Randomised controlled trial examining the effect of an outpatient exercise training programme on haemodynamics and cardiac MR parameters of right ventricular function in patients with pulmonary arterial hypertension: the ExPAH study protocol

Abstract

IntroductionPulmonary hypertension (PH) is a potentially life-threatening condition characterised by elevated pulmonary artery pressure. Early stage PH patients are often asymptomatic. Disease progression is associated with impairment of right ventricular function and progressive dyspnoea. Current guidelines recommend exercise training (grade IIa, level B). However, many questions remain regarding the mechanisms of improvement, intensity of supervision and optimal frequency, duration and intensity of exercise. This study will assess the effect of an outpatient rehabilitation programme on haemodynamics and cardiac right ventricular function in patients with pulmonary arterial hypertension (PAH), a subgroup of PH.Methods and analysisThis randomised controlled trial involves both a major urban tertiary and smaller regional hospital in New South Wales, Australia. The intervention will compare an outpatient rehabilitation programme with a control group (home exercise programme). Participants will be stable on oral PAH-specific therapy. The primary outcome measure will be right ventricular ejection fraction measured by cardiac MRI. Secondary outcomes will include haemodynamics measured by right heart catheterisation, endurance, functional capacity, health-related quality of life questionnaires and biomarkers of cardiac function and inflammation.Ethics approval and disseminationEthical approval has been granted by St Vincent's Hospital, Sydney (HREC/14/SVH/341). Results of this study will be disseminated through presentation at scientific conferences and in scientific journals.Trial registration numberACTRN12615001041549; pre-results.

Inflammatory Mediators Drive Adverse Right Ventricular Remodeling and Dysfunction and Serve as Potential Biomarkers

“…More studies are therefore necessary to explore a potentially more optimal exercise regimen and to investigate effects of training on RV adaptation/maladaptation. A randomized controlled trial to evaluate the effect of exercise training program on hemodynamics and cardiac magnetic resonance-derived parameters of RV function in patients with PAH (the ExPAH study) is currently underway ( Chia et al, 2017 ).…”

Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review

“…Exercise intensity was usually prescribed and monitored using heart rate (HR), pulse oxy-hemoglobin saturation (SpO 2 ), and rating of perceived exertion (RPE) in PAH patients (12,(14)(15)(16)(17). Some criteria including HR below 120 bpm and SpO 2 below 85% were used as termination criteria during exercise training in individuals with PAH (15,(17)(18)(19)(20)(21).…”

Add‐on interventions during pulmonary rehabilitation

“…PR programmes including resistance training have shown to be successful in, for example, patients with asthma and interstitial lung disease, and there is limited evidence for pulmonary hypertension, with a recommendation by the European Society of Cardiology and European Respiratory Society for closely supervision of exercise programmes for deconditioned patients . More studies are on the way . Patients with interstitial lung disease and pulmonary hypertension might suffer from severe exercise induced desaturation, in which oxygen therapy or NHF are appropriate tools during exercise training.…”