title: Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.
abstract: 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.
authors.affiliation: Department of Cardiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Derliz
authors.initials: D
authors.lastname: Mereles
authors.forename: Nicola
authors.initials: N
authors.lastname: Ehlken
authors.forename: Sandra
authors.initials: S
authors.lastname: Kreuscher
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ghofrani
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Michael
authors.initials: M
authors.lastname: Halank
authors.forename: F Joachim
authors.initials: FJ
authors.lastname: Meyer
authors.forename: Gabriele
authors.initials: G
authors.lastname: Karger
authors.forename: Jan
authors.initials: J
authors.lastname: Buss
authors.forename: Jana
authors.initials: J
authors.lastname: Juenger
authors.forename: Nicole
authors.initials: N
authors.lastname: Holzapfel
authors.forename: Christian
authors.initials: C
authors.lastname: Opitz
authors.forename: Jörg
authors.initials: J
authors.lastname: Winkler
authors.forename: Felix F J
authors.initials: FF
authors.lastname: Herth
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Horst
authors.initials: H
authors.lastname: Olschewski
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Grünig
mesh_terms: 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