Effects of Exercise Training on Exercise Capacity in Pulmonary Arterial Hypertension: A Systematic Review of Clinical Trials

Babu, Abraham Samuel; Padmakumar, R; Maiya, Arun G.; Mohapatra, Aswini Kumar; Kamath, Ramachandra

doi:10.1016/j.hlc.2015.10.015

Cited by 60 publications

(73 citation statements)

References 46 publications

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“…This emerging data has been seen specifically in the WHO group I PAH (Babu et al, 2016; Chan et al, 2013). Our study shows exercise tolerance improvements in terms of speed in mph and increased duration of exercise across multiple etiologies of PHTN after a course of structured PR.…”

Section: Discussionmentioning

confidence: 83%

Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients

Talwar¹,

Sahni²,

Verma³

et al. 2017

J Exerc Rehabil

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Pulmonary rehabilitation (PR) is part of the recommended management plan of pulmonary hypertension (PHTN) and is important to better quality of life and exercise tolerance. This study aimed at determining effectiveness of PR on exercise capacity. Retrospective chart analysis was conducted on patients referred to our PHTN clinic for PR. Patients who had PHTN diagnosed on right heart catheterization (defined by mean pulmonary artery pressure>25 mmHg) and completed a standardized 12-week PR program were considered for the study. Patients’ baseline exercise tolerance was recorded as speed attainable on a treadmill and duration of exercise in minutes. Demographics, age, sex, and oxygen use were obtained from chart review. Eighteen PHTN patients (5 male, 13 female; mean age 67.7±11.6 years) were considered for the study (six World Health Organization [WHO] group 1 pulmonary arterial hypertension [33.33%], eight WHO group III PHTH [44.44%], two WHO group IV and two WHO V PHTN [11.11%]). Treadmill speed improved following rehabilitation (1.3 mph [interquartile range {IQR}, 1.0–1.8 mph] to 2.2 mph [IQR, 1.3–2.8 mph]; P<0.0001, Wilcoxon signed rank test). Median exercise time improved (27 min (IQR, 22–30 min) to 30 min (IQR, 24–30 min); not significant. Improvement was defined only as an increase in speed or duration, or both. Sixteem of 18 participants improved (88.9% [95% exact binomial confidence interval, 65.3%–98.6%). Patients with PHTN benefit from a structured PR program to improve their exercise capacity and should be enrolled in PR programs as part of their management.

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Section: Discussionmentioning

confidence: 83%

Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients

Talwar¹,

Sahni²,

Verma³

et al. 2017

J Exerc Rehabil

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“…104–107 One main conclusion was that improvements in 6MWD varied with different exercise modalities, favoring a combination of aerobic resistance and respiratory muscle training. 105 Further evidence comes from two systematic reviews with meta-analyses which included controlled interventional studies published up to 2013 106 and prospective interventional studies published up to 2015. 107 The meta-analyses demonstrated that ET led to a significant increase in 6MWD with a mean improvement of 72 m versus controls and 53 m versus baseline, respectively, accompanied by slight increases in peak VO 2 (2.2 mL/kg/min versus controls and 1.8 mL/kg/min versus baseline, respectively).…”

Section: Therapeutic Effects Of Exercisementioning

confidence: 99%

Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension

et al. 2017

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Pulmonary hypertension (PH) is characterized by severe exercise limitation mainly attributed to the impairment of right ventricular function resulting from a concomitant elevation of pulmonary vascular resistance and pressure. The unquestioned cornerstone in the management of patients with pulmonary arterial hypertension (PAH) is specific vasoactive medical therapy to improve pulmonary hemodynamics and strengthen right ventricular function. Nevertheless, evidence for a beneficial effect of exercise training (ET) on pulmonary hemodynamics and functional capacity in patients with PH has been growing during the past decade. Beneficial effects of ET on regulating factors, inflammation, and metabolism have also been described. Small case-control studies and randomized clinical trials in larger populations of patients with PH demonstrated substantial improvements in functional capacity after ET. These findings were accompanied by several studies that suggested an effect of ET on inflammation, although a direct link between this effect and the therapeutic benefit of ET in PH has not yet been demonstrated. On this background, the aim of the present review is to describe current concepts regarding the effects of exercise on the pulmonary circulation and pathophysiological limitations, as well as the clinical and mechanistic effects of exercise in patients with PH.

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“…The complexity of this disease, including high pulmonary pressures, ventilation-perfusion abnormalities, dysfunction in peripheral oxygen extraction and respiratory muscle dysfunction makes the benefit and safety of exercise therapy difficult to predict. Meta-analysis of studies published between 1980 and 2015 revealed 15 studies of moderate to good quality (using the Downs and Black Quality Index) comprising 477 total patients [51]. Exercise training resulted in significant increase in exercise capacity, modest improvement in VO2 (1–2ml/kg-min) and functional class, and minimal adverse effects.…”

Section: The Evidence Behind Current Practicementioning

confidence: 99%

Cardiorespiratory Fitness and Atherosclerosis: Recent Data and Future Directions

Mehanna

Hamik

2016

Curr Atheroscler Rep

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Historically the relationship between exercise and the cardiovascular system was viewed as unidirectional, with disease resulting in exercise limitation and hazard. This article reviews and explores the bidirectional nature, delineating the effects, generally positive, on the cardiovascular system and atherosclerosis. Exercise augments eNOS, affects redox potential, and favorably affects mediators of atherosclerosis including lipids, glucose homeostasis, and inflammation. There are direct effects on the vasculature as well as indirect benefits related to exercises induced changes in body composition and skeletal muscle. Application of aerobic exercise to specific populations is described, with the hope that this knowledge will move the science forward and improve individual patient outcome.

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Effects of Exercise Training on Exercise Capacity in Pulmonary Arterial Hypertension: A Systematic Review of Clinical Trials

Cited by 60 publications

References 46 publications

Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients

Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients

Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension

Cardiorespiratory Fitness and Atherosclerosis: Recent Data and Future Directions

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