Background: The shift toward a preventative approach in medical aftercare of congenital heart disease (CHD) patients has led to encouragement of regular physical activity (PA) in this patient population. Objective measures are crucial in accurately displaying PA levels and have increasingly found their way into clinical research. This review aims to give an overview about quality, methodology, and outcomes of current scientific work on accelerometers objectively assessing PA in patients with CHD. Methods: Systematically researched literature in all relevant databases (PubMed, Cochrane, and Scopus) over the past decade (2009–2019) with history of CHD and accelerometer-based PA assessment was evaluated by 2 independent reviewers according to the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. Results: Eight articles with 664 pediatric patients with CHD aged 3–18 years (range 10–162 patients), 5 studies with 574 adults with CHD aged 18–63 years (range 28–330 patients), and 3 studies with 177 pediatric patients and adults with CHD aged 8–52 years were included. Two studies were rated “good”; 9, “fair”; and 5, “poor.” Methodologies and devices differed substantially across all studies. Conclusions: Overall study quality was fair at best, and due to difficult methodological comparability of the studies, no clear answer on how active patients with CHD really are can currently be given. Larger studies carefully considering collection and processing criteria, and correct reporting standards exploring PA in patients with CHD from different angles are needed.

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