Effects of an Outpatient Service Rehabilitation Programme in Patients Affected by Pulmonary Arterial Hypertension: An Observational Study

Bussotti, Maurizio; Gremigni, Paola; Pedretti, Roberto F.E.; Kransinska, Patrycja; Marco, Silvia Di; Corbo, Paola; Marchese, Giovanni; Totaro, Paolo

doi:10.2174/1871529x16666161130123937

Cited by 26 publications

(55 citation statements)

References 33 publications

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“…Exercise training can lead to meaningful improvements in exercise capacity, muscular function, QoL and possibly right ventricular function and pulmonary haemodynamics [3]. Beneficial effects of exercise training have been shown in six randomised controlled trials [15,[22][23][24][25][26], three controlled trials [27][28][29], 10 prospective cohort studies [16][17][18][19][20][21][30][31][32][33][34][35], three case series [34][35][36], two retrospective cohort studies [37,38] and four meta-analyses [39][40][41] including one Cochrane review [42]. Beside the clinical effects, it has also been shown that exercise training may reduce inflammation and cell proliferation on a molecular level and may have a beneficial effect on the pulmonary vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Data for 519 patients are available for exercise training at ∼60% of peak heart rate, not exceeding 120 beats•min −1 , with an oxygen saturation greater than 85-90% [68]. Additional respiratory training was performed in the inpatient studies in Germany, one outpatient based study in Italy [36] and one home-based study in Japan [32]. This training component was aimed at strengthening the respiratory muscles and to increase the awareness of different breathing patterns and techniques [69].…”

Section: Training Components and Intensitymentioning

confidence: 99%

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ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

et al. 2018

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Objectives of this European Respiratory Society task force were to summarise current studies, to develop strategies for future research and to increase availability and awareness of exercise training for pulmonary hypertension (PH) patients.An evidence-based approach with clinical expertise of the task force members, based on both literature search and face-to-face meetings was conducted. The statement summarises current knowledge and open questions regarding clinical effects of exercise training in PH, training modalities, implementation strategies and pathophysiological mechanisms.In studies (784 PH patients in total, including six randomised controlled trials, three controlled trials, 10 prospective cohort studies and four meta-analyses), exercise training has been shown to improve exercise capacity, muscular function, quality of life and possibly right ventricular function and pulmonary haemodynamics. Nevertheless, further studies are needed to confirm these data, to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.As exercise training appears to be effective, cost-efficient and safe, but is scarcely reimbursed, support from healthcare institutions, commissioners of healthcare and research funding institutions is greatly needed. There is a strong need to establish specialised rehabilitation programmes for PH patients to enhance patient access to this treatment intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Training Components and Intensitymentioning

confidence: 99%

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

et al. 2018

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“…nCPET may be useful diagnostically, however, only when targeted to specific at-risk populations such as scleroderma patients 32 or those in whom PH is suspected by echocardiograpy. 33 Data from nCPET incrementally predicts mortality when added to resting hemodynamics. 20 However, using baseline data, nCPET adds marginal value when added to the prognostic capabilities of the 6MWD, 34 but nCPET may add incremental prognostic value in clinically stable patients on therapy.…”

Section: Methodsmentioning

confidence: 99%

“…31,32 While elevated V E/V CO 2 relationships may be explained by reduced lung perfusion and an increase of dead space ventilation in the affected areas, hypocapnia demonstrates that there is an additional component of hyperventilation present and visible already at rest. 33 Recent studies have shown that autonomic nervous system disturbances may play an important role in ventilatory inefficiency, and that there may be an additional component of increased chemoreceptor sensitivity leading to hyperventilation in PAH. 34 Farina et al 35 demonstrated that ventilatory responses to brief periods of inspiratory hypoxia and steady-state hyperoxic hypercapnia in subjects with PAH were about twofold greater than in matched controls.…”

Section: The Pulmonary Ventilation/perfusion Relationshipmentioning

confidence: 99%

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2019

Advances in Pulmonary Hypertension

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“…Verma et al [273] suggest a combination of pharmacotherapy and psychotherapy, in particular CBT. There exist few studies on psychological interventions in pulmonary hypertension [275][276][277]. In particular, attention is focused on the teaching of relaxation and slow breathing techniques [275,277].…”

Section: Psychological Interventionsmentioning

confidence: 99%

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Angelino

Porta

Abatello

et al. 2018

Monaldi Arch Chest Dis

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Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on 'new' conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings.

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Effects of an Outpatient Service Rehabilitation Programme in Patients Affected by Pulmonary Arterial Hypertension: An Observational Study

Abstract: Cardiorespiratory training in a outpatient service is a suitable option for patients with PAH in WHO FC II/III thanks to improved exercise capacity and QoL, which may allow them to achieve better outcomes.

Cited by 26 publications

References 33 publications

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension

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Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

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