title: Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension: a preliminary study.
abstract: BACKGROUND
  Management of chronic thromboembolic pulmonary hypertension (CTEPH) has recently improved because of advances in pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and disease-targeted medications. However, patients with inoperable CTEPH or persistent pulmonary hypertension (PH) after these interventions continue to exhibit impaired exercise capacity and limited quality of life (QOL).
  
  
  METHODS
  Eight patients with inoperable or residual CTEPH (mean age, 64±12 years; WHO functional class II/III, 6/2; mean pulmonary artery pressure, 47±13 mmHg) in stable condition and receiving disease-targeted medications participated in a 12-week home-based pulmonary rehabilitation program (muscle strength training, respiratory exercises, and walking) with supervised hospital sessions from March 2012 to January 2014. Efficacy parameters were prospectively evaluated at baseline and at completion of the 12-week program.
  
  
  RESULTS
  After completion of the pulmonary rehabilitation program, the 6-minute walking distance (6MWD) (33.3±25.1 m), St. George׳s Respiratory Questionnaire activity score, quadriceps force, and 7-day physical activity level were significantly improved compared with baseline. All subjects completed the rehabilitation program. Although one patient experienced presyncope during the in-hospital exercise sessions, no other severe adverse events or complications of pulmonary rehabilitation were observed.
  
  
  CONCLUSIONS
  These findings suggest that home-based pulmonary rehabilitation with closely supervised sessions may safely improve exercise capacity, leg muscle strength, general activity in daily life and health-related QOL in CTEPH patients.
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan; Division of Rehabilitation, Chiba University Hospital, Japan. Electronic address: inagaki-tb@hospital.chiba-u.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inagaki
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: jirotera@chiba-u.jp.
authors.forename: Jiro
authors.initials: J
authors.lastname: Terada
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: ntanabe@faculty.chiba-u.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanabe
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: chumito_03@yahoo.co.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Kawata
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: daikasai6075@yahoo.co.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kasai
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: sugiura@js3.so-net.ne.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: ayakosh@nifty.com.
authors.forename: Ayako
authors.initials: A
authors.lastname: Shigeta
authors.affiliation: Division of Rehabilitation, Chiba University Hospital, Japan. Electronic address: asayumi@faculty.chiba-u.jp.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Asano
authors.affiliation: Division of Rehabilitation, Chiba University Hospital, Japan. Electronic address: atsushi_murata@faculty.chiba-u.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Murata
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: tsushimakenji@yahoo.co.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsushima
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: ytada@faculty.chiba-u.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tada
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: sakaos@faculty.chiba-u.jp.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Sakao
authors.affiliation: Department of Respirology, Graduate School of Medicine, Chiba University, Japan. Electronic address: tatsumi@faculty.chiba-u.jp.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Tatsumi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001945:Breathing Exercises; D002908:Chronic Disease; D015444:Exercise; D005260:Female; D006699:Home Care Services; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology* / Q000534:rehabilitation*; D007866:Leg / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology*; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength; D015397:Program Evaluation; D011655:Pulmonary Embolism / Q000503:physiopathology / Q000534:rehabilitation*; D011788:Quality of Life; D016896:Treatment Outcome; D016138:Walking
keywords: Chronic thromboembolic pulmonary hypertension; Exercise training; Health-related quality Of life; Physical activity; Pulmonary rehabilitation