Exercise training in pulmonary arterial hypertension associated with connective tissue diseases

Abstract

IntroductionThe objective of this prospective study was to assess short- and long-term efficacy of exercise training (ET) as add-on to medical therapy in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-APAH).MethodsPatients with invasively confirmed CTD-APAH received ET in-hospital for 3 weeks and continued at home for 12 weeks. Efficacy parameters have been evaluated at baseline and after 15 weeks by blinded-observers. Survival rate has been evaluated in a follow-up period of 2.9 ± 1.9 years.ResultsTwenty-one consecutive patients were included and assessed at baseline, and after 3 weeks, 14 after 15 weeks. Patients significantly improved the mean distance walked in 6 minutes compared to baseline by 67 ± 52 meters after 3 weeks (p < 0.001) and by 71 ± 35 meters after 15 weeks (p = 0.003), scores of quality of life (p < 0.05), heart rate at rest, peak oxygen consumption, oxygen saturation and maximal workload. Systolic pulmonary artery pressure and diastolic systemic blood pressure improved significantly after 3 weeks of ET. The 1- and 2-year overall-survival rates were 100%, the 3-year survival 73%. In one patient lung transplantation was performed 6 months after ET.ConclusionET as add-on to medical therapy is highly effective in patients with CTD-APAH to improve work capacity, quality of life and further prognostic relevant parameters and possibly improves the 1-, 2- and 3-year survival rate. Further randomized controlled studies are needed to confirm these results.Trial registrationClinicalTrials.gov: NCT00491309.

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

“…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].…”

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.…”

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].…”