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146 Journal of Cardiopulmonary Rehabilitation and Prevention 2023;43:145-150 www.jcrpjournal.com In contrast, QOL was not altered from preto post-CRP herein. This was surprising and may be due to CRP duration. It may also be explained by improved disease consciousness, given that clinical variables did not worsen during this time frame. The high adherence in the present study may be due, in part, to the patients not missing school, as the CRP sessions were conducted in the afternoon. Furthermore, patient trust in the program is encouraged by the absence of adverse events and positive change (albeit nonsignificant) in the IPAQ-C score. In contrast to other studies, maximal expiratory pressure, body mass index, and 6-min walk test were not improved from preto post-CRP in pediatric patients with CHD.9-11 It is possible that with a larger sample or control group, statistical differences may have been detected in these outcomes. In conclusion, the CRP elicited improvements in inspiratory muscle strength in children with CHD without any adverse events reported. Future studies with larger sample sizes are necessary to investigate the impact of cardiac rehabilitation on other clinical outcomes.