Pulmonary hypertension and exercise training: a synopsis on the more recent evidences

Abstract

The benefits of exercise training in virtually all humans, including those with a clinically stable chronic disease are numerous. The potential value lies in the fact that functional capacity is oftentimes significantly compromised. Exercise training not only play a role in reversing some of the pathophysiologic processes associated with chronic diseases but also improves clinical trajectory. Given the significant pathologic consequences associated with pulmonary hypertension and its implications for deteriorating right ventricular function as well as the perceived potential for a precipitous and possibly critical drop in cardiac output during periods of physical exertion, exercise training was historically not recommended for these patients. More recently, a promising body of literature demonstrating the safety and efficacy of exercise training (with benefit on exercise capacity, peak oxygen consumption and quality of life) in pulmonary hypertension patients has emerged, but the conclusion about the effects of exercise training were non-exhaustive and therefore there is still a lack of knowledge regarding exercise training for these patients. Thus, we aim to ascertain the current effectiveness of exercise rehabilitation for pulmonary hypertension by performing a brief overview on the latest currently available evidences in such an "at a glance" synopsis addressed to summarize/quantify the more recent existing body of literature. KEY MESSAGES Exercise training was historically not recommended in pulmonary hypertension. Recently, exercise training safety-efficacy in pulmonary hypertension has emerged. Exercise training should be recommended in addition to optimal medical therapy.

Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations

“…Physical activity is one of the most important modifiable factors in our lifestyle and may significantly impact the prevention and treatment of cardiovascular diseases [ 21 ]. Exercise may modulate a variety of molecular mechanisms related to proliferation, apoptosis, oxidative stress, inflammation, thrombosis, proteolysis, and vasodilatation [ 19 , 22 , 23 ].…”

“…There is also insufficient data on what forms, frequencies, and intensities of exercise are required to obtain the most beneficial results [ 23 , 24 , 26 , 27 , 28 ]. The available literature shows that in addition to daily activity, regular endurance (or aerobic) training, strength training, and respiratory muscle training ought to be done [ 3 , 21 , 29 , 30 , 31 ]. Aerobic, resistance, and inspiratory muscle training, supported by individually adapted general conditioning training (also known as general fitness), stretching, body awareness training, neuromuscular relaxation techniques, positional relaxation, fascial therapy, etc., provide significant functional and physiological improvement [ 29 , 30 ].…”

Exploring a physiotherapy well‐being review to deliver community‐based rehabilitation in patients with pulmonary hypertension

“…6 It has now been established that exercise in patients with pulmonary hypertension is safe and leads to improvements in functional ability and quality of life. 7,8 While further work is required to fully understand the physiological effects of exercise training in patients with pulmonary hypertension, 9 change in skeletal muscle function and cardiac function as well as reversal of pre-existing deconditioning are potential mechanisms. 10,11 In a systematic review of studies of exercise therapy in pulmonary hypertension, Morris et al 12 demonstrated improvements in six-minute walk distance of 60 m as well as significant improvements in quality of life and only a single adverse event (light-headedness during exercise) across 206 study participants.…”

“…There has been increasing interest and a growing evidence base for exercise training in patients with pulmonary hypertension since the first randomised controlled trial in 2006 6 . It has now been established that exercise in patients with pulmonary hypertension is safe and leads to improvements in functional ability and quality of life 7 , 8 . While further work is required to fully understand the physiological effects of exercise training in patients with pulmonary hypertension, 9 change in skeletal muscle function and cardiac function as well as reversal of pre‐existing deconditioning are potential mechanisms 10 , 11 .…”

Circulating MicroRNA Markers for Pulmonary Hypertension in Supervised Exercise Intervention and Nightly Oxygen Intervention

“…The current World Symposium on Pulmonary Hypertension (WSPH) classification of PH is based on a combination of patient characteristics, clinical features and cardiopulmonary hemodynamics and these WHO groups are used to inform drug treatment options ( Simonneau et al, 2013 ). Recently, PH interventions based on supervised exercise training and nightly oxygen have been developed that have significant therapeutic effect to a degree that is expected from adding another drug for multi-drug treatment of PH ( Mereles et al, 2006 ; Grunig et al, 2011 , 2012a , b ; Nagel et al, 2012 ; Becker-Grunig et al, 2013 ; Schumacher et al, 2014 ; Pandey et al, 2015 ; Ulrich et al, 2015 ; Ehlken et al, 2016 ; Gonzalez-Saiz et al, 2017 ; Keusch et al, 2017 ; Moreira-Goncalves et al, 2017 ; Richter et al, 2017 ; Leggio et al, 2018 ). Already after a 3-week period, supervised exercise training improved, for example, the 6MWD and hemodynamics, which are important signs for PH prognosis ( Grunig et al, 2012a , b ).…”