Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial

Abstract

AimsThe impact of exercise training on the right heart and pulmonary circulation has not yet been invasively assessed in patients with pulmonary hypertension (PH) and right heart failure. This prospective randomized controlled study investigates the effects of exercise training on peak VO2/kg, haemodynamics, and further clinically relevant parameters in PH patients.Methods and resultsEighty-seven patients with pulmonary arterial hypertension and inoperable chronic thrombo-embolic PH (54% female, 56 ± 15 years, 84% World Health Organization functional class III/IV, 53% combination therapy) on stable disease-targeted medication were randomly assigned to a control and training group. Medication remained unchanged during the study period. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks. Primary endpoint was the change in peak VO2/kg. Secondary endpoints included changes in haemodynamics. For missing data, multiple imputation and responder analyses were performed. The study results showed a significant improvement of peak VO2/kg in the training group (difference from baseline to 15 weeks: training +3.1 ± 2.7 mL/min/kg equals +24.3% vs. control −0.2 ± 2.3 mL/min/kg equals +0.9%, P < 0.001). Cardiac index (CI) at rest and during exercise, mean pulmonary arterial pressure, pulmonary vascular resistance, 6 min walking distance, quality of life, and exercise capacity significantly improved by exercise training.ConclusionLow-dose exercise training at 4–7 days/week significantly improved peak VO2/kg, haemodynamics, and further clinically relevant parameters. The improvements of CI at rest and during exercise indicate that exercise training may improve the right ventricular function. Further, large multicentre trials are necessary to confirm these results.

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.…”

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

“…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. …”

“…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.…”

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review

“…Moreover, a clinically important research question is whether these drugs would increase exercise capacity in the hypoxic environment also in patients with PAH/CTEPH or other respiratory diseases. Whether supplemental oxygen therapy in addition to current drugs would improve the capacity to perform daily activities or effectiveness of training in PAH/CTEPH patients with exercise-induced hypoxemia remains to be determined in future randomized trials (11). Further studies might investigate other potential therapeutic options, such as inhaled steroids, betamimetics, and other agents (6,54).…”