Effect of Exercise and Respiratory Training on Clinical Progression and Survival in Patients with Severe Chronic Pulmonary Hypertension

Abstract

Background: Even though specific agents for the treatment of patients with pulmonary hypertension (PH) are available, in PH patients, physical capacity and quality of life (QoL) are often restricted and survival is reduced. Objectives: This study prospectively investigated the long-term effects of respiratory and exercise training in patients with severe chronic PH regarding safety, time to clinical worsening and survival. Methods: Fifty-eight consecutive patients with severe PH on stable disease-targeted medication received exercise and respiratory training in hospital for 3 weeks and continued at home. They were prospectively followed for 24 ± 12 months. Primary endpoints were time to clinical worsening and survival. Adverse events and changes in the 6-min walking test, QoL, WHO functional class and gas exchange were secondary endpoints and were evaluated at baseline and at weeks 3 and 15. Results: All patients tolerated the exercise training well without severe adverse events. In week 15, 6-min walking test results were significantly improved compared to baseline (by 84 ± 49 m, p < 0.001), as well as QoL scores, WHO functional class (from 2.9 ± 0.5 to 2.6 ± 0.6, p < 0.01), peak oxygen consumption (from 12.5 ± 3.0 to 14.6 ± 3.9 ml/min/kg, p < 0.001), heart rate at rest (from 75 ± 12 to 61 ± 18 beats/min, p < 0.001) and maximal workload (from 65 ± 21 to 80 ± 25 W, p < 0.001). Survival at 1 and 2 years was 100 and 95%, respectively. Fifteen events occurred during the follow-up. Conclusion: This study indicates that exercise and respiratory training as add-on to medical treatment may improve exercise capacity and QoL, and that they have a good long-term safety in the described setting.

Pulmonary rehabilitation in moderate pulmonary hypertension

“…The patient in this study had a 50 per cent reduction in his dyspnoea, going from 4 to 2, a situation that completely changes the outlook regarding the appearance of symptoms during the performance of activities of daily living. There were benefits in the functional classification of the WHO, starting in class III and ending in class II, which is similar to that found by Ehlken et al, 30 who in a clinical trial found in 3 weeks of training significant improvements in the functional class of 2.8±0.6 to 2.4±0.5; however, although in this and in Grunig's study 31 there was a decrease in the average classification score, it could not be established if they changed the grade from one stage to another, as it does in the case reported by us.…”

Safety and efficacy of exercise training in various forms of pulmonary hypertension

“…Exercise training also improved peak oxygen consumption and World Health Organization (WHO) functional class [1], and possibly the clinical outcome, with 1-and 2-yr survival rates of 100 and 95%, respectively [4]. Importantly, no severe adverse events occurred in the previously assessed training groups.…”

Current issues in evaluation of the right ventricle condition: Role of gender and ethnic features and exercise

“…[45], при этом не было выявлено отрицательного влияния физических тре-нировок на внутрисердечную гемодинамику, которая контролировалась инвазивными методами исследова-ния. В настоящее время вопрос физических трениро-вок у больных с легочной гипертензией продолжает активно изучаться [46][47][48][49], хотя часто и без привлече-ния ЭхоКГ методов исследования ПЖ. Нагрузочная допплер-ЭхоКГ для проведения скрининга легочной гипертензии не рекомендована из-за отсутствия доста-точной доказательной базы и утвержденных критериев диагностики [42].…”