Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.
BACKGROUND
Pulmonary hypertension (PH) is associated with restricted physical capacity, limited quality of life, and a poor prognosis because of right heart failure. The present study is the first prospective randomized study to evaluate the effects of exercise and respiratory training in patients with severe symptomatic PH.


RESULTS
Thirty patients with PH (21 women; mean age, 50+/-13 years; mean pulmonary artery pressure, 50+/-15 mm Hg; mean World Health Organization [WHO] class, 2.9+/-0.5; pulmonary arterial hypertension, n=23; chronic thromboembolic PH, n=7) on stable disease-targeted medication were randomly assigned to a control (n=15) and a primary training (n=15) group. Medication remained unchanged during the study period. Primary end points were the changes from baseline to week 15 in the distance walked in 6 minutes and in scores of the Short Form Health Survey quality-of-life questionnaire. Changes in WHO functional class, Borg scale, and parameters of echocardiography and gas exchange also were assessed. At week 15, patients in the primary and secondary training groups had an improved 6-minute walking distance; the mean difference between the control and the primary training group was 111 m (95% confidence interval, 65 to 139 m; P<0.001). Exercise training was well tolerated and improved scores of quality of life, WHO functional class, peak oxygen consumption, oxygen consumption at the anaerobic threshold, and achieved workload. Systolic pulmonary artery pressure values at rest did not change significantly after 15 weeks of exercise and respiratory training (from 61+/-18 to 54+/-18 mm Hg) within the training group.


CONCLUSIONS
This study indicates that respiratory and physical training could be a promising adjunct to medical treatment in severe PH. The effects add to the beneficial results of modern medical treatment.
Mereles
Derliz
D
Department of Cardiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
Ehlken
Nicola
N
Kreuscher
Sandra
S
Ghofrani
Stefanie
S
Hoeper
Marius M
MM
Halank
Michael
M
Meyer
F Joachim
FJ
Karger
Gabriele
G
Buss
Jan
J
Juenger
Jana
J
Holzapfel
Nicole
N
Opitz
Christian
C
Winkler
Jörg
J
Herth
Felix F J
FF
Wilkens
Heinrike
H
Katus
Hugo A
HA
Olschewski
Horst
H
Grünig
Ekkehard
E
D000328:Adult; D002908:Chronic Disease; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000534:rehabilitation / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011788:Quality of Life; D012129:Respiratory Function Tests; D012138:Respiratory Therapy