title: Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension.
abstract: BACKGROUND
  Aim of this prospective study was to evaluate the effects of exercise training in patients with inoperable or residual chronic thromboembolic pulmonary hypertension (CTEPH).
  
  
  METHODS
  Thirty-five consecutive patients with invasively confirmed inoperable or residual CTEPH (16 women;19 men; mean age 61±15 years, mean pulmonary artery pressure, 63±20 mmHg; primary inoperable n = 33, persisting pulmonary hypertension after pulmonary endarterectomy n = 2) on stable disease-targeted medication received exercise training in-hospital for 3 weeks and continued at home for 15 weeks. Medication remained unchanged during the study period. Efficacy parameters have been evaluated at baseline, after 3 and 15 weeks by blinded-observers. Survival rate has been evaluated in a follow-up period of median 36.4 months (interquartile range 26.6-46.6 months).
  
  
  RESULTS
  All patients tolerated exercise training without severe adverse events. Patients significantly improved the mean distance walked in 6 minutes compared to baseline by 61±54 meters after 3 weeks (p<0.001) and by 71±70 meters after 15 weeks (p = 0.001), as well as scores of quality-of-life questionnaire, peak oxygen consumption and maximal workload. NT-proBNP improved significantly after 3 weeks of exercise training (p = 0.046). The 1-year survival rate was 97%, 2-year survival rate was 94% and the 3-year-survival 86% respectively.
  
  
  CONCLUSIONS
  Training as add-on to medical therapy may be effective in patients with CTEPH to improve work capacity, quality of life and further prognostic relevant parameters and possibly improves the 1-, 2- and 3-year survival rate. Further multicentric randomized controlled studies are needed to confirm these promising results.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01398345.
authors: Centre for Pulmonary Hypertension, Thoraxclinic at University Hospital Heidelberg, Heidelberg, Germany.
authors: Christian
authors: C
authors: Nagel
authors: Felix
authors: F
authors: Prange
authors: Stefan
authors: S
authors: Guth
authors: Jochen
authors: J
authors: Herb
authors: Nicola
authors: N
authors: Ehlken
authors: Christine
authors: C
authors: Fischer
authors: Frank
authors: F
authors: Reichenberger
authors: Stephan
authors: S
authors: Rosenkranz
authors: Hans-Juergen
authors: HJ
authors: Seyfarth
authors: Eckhard
authors: E
authors: Mayer
authors: Michael
authors: M
authors: Halank
authors: Ekkehard
authors: E
authors: Grünig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015444:Exercise; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D011788:Quality of Life; D012008:Recurrence; D016019:Survival Analysis; D055815:Young Adult