Long-Term Effect of an Exercise Training Program on Physical Functioning and Quality of Life in Pulmonary Hypertension: A Randomized Controlled Trial

Abstract

The aim of this study was to evaluate the effects of a 6-month combined aerobic and strength exercise training program on functional and psychological aspects and health-related quality of life in patients with PH and to evaluate its longer-term impact. In total, 22 stable patients (mean age 53.9 ± 13.8 , 13 female) with pulmonary hypertension of World Health Organization (WHO) class I-III participated in a nine-month study. They were randomly assigned into two groups: Group A participated in a 6-month combined aerobic and strength exercise training program, whereas Group B remained untrained. All patients underwent physical and psychological assessment at baseline and at month 6 (after completing the exercise program) and physical assessment after 9 months (3 months posttraining). After the 6-month exercise training program, patients of Group A significantly improved their physical (6MWD, STS 10 rep, STS 20 rep, TUG, lower limb strength, cardiopulmonary exercise time, METs, peak VO2, VCO2, and VE/VCO2 slope) and psychological aspects (SF-36, STAI, and BDI). Between the two groups, differences were observed at the 6MWD (95% CI: 36.2-64.6, η 2 = 0.72 ), STS 10 rep (95% CI: 6.6-2.2, η 2 = 0.4 ), STS 20 rep (95% CI: 10.8-2.4, η 2 = 0.34 ), lower limb strength (95% CI: 7.2-3.6, η 2 = 0.38 ), cardiopulmonary exercise time (95% CI: 0.1-3.3, η 2 = 0 . 2 ), and VCO2 (95% CI: 0.1-0.5, η 2 = 0 . 2 ). Additionally, psychological changes were noted at SF-36, PCS (95% CI: 3.6-14.8, η 2 = 0.35 ), MCS (95% CI: 1.3-16.1, η 2 = 0.22 ), TCS (95% CI: 1.3-16.1, η 2 = 0.22 ), and STAI (95% CI: 1.8-28.2, η 2 = 0.18 ). The favorable results of exercise were maintained at the 3-month posttraining follow-up assessment. No exercise-induced complications were observed throughout the study. In conclusion, a long-term exercise training program is a safe and effective intervention to improve functional status, psychological aspects, and health-related quality of life in patients with PH.

Exercise Rehabilitation Training in Patients With Pulmonary Hypertension: A Review

“…Ehlken et al [21] reported their RCT with peak VO 2 as the primary endpoint that after 15 weeks of ERT, the 6MWD and peak VO 2 of the training group were significantly improved compared with the control group. The results of this study are consistent with most other studies [15,22,25,27,32,35,37,50]. In addition, Ehlken et al also invasively measured the haemodynamic changes of studied patients by RHC.…”

“…Recently, two ERT studies lasting 6 months were designed aiming to evaluate the long-term effects of ERT on PH. Studies have shown that after 6 months of combined aerobic and strength training, the physical function of the patients as reflected by the 6MWD, lower limb strength, CPET variables, and mental health scores have been significantly improved compared with the control group [20], and these beneficial results were still maintained 3 months after the termination of the ERT [25]. In follow-up, the survival rate in the first 2 years for these patients with PH was 100% and 95%, respectively [50].…”

“…We used "hypertension, pulmonary" Medical Subject Headings (MESH) terms as the keyword in the electronic PubMed database, combined with "exercise" (MESH) OR "rehabilitation" (MESH) OR "exercise training," respectively. Twelve (12) RCTs [15,[20][21][22][23][24][25][26][27][28][29][30] were found, and the main contents were summarised in Table 1. All patients enrolled in the current studies have received optimised medical therapy and are in the clinically stable phase of PH.…”

“…As to the management of chronic thromboembolic PH (CTEPH) in group 4, pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) can be considered in addition to the currently recommended oral drug, riociguat. A large number of clinical studies have suggested that ERT is beneficial for inoperable CTEPH patients with respect to the 6MWD, performance in CPET, QoL, WHO-FC, pulmonary flow and perfusion, mPAP, pulmonary vascular resistance (PVR), muscle strength, respiratory muscle function, and five-repetition sit-stand test [15,21,[25][26][27]29,30]. Recently published studies have shown that ERT is also beneficial to patients who have just received PEA and BPA, and is an effective means of follow-up treatment after surgery.…”

“…One study reported that the incidence of adverse reactions was 13.6% [32], which included decreased blood oxygen during exercise [15], excessive fatigue [20], muscle aches and back pain [22], tachycardia [20,27], transient dizziness [15,27,50], presyncope [42], and syncope [32]. Some other adverse events judged to be unrelated to training by physicians were also commonly reported, for example, respiratory, urinary tract and gastrointestinal infections, and pericardial effusion [25,35,40]. Moreover, the most adverse events occurred during the initial 3 weeks of training in the hospital and the incidence decreased during the study period at home after the patients became aware of their limitations.…”