Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi+12 trial

González-Saiz, Laura; Fiuza‐Luces, Carmen; Sanchís-Gomar, Fabián; Santos‐Lozano, Alejandro; Quezada-Loaiza, Carlos A.; Flox-Camacho, Ángela; Munguía‐Izquierdo, Diego; Ara, Ignacio; Santalla, Alfredo; Morán, María; Sanz-Ayan, Paz; Escribano, Pilar; Lucía, Alejandro

doi:10.1016/j.ijcard.2016.12.026

Cited by 87 publications

(101 citation statements)

References 47 publications

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“…Rehabilitation physicians cited appropriate intensity, ease of access and safety as the main reasons for recommending an inpatient setting. Interestingly, most published exercise training programs have utilised an intensive inpatient protocol, 15,39,[41][42][43][44][45][46][47][48] such that rehabilitation physicians are in line with the current evidence base. However, inpatient rehabilitation is expensive and may not be widely available.…”

Section: Exercise Patternsmentioning

confidence: 99%

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

et al. 2020

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Exercise training was not traditionally recommended for patients with pulmonary hypertension. However, recent work has demonstrated that exercise improves endurance and quality-of-life in patients with pulmonary hypertension. Unfortunately, patients with pulmonary hypertension are often sedentary. While some studies have examined patient attitudes to exercise, none have investigated physician perspectives on exercise in patients with pulmonary hypertension. This multinational survey of physicians involved in treating patients with pulmonary hypertension sought to ascertain physician attitudes to exercise and physician-identified barriers and enablers of exercise in this patient population. We collected cross-sectional survey data from a cohort of 280 physicians, including rehabilitation physicians, cardiologists, respiratory physicians and rheumatologists. We found that overall, 86% physicians recommended exercise, in line with current guidelines, although there were differences in the rationale for prescribing exercise and in the type of exercise prescription. Barriers to exercise included patient-related factors, such as patient ill health preventing exercise; poor patient motivation and lack of understanding regarding the benefits of exercise. Systemic barriers included cost/funding issues and limited availability of appropriate services. Perceived enablers of exercise included access to appropriate programmes, provision of education and supportive treating clinicians. Further research is required to identify and implement interventions to promote physical activity in patients with pulmonary hypertension.

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Section: Exercise Patternsmentioning

confidence: 99%

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

et al. 2020

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“…Consequently, a physical inactivity and atrophy spiral is established and symptoms are present even on light exertion. Exercise interventions can improve muscle properties …”

Section: Skeletal Muscle Factorsmentioning

confidence: 99%

“…Exercise interventions can improve muscle properties. [90][91][92] Skeletal muscle abnormalities Skeletal muscle abnormalities have only recently been recognized as important in the pathophysiology of exercise intolerance in PAH. 4,53,93,94 In 2007, Bauer et al 4 were the first to report that skeletal muscle impairment existed in idiopathic PAH subjects and correlated with exercise intolerance (6MWD).…”

Section: Physical Inactivity Spiral Deconditioning and Frailtymentioning

confidence: 99%

Pathophysiology of exercise intolerance in pulmonary arterial hypertension

et al. 2017

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Pulmonary arterial hypertension (PAH) is a chronic disease with poor prognosis and important exercise limitation despite the proliferation of treatment options in the last decade. Chronically increased right ventricular (RV) afterload results in right heart failure and without treatment, rapid clinical deterioration is common. Exercise intolerance is the cardinal feature of the disease impacting upon quality of life and clinical outcome. The pathophysiological mechanisms that lead to reduced exercise capacity in this population are complex with ventriculoarterial uncoupling likely to be the predominant feature. The relative contributions of additional factors that contribute to exercise limitation beyond ventriculoarterial uncoupling have not been characterized. This review addresses these factors with a focus on recent developments and uncertainties. RV maladaptation and the intricate interplay between the heart, abnormal pulmonary vascular bed and peripheral factors such as dysfunction of the respiratory and peripheral muscles are discussed in detail.

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“…Our initial literature search retrieved 743 records. From them, 31 potentially eligible RCTs were identified . Studies were excluded from the analysis if they did not include CTEPH patients as the study population, did not have a completely randomized design, were letter and review articles, or were low‐quality studies.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were excluded from the analysis if they did not include CTEPH patients as the study population, did not have a completely randomized design, were letter and review articles, or were low‐quality studies. Ultimately, 6 of the 31 studies were selected; of those not included, 12 were excluded from the meta‐analysis because they did not provide data specific to CTEPH subgroup, 5 were excluded because they used the same data set as another study included in this meta‐analysis, 3 were excluded because they focused on prevention of lung injury after PEA, 2 were excluded because they were open‐label extension studies of a RCT already included in our analysis, 1 was excluded because of its study quality, 1 was excluded because it was a short‐term (1 day) evaluation of haemodynamic changes in patients receiving epoprostenol and the other one was excluded because it compared the treatment effects of high‐dose with low‐dose treprostinil administration . All of the included RCTs were peer‐reviewed articles, and all of them were written in English.…”

Section: Resultsmentioning

confidence: 99%

A meta‐analysis of randomized controlled trials in targeted treatments of chronic thromboembolic pulmonary hypertension

Zhang

Huang

et al. 2019

Clinical Respiratory J

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Background Chronic thromboembolic pulmonary hypertension (CTEPH) results in a progressively worsening course associated with substantial morbidity and mortality. The purpose of this comprehensive study was to determine the clinical efficacy of targeted therapeutic interventions for this disease. Methods We searched Medline, Embase, Cochrane databases and Pubmed for relevant clinical studies. Randomized controlled trials comparing the effects of targeted treatments to control in CTEPH population were included. Pooled estimates were calculated using a random effect model. Heterogeneity was determined using the I2 statistic. Results This analysis included 6 studies with a total of 565 patients. We found that targeted treatments approved for pulmonary arterial hypertension (PAH) were associated with a larger improvement in exercise capacity, haemodynamic parameters, functional status and clinical symptom. There were no statistically significant differences associated with targeted treatments compared with control in all‐cause mortality and safety outcomes. Conclusions This is the first systematic review and meta‐analysis of randomized controlled trials revealing a positive role of PAH‐targeted therapies in CTEPH. Future larger randomized trials with a focus on long‐term clinical outcomes are urgently needed.

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Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi+12 trial

Cited by 87 publications

References 47 publications

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

Pathophysiology of exercise intolerance in pulmonary arterial hypertension

A meta‐analysis of randomized controlled trials in targeted treatments of chronic thromboembolic pulmonary hypertension

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