The benefit of exercise training in pulmonary hypertension: a clinical review

Chia, Karen S. W.; Wong, Peter; Faux, Steven; McLachlan, Craig S.; Kotlyar, Eugene

doi:10.1111/imj.13159

Cited by 24 publications

(28 citation statements)

References 52 publications

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“…Pulmonary hypertension is a cause of reduced exercise capacity; it may precede overt manifest pulmonary hypertension and is associated with a decreased life expectancy [28]. However, exercise training has been shown to be safe in these patients [11][12][13][14][15][16][29][30][31], and European guidelines recommend its use in experienced centers for patients who are clinically stable, on optimal pharmacological treatment [17,19].…”

Section: Discussionmentioning

confidence: 99%

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

Rovere

Pinna

et al. 2018

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Background: After undergoing a procedure of pulmonary endarterectomy (PEA), patients with chronic thromboembolic pulmonary hypertension (CTEPH) may still experience reduced exercise capacity. Data on effects of exercise training in these patients are scant. Objectives: To evaluate the effectiveness of exercise training after PEA for CTEPH and if the presence of “residual pulmonary hypertension” may affect the outcome. Methods: Retrospective data analysis of CTEPH patients undergoing inpatient exercise training after PEA. According to predefined criteria, patients were divided into those with (group 1) and without (group 2) a “good” post-surgery hemodynamic response. Assessments of the 6-min walking distance test (6-min walking distance test [6 MWT]: primary outcome) were performed before and after surgery (before training), after training and at 3-month follow-up. Hemodynamic and lung function data were also analyzed. Results: Data of 84 and 26 patients of groups 1 and 2, respectively, were analyzed. After surgery patients showed a reduction in 6 MWT, which significantly reversed after training and further improved at 3 months (p = 0.0001), without any significant difference between groups. The percentage of patients reaching the minimal clinically important difference in 6 MWT was similar between groups. The significant (p = 0.0001) post-surgery improvement in hemodynamics was maintained at 3 months without any significant difference between groups. New York Heart Association functional class improved in parallel to the hemodynamic improvement. Conclusions: Exercise training in patients with CTEPH after PEA, an inpatient exercise training program, improves exercise capacity for up to 3 months, independently of the post-surgery hemodynamic response.

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Section: Discussionmentioning

confidence: 99%

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

Rovere

Pinna

et al. 2018

Respiration

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“…It was thought that exercise could be a major risk due to increased blood flow, a drop in cardiac output that may worsen right ventricular function or risk of arrhythmia and hypoxia [ 85 – 87 ]. However, more and more studies now show that exercise training can actually be safe and beneficial for exercise capacity, peak oxygen capacity, systemic pulmonary artery pressure, heart rate, and quality of life of patients with various forms of pulmonary hypertension [ 88 – 92 ].…”

Section: Exercise Interventionsmentioning

confidence: 99%

“…There are different kinds of exercise training that are used in cardiac and pulmonary diseases: (1) aerobic exercise training, like cycling or walking; (2) strength training; and (3) respiratory exercise training [ 88 ]. Respiratory training often consists of body perception, yoga, and respiratory muscle strengthening exercises [ 85 ].…”

Section: Exercise Interventionsmentioning

confidence: 99%

“…Sessions were often performed between 2 and 5 times per week. Among others, improvements have been found in 6MWD, fatigue, peak VO 2 , QoL, increased amount of capillaries per muscle fiber, mean pulmonary blood volume, lower resting heart rate, and increased strength of different muscles (including the respiratory muscles) [ 86 – 88 , 96 – 98 ].…”

Section: Exercise Interventionsmentioning

confidence: 99%

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Increasing quality of life in pulmonary arterial hypertension: is there a role for nutrition?

et al. 2018

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Pulmonary arterial hypertension (PAH) is a progressive disease primarily affecting the pulmonary vasculature and heart. PAH patients suffer from exercise intolerance and fatigue, negatively affecting their quality of life. This review summarizes current insights in the pathophysiological mechanisms underlying PAH. It zooms in on the potential involvement of nutritional status and micronutrient deficiencies on PAH exercise intolerance and fatigue, also summarizing the potential benefits of exercise and nutritional interventions. Pubmed/Medline, Scopus, and Web of Science were searched for publications on pathophysiological mechanisms of PAH negatively affecting physical activity potential and nutritional status, and for potential effects of interventions involving exercise or nutritional measures known to improve exercise intolerance. Pathophysiological processes that contribute to exercise intolerance and impaired quality of life of PAH patients include right ventricular dysfunction, inflammation, skeletal muscle alterations, and dysfunctional energy metabolism. PAH-related nutritional deficiencies and metabolic alterations have been linked to fatigue, exercise intolerance, and endothelial dysfunction. Available evidence suggests that exercise interventions can be effective in PAH patients to improve exercise tolerance and decrease fatigue. By contrast, knowledge on the prevalence of micronutrient deficiencies and the possible effects of nutritional interventions in PAH patients is limited. Although data on nutritional status and micronutrient deficiencies in PAH are scarce, the available knowledge, including that from adjacent fields, suggests that nutritional intervention to correct deficiencies and metabolic alterations may contribute to a reduction of disease burden.

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“…These studies are generally small in size, and are of varying quality (only six randomised controlled trials (RCTs)). 15 Several studies 12 16–22 using the Mereles et al 13 inpatient protocol (described previously) reported improvement in a number of outcome measures, including 6MWT and QOL. The largest RCT of these studies (n=87), recently published by Ehlken et al 20 has further added to the current body of knowledge by showing that exercise training using the Mereles et al inpatient protocol improved haemodynamics.…”

Section: Introductionmentioning

confidence: 96%

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

et al. 2017

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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.

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The benefit of exercise training in pulmonary hypertension: a clinical review

Cited by 24 publications

References 52 publications

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

Exercise Training After Pulmonary Endarterectomy for Patients with Chronic Thromboembolic Pulmonary Hypertension

Increasing quality of life in pulmonary arterial hypertension: is there a role for nutrition?

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

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