Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease

Becker-Grünig, T; Klose, Hans; Ehlken, Nicola; Lichtblau, Mona; Nagel, Christian; Fischer, Christine; Gorenflo, Matthias; Tiede, Henning; Schranz, Dietmar; Hager, Alfred; Kaemmerer, Harald; Miera, Oliver; Ulrich, Silvia; Speich, Rudolf; Uiker, Sören; Grünig, Ekkehard

doi:10.1016/j.ijcard.2012.09.036

Cited by 121 publications

(137 citation statements)

References 29 publications

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“…This was based on a randomized controlled trial (RCT) that demonstrated an improvement (Tables 13 and 14) It is recommended to perform regular follow-up assessments every 3-6 months in stable patients (Table 14) Class a [96,97,99] Achievement/maintenance of a low-risk profile ( in exercise and functional capacity and in quality of life in patients with PH who took part in a training programme as compared with an untrained control group [152]. Since then, additional uncontrolled experiences have supported these data utilising different models of exercise training [153][154][155][156][157]. Two additional RCTs have been published reporting that trained PAH patients reached higher levels of physical activity, had decreased fatigue severity and showed improved 6MWD, cardiorespiratory function and patient-reported quality of life as compared with untrained controls [158,159].…”

Section: Physical Activity and Supervised Rehabilitationmentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

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Section: Physical Activity and Supervised Rehabilitationmentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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“…44 Future studies are needed to determine whether these favorable effects of exercise training can translate into a reduction in long-term major adverse clinical outcomes. 14,[17][18][19][20][21][22]27,29 and peak absolute oxygen uptake (mL/min) on pooled analysis of included studies (n=6, B). 14,[19][20][21]27 The mechanisms underlying improvement in exercise tolerance with exercise training among patients with pulmonary hypertension are not well understood.…”

Section: Pandey Et Al Exercise Training In Pulmonary Hypertension 1039mentioning

confidence: 99%

“…Several small studies have evaluated exercise training as an adjunctive therapeutic strategy in patients with chronic pulmonary hypertension. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Although most of these studies were small and not designed to address clinical end points, such as mortality or hospitalizations, related to pulmonary hypertension, they have demonstrated a variable degree of improvement in exercise tolerance and quality of life in response to training.Therefore, because of the uncertainty about the benefit of structured exercise training programs in patients with pulmonary hypertension, we performed this systematic review and meta-analysis to assess the efficacy and safety of structured exercise training regimens in patients with pulmonary hypertension. …”

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confidence: 99%

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

108

110

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P ulmonary hypertension is a chronic cardiopulmonary disorder characterized by progressive increasing pulmonary vascular resistance, leading to right ventricular heart failure. 1 Prevalence of pulmonary hypertension is estimated to be 10 to 15 cases per million with a mortality rate of 15% per year. 2 Over the past 2 decades, targeted pharmacological therapies have been effective in reducing disease progression and improving the survival rate among patients with pulmonary hypertension.3,4 However, most patients remain symptomatic with significant exercise intolerance and reduced quality of life despite being on optimal medical therapy. 5,6 Thus, there is an unmet need for adjunctive therapeutic strategies to improve exercise tolerance and quality of life among these patients. Clinical Perspective on p 1043Exercise intolerance in patients with pulmonary hypertension is associated with a reduced maximal oxygen uptake and early onset of anaerobic threshold, similar to patients with severe heart failure. 7 The decrease in pulmonary vasculature distensibility associated with pulmonary hypertension leads to marked increases in pulmonary arterial mean pressure during exercise. This results in reduced pulmonary blood flow and low cardiac output insufficient to meet the metabolic demands of exercise. [7][8][9] Furthermore, pulmonary hypertension patients have significant skeletal muscle abnormalities leading to impaired peripheral oxygen utilization. These central and peripheral abnormalities contribute significantly to the exercise intolerance and functional limitation in patients with pulmonary hypertension. 10,11 Exercise training has been shown to improve cardiorespiratory fitness, functional status, and clinical outcomes in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). 12,13 Considering the overlap in the pathophysiological derangements Original Article© 2015 American Heart Association, Inc.Circ Heart Fail is available at http://circheartfailure.ahajournals.org DOI: 10.1161/CIRCHEARTFAILURE.115.002130Background-Exercise training has been shown to improve cardiorespiratory fitness, physical capacity, and quality of life in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease. However, its role in management of pulmonary hypertension is not well defined. In this study, we aim to evaluate the efficacy and safety of exercise training in patients with pulmonary hypertension. Methods and Results-We included all prospective intervention studies that evaluated the efficacy and safety of exercise training in patients with pulmonary hypertension. Primary outcome of this meta-analysis was a change in 6-minute walk distance. We also assessed the effect of exercise on peak oxygen uptake, resting pulmonary arterial systolic pressure, peak exercise heart rate, and quality of life. A total of 469 exercise-training participants enrolled in 16 separate training studies were included. In the pooled ana...

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“…However, recent evidence suggests almost universal benefit from regular aerobic conditioning in associated diseases, including other types of PAH and left heart disease. 38,39 A small nonrandomized cohort study of a mixed PAH-CHD sample, half with ES, reports that conditioning is safe and may be effective 40 ; European guidelines support a possible role for supervised exercise rehabilitation in deconditioned patients with PAH, without a distinction based on the presence of CHD (class IIa). 27 Recommendations defining optimal exercise type, intensity, and potential efficacy await further investigation (eg, NCT01397110 at clinicaltrials.gov).…”

Section: Specific Supportive Care For Patients With Esmentioning

confidence: 99%

Clinical Evaluation and Management of Pulmonary Hypertension in the Adult With Congenital Heart Disease

Opotowsky

2015

Circulation

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200P ulmonary hypertension (PH) refers to elevated pulmonary artery (PA) pressure (PAP), defined as mean PAP≥25 mm Hg. PH is not synonymous with pulmonary arterial hypertension (PAH), which specifies resistive PH characterized by elevated pulmonary vascular resistance (PVR) and normal pulmonary venous pressure. Approximately 5% to 10% of adults with congenital heart disease (CHD) have PH, and this subset of CHD patients is at higher risk of hospitalization and death. [1][2][3] Understanding the epidemiology of PH associated with CHD (PH-CHD) is not straightforward, however, because definitions of PH-CHD and diagnostic techniques vary. Appropriate diagnosis and the management of PH-CHD rest on identifying the cause of elevated PAP: high pulmonary venous pressure, high pulmonary vascular resistance, high pulmonary flow, or some combination of these factors, which are referred to throughout this review as passive, resistive, hyperkinetic, and polygenic PH, respectively (Table 1).Prognosis in PH-CHD depends on the underlying cause, pulmonary vascular pathophysiology, and the interaction between the right heart and pulmonary circulation. Adult CHD is heterogeneous, with myriad permutations of underlying defects, previous interventions, and associated comorbidities. Although comprehensive understanding of clinical context is a prerequisite, identifying the optimal therapy for a patient with PH-CHD depends more heavily on an understanding of pathophysiology than it does on the underlying diagnosis. Therefore, the goal of this review is to frame an understanding of PH-CHD in terms of fundamental cardiopulmonary hemodynamic pathophysiology and to emphasize the clinical assessment and management of situations commonly encountered by adult cardiologists caring for patients with PH-CHD. Classifications of PH and PH-CHDClassification schemes in PH represent clinical perspectives of underlying pathophysiology and tend to parallel fundamental hemodynamic relationships of the pulmonary circulation. PVR

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Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease

Cited by 121 publications

References 29 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Clinical Evaluation and Management of Pulmonary Hypertension in the Adult With Congenital Heart Disease

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