Principles of Rehabilitation and Reactivation: Pulmonary Hypertension

Abstract

Most recently, a specialized and carefully monitored exercise training and rehabilitation program has been recommended as add-on to medical treatment in patients with pulmonary arterial hypertension (class I, level of evidence A). Three prospective randomized, controlled trials, 10 prospective uncontrolled trials, 2 retrospective studies and 2 case series in more than 470 patients with severe pulmonary hypertension (PH) and right heart failure reported beneficial effects of a specialized exercise training and rehabilitation program, i.e. significant improvement in symptoms, exercise capacity, cardiorespiratory function and quality of life, compared with untrained controls. All training studies reported an acceptable safety profile, and some uncontrolled studies showed excellent 1- and 2-year survival rates. However, most studies had a quite small sample size (ranging from 2 to 183 patients) and an uncontrolled design, and they were not designed to assess hemodynamic changes, time to clinical worsening and survival. Nevertheless, there is large evidence that exercise training programs should be performed by centers experienced in both PH patient care and rehabilitation. The best method and duration of the training, characteristics of supervision, and the mechanisms resulting in symptom improvement and increased functional capacity are unclear. In this review, we summarize data of molecular and clinical effects of exercise training in PH patients. Furthermore, we discuss safety data and the role of a self-care management of exercise training in these patients.

Respiratory muscle strength in patients with pulmonary hypertension: The relationship with exercise capacity, physical activity level, and quality of life

“…30 Reduced mouth pressures can affect the physical activity level of patients with PH. 30 Reduced mouth pressures can affect the physical activity level of patients with PH.…”

“…It has been demonstrated that exercise training is a safe and useful add-on therapy in patients with PH. 30 Reduced mouth pressures can affect the physical activity level of patients with PH. A better understanding of the relationship between respiratory function and physical activity may provide proper functional assessment and treatment strategies in the management of patients with PH.…”

Hipertensión arterial pulmonar: el entrenamiento físico como complemento de la terapia farmacológica

“…En el caso que el paciente esté bien estabilizado, se podrían dar recomendaciones de actividades físicas sencillas para el hogar, como lo son las caminatas, con el objeto de minimizar los riesgos. En tales casos, la supervisión se realiza a través de llamadas telefónicas por parte del médico tratante, o bien del fisioterapeuta a cargo [24][25][26] y, probablemente, sea recomendable que los pacientes dispongan de un oxímetro de pulso en domicilio para limitar sus ejercicios evitando taquicardias > 120/min y desaturaciones < 90%.…”

“…No queda claro el papel que les cabe a la elongación y a los ejercicios de equilibrio, pero sin duda son un buen complemento, al igual que el entrenamiento de diafragma [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . Asimismo, se recomienda que en los días en que no se realice entrenamiento aeróbico, se haga entrenamiento de musculatura respiratoria y ejercicios de carga por 15 a 30 min [24][25][26] . Por otra parte, falta evidencia que demuestre si una modalidad exclusivamente de cargas es igual o superior a un entrenamiento fundamentalmente aeróbico, al igual que determinar cuáles son las periodicidades y tiempos óptimos.…”

Demand for exercise training in patients with pulmonary arterial hypertension in Scotland

“…The BSS is distinct from previous services [3,4] with respect to the incorporation of respiratory expertise, the widening of the range of professionals in the team and its primary mode of delivery in the outpatient clinic, with two appointments and a home visit within 4 weeks. At the first clinic visit, patients were assessed by respiratory medicine and palliative care clinicians and an individualised plan of treatment was agreed.…”