title: Exercise intolerance in pulmonary hypertension: mechanism, evaluation and clinical implications.
abstract: Exercise intolerance in pulmonary hypertension (PH) is a major factor affecting activities of daily living and quality of life. Evaluation strategies (i.e., non-invasive and invasive tests) are integral to providing a comprehensive assessment of clinical and functional status. Despite a growing body of literature on the clinical consequences of PH, there are limited studies discussing the contribution of various physiological systems to exercise intolerance in this patient population.
  
  
  
  This review, through a search of various databases, describes the physiological basis for exercise intolerance across the various PH etiologies, highlights the various exercise evaluation methods and discusses the rationale for exercise training amongst those diagnosed with PH. Expert commentary: With the growing importance of evaluating exercise capacity in PH (class 1, Level C recommendation), understanding why exercise performance is altered in PH is crucial. Thus, the further study is required for better quality evidence in this area.
authors.affiliation: a Department of Physiotherapy, School of Allied Health Sciences , Manipal University , Manipal , Karnataka , India.
authors.forename: Abraham Samuel
authors.initials: AS
authors.lastname: Babu
authors.affiliation: b Department of Physical Therapy and Department of Kinesiology and Nutrition , University of Illinois at Chicago , Chicago , USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: c Veterans Affairs Health Center , Stanford University , Palo Alto , CA , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.affiliation: d Department of Cardiology, Kasturba Medical College , Manipal University , Manipal , India.
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Padmakumar
authors.affiliation: a Department of Physiotherapy, School of Allied Health Sciences , Manipal University , Manipal , Karnataka , India.
authors.forename: Arun G
authors.initials: AG
authors.lastname: Maiya
authors.affiliation: e Department of Physical Therapy , Millers School of Medicine , Miami , FL , USA.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Cahalin
authors.affiliation: f Pulmonary Vascular Disease Program, Dyspnea and Performance Evaluation Center, Pulmonary Critical Care Medicine, Cardiovascular Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Waxman
authors.affiliation: g Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School , The University of Queensland School of Medicine , New Orleans , LA , USA.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
mesh_terms: D000203:Activities of Daily Living; D017079:Exercise Tolerance / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology*; D011788:Quality of Life
keywords: Exercise; cardiopulmonary exercise testing; exercise capacity; pulmonary hypertension