Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients

Abstract

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.

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

“…Exercise training can lead to meaningful improvements in exercise capacity, muscular function, QoL and possibly right ventricular function and pulmonary haemodynamics [3]. Beneficial effects of exercise training have been shown in six randomised controlled trials [15,[22][23][24][25][26], three controlled trials [27][28][29], 10 prospective cohort studies [16][17][18][19][20][21][30][31][32][33][34][35], three case series [34][35][36], two retrospective cohort studies [37,38] and four meta-analyses [39][40][41] including one Cochrane review [42]. Beside the clinical effects, it has also been shown that exercise training may reduce inflammation and cell proliferation on a molecular level and may have a beneficial effect on the pulmonary vessels.…”

Individualized home-based exercise program for idiopathic pulmonary arterial hypertension patients: a preliminary study

“…Signifi cant improvement in chest excursions confi rm changes in breathing pattern suggesting better engagement of diaphragm during breathing after the program. The program emphasized promoting the engagement of diaphragm and "slow breath" to improve breathing pattern 34 and inspiratory muscle strength 35,36 that contributes to better exercise capacity 6,37 as well as more adaptive stress response (autonomic balance) 34,38 as were mentioned by the participants practicing the breathing exercises almost every day to manage daily activities. Because neither the pulmonary function nor level of oxygen consumption was assessed after the exercise program in the present study, the directly defi ned effects remain unclear and further studies are required.…”

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

“…Pulmonary hypertension is a cause of reduced exercise capacity; it may precede overt manifest pulmonary hypertension and is associated with a decreased life expectancy [28]. However, exercise training has been shown to be safe in these patients [11][12][13][14][15][16][29][30][31], and European guidelines recommend its use in experienced centers for patients who are clinically stable, on optimal pharmacological treatment [17,19].…”