Adolescents with CHD have concerns with their physical bodies. They described physical characteristics that visually set them apart: cyanotic lips, small stature, and surgical scars. found that they defined many of their problems in terms of impairment, indicating that their social exclusion was because of their physical characteristics such as decreased stamina and limited ability to keep up. Other physical characteristics typical in young adults with CHD were breathlessness, decreased endurance and pace, and a need for more frequent rest periods. These all limited the interviewed adolescents' ability to participate in physical education, after-school sports teams, horseback riding, bicycling, and scuba diving. The regular day-to-day activities that healthy adolescents take for granted become off limits for some adolescents with CHD, thus potentially leading to feelings of social exclusion. Missing from the literature was any direct reference to whether feelings of exclusion factored into their quality of life.