Ambulatory Rehabilitation Improves Exercise Capacity in Patients With Pulmonary Hypertension

Fox, Benjamin D.; Kassirer, Michael; Weiss, Israela; Raviv, Yael; Peled, Nir; Shitrit, David; Kramer, Mordechai R.

doi:10.1016/j.cardfail.2010.10.004

Cited by 109 publications

(115 citation statements)

References 17 publications

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“…We observed a high degree of tolerance to training with low dropout rates and exercise-associated adverse events comparable with that observed with exercise training in patients with heart failure. 48 Furthermore, the rate of major adverse events, such as right heart failure, mortality, and worsening pulmonary hypertension observed on pooled analysis, was much lower than that reported in pulmonary 14,17,[19][20][21][27][28][29] and peak exercise heart rate (n=9, B). 14,[17][18][19][20][21][22]27,29 CI indicates confidence interval.…”

Section: Discussionmentioning

confidence: 72%

“…Fourth, most of the included studies were single-center based and had a relatively short duration of follow-up. Future multicenter randomized control trials with longer duration follow-up are needed to 4 Exercise intolerance with cyanosis in 2 patients Fox et al 2011 17 …”

Section: Discussionmentioning

confidence: 99%

“…Several small studies have evaluated exercise training as an adjunctive therapeutic strategy in patients with chronic pulmonary hypertension. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Although most of these studies were small and not designed to address clinical end points, such as mortality or hospitalizations, related to pulmonary hypertension, they have demonstrated a variable degree of improvement in exercise tolerance and quality of life in response to training.Therefore, because of the uncertainty about the benefit of structured exercise training programs in patients with pulmonary hypertension, we performed this systematic review and meta-analysis to assess the efficacy and safety of structured exercise training regimens in patients with pulmonary hypertension. …”

mentioning

confidence: 99%

“…44 Future studies are needed to determine whether these favorable effects of exercise training can translate into a reduction in long-term major adverse clinical outcomes. 14,[17][18][19][20][21][22]27,29 and peak absolute oxygen uptake (mL/min) on pooled analysis of included studies (n=6, B). 14,[19][20][21]27 The mechanisms underlying improvement in exercise tolerance with exercise training among patients with pulmonary hypertension are not well understood.…”

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confidence: 99%

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Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

106

110

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P ulmonary hypertension is a chronic cardiopulmonary disorder characterized by progressive increasing pulmonary vascular resistance, leading to right ventricular heart failure. 1 Prevalence of pulmonary hypertension is estimated to be 10 to 15 cases per million with a mortality rate of 15% per year. 2 Over the past 2 decades, targeted pharmacological therapies have been effective in reducing disease progression and improving the survival rate among patients with pulmonary hypertension.3,4 However, most patients remain symptomatic with significant exercise intolerance and reduced quality of life despite being on optimal medical therapy. 5,6 Thus, there is an unmet need for adjunctive therapeutic strategies to improve exercise tolerance and quality of life among these patients. Clinical Perspective on p 1043Exercise intolerance in patients with pulmonary hypertension is associated with a reduced maximal oxygen uptake and early onset of anaerobic threshold, similar to patients with severe heart failure. 7 The decrease in pulmonary vasculature distensibility associated with pulmonary hypertension leads to marked increases in pulmonary arterial mean pressure during exercise. This results in reduced pulmonary blood flow and low cardiac output insufficient to meet the metabolic demands of exercise. [7][8][9] Furthermore, pulmonary hypertension patients have significant skeletal muscle abnormalities leading to impaired peripheral oxygen utilization. These central and peripheral abnormalities contribute significantly to the exercise intolerance and functional limitation in patients with pulmonary hypertension. 10,11 Exercise training has been shown to improve cardiorespiratory fitness, functional status, and clinical outcomes in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). 12,13 Considering the overlap in the pathophysiological derangements Original Article© 2015 American Heart Association, Inc.Circ Heart Fail is available at http://circheartfailure.ahajournals.org DOI: 10.1161/CIRCHEARTFAILURE.115.002130Background-Exercise training has been shown to improve cardiorespiratory fitness, physical capacity, and quality of life in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease. However, its role in management of pulmonary hypertension is not well defined. In this study, we aim to evaluate the efficacy and safety of exercise training in patients with pulmonary hypertension. Methods and Results-We included all prospective intervention studies that evaluated the efficacy and safety of exercise training in patients with pulmonary hypertension. Primary outcome of this meta-analysis was a change in 6-minute walk distance. We also assessed the effect of exercise on peak oxygen uptake, resting pulmonary arterial systolic pressure, peak exercise heart rate, and quality of life. A total of 469 exercise-training participants enrolled in 16 separate training studies were included. In the pooled ana...

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

106

110

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“…6MWD was also shown to improve after rehabilitation in idiopathic and thromboembolic PAH patients [121,243,244]. In these studies, control groups usually deteriorated, resulting in differences between the rehabilitation and control groups of 80-110 m (table 3).…”

Section: Nonpharmacological Interventionsmentioning

confidence: 85%

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

et al. 2016

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This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others. @ERSpublications A review of exercise testing to evaluate interventions aimed to improve exercise tolerance in respiratory patients

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