It is well established that cardiac rehabilitation (CR) improves survival, functional ability, and quality of life in adults on LVAD support [6, 7]. Hayes et al. investigated whether supervised exercise training improved maximal exercise capacity (peak VO₂), submaximal exercise capacity (6 min walk distance, 6MWD), and quality of life (QoL) scores in 14 adult LVAD patients, through a prospective, assessor-blinded randomized controlled trial [8]. They demonstrated no adverse events, with a trend toward improved peak VO₂, 6MWD, and QoL in the exercise group (n = 7) as compared with the control group. However, the difference was not statistically significant and warranted further evaluation with a larger cohort. In a larger study completed by Kerrigan et al., improved indicators of functional capacity and health status were demonstrated among 26 adults with LVADs who attended CR. Functional capacity was determined by peak oxygen uptake, treadmill time, 6MWD, and leg strength. They concluded that CR was well tolerated by LVAD patients, and when all metrics of functional capacity were assessed in their entirety, CR was favorably associated with increased exercise tolerance [9]. In contrast, little is known regarding the utility of formal outpatient CR in children on VAD support. The goal of all CR therapy is to improve patient’s functional abilities, exercise endurance, and most importantly QoL. Outpatient CR may be of variable benefit depending on the patient’s age, developmental abilities, underlying cardiac disease, comorbidities, and duration of illness prior to device support. Facilitating a return back to school and participation in extracurricular activities should be the primary goal of CR program. Many children and adolescents may benefit from a tailored CR program that is focused on activities that interest the pediatric population, such as sports and games. Assessment by a comprehensive team of physiotherapists, occupational therapists, and rehabilitation physicians will help delineate deficiencies in functional abilities and areas for improvement. The level of deconditioning prior to VAD support will likely dictate the potential for functional improvement post VAD support. Most children on dischargeable VAD support (HeartWare^®, HeartMate II^®, and Syncardia^®) are of ages and developmental abilities to participate in many exercise regimes. Additionally, exercise testing including 6MWD, treadmill, and bicycle exercise tests is generally feasible in most ambulatory children and adolescents, allowing metrics to measure improvement. Pediatric centers are learning from the experiences garnered by adult cardiovascular facilities in terms of evaluation and availability of rehabilitation services. We expect that with the growing population of complex cardiac children transitioning to outpatient facilities, CR for children will be an area of tremendous potential for evaluation and development.