Preparing a patient for independent cardiac care is an ongoing process that should start in early ado- lescence if not soonerS3.5-3 and may extend beyond 18 years of age in many patients. The recommen- dation and goals for transition and transition ed- ucation have been described and include verbal, written, and experiential efforts to teach patients and families about their specific heart disease, ex- pectations, and concerns regarding CHD, as well as skills to navigate the healthcare system as an Lack of education about the need for transition and lifelong cardiac care leads to gaps in care that can result in increased hospitaliza- tions, need for urgent intervention, and increased A structured approach to transi- tion education improves health related knowledge This education is a continual process that includes after transfer to an ACHD care provider.S3.5-4 3.6. Exercise and Sports Recommendations for Exercise and Sports Referenced studies that support recommendations are summarized in Online Data Supplement 13. 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. 