendency for less activityS3.6-5,S3.6-9 and a greater prevalence than in the general population. Studies describe the beneficial effects and safety of exercise programs for patients across the spec- trum of CHD.S3.6-18,S3.6-19 Activity recommendations should be individualized based on the patient s clinical status and their interests.S3.6-20 2. 