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. There is evidence that exercise capacity varies among congenital heart defects, with declining capacity (generally) as complexity increases.S3.6-10,S3.6-11 Knowledge of the typical exercise capacity for patients with a specific lesion is im- portant when making appropriate activity Self-directed activity is usually at 40% to 60% of maximal exercise ca- pacity, whereas fitness training occurs at 60% to Exercise capacity is defined in relation to maximal oxygen con- sumption. The writing committee recognizes that not all ACHD centers will have the resources to conduct CPET, which is the preferred method of evaluation. If CPET cannot be performed, other exercise tests using an established treadmill or bicycle ergometer protocol are an acceptable al- ternative for assessing exercise capacity, recogniz- ing that valuable information may be unavailable compared with CPET. 3. As with other populations of cardiac patients, in- activity leads to reduced exercise performance. Regular exercise and cardiac rehabilitation may improve exercise capacity and HF symptoms, and ought to be encouraged.S3.6-6,S3.6-7,S3.6-21,S3.6-22 CLINICAL STATEMENTS AND GUIDELINES 3.7. Mental Health and Neurodevelopmental Issues Recommendations for Mental Health and Neurodevelopmental Issues Referenced studies that support recommendations are summarized in Online Data Supplement 14. COR LOE Recommendations I B-NR Patients with ACHD should be evaluated for depression and anxiety.S3.7-1 S3.7-3 IIa B-NR Referral for mental health evaluation and treatment is reasonable in patients with IIb B-NR Neurodevelopmental or neuropsychological testing may be considered in some patients with ACHD to guide therapies that enhance academic, behavioral, psychosocial, and Synopsis Mental health and neurodevelopmental issues are com- mon in patients with ACHD and may significantly affect QoL. 