Effects of Different Types of Exercise Training on Pulmonary Arterial Hypertension: A Systematic Review

Abstract

Pulmonary arterial hypertension (PAH) represents a chronic progressive disease characterized by high blood pressure in the pulmonary arteries leading to right heart failure. The disease has been a focus of medical research for many years due to its worse prognosis and limited treatment options. The aim of this study was to systematically assess the effects of different types of exercise interventions on PAH. Electronic databases were searched until July 2019. MEDLINE database was used as the predominant source for this paper. Studies with regards to chronic physical activity in adult PAH patients are compared on retrieving evidence on cellular, physiological, and psychological alterations in the PAH setting. Twenty human studies and 12 rat trials were identified. Amongst all studies, a total of 628 human subjects and 614 rats were examined. Regular physical activity affects the production of nitric oxygen and attenuates right ventricular hypertrophy. A combination of aerobic, anaerobic, and respiratory muscle training induces the strongest improvement in functional capacity indicated by an increase of 6 MWD and VO2 peak. In human studies, an increase of quality of life was found. Exercise training has an overall positive effect on the physiological and psychological components of PAH. Consequently, PAH patients should be encouraged to take part in regular exercise training programs.

Physical Activity and Mental Health of Patients with Pulmonary Hypertension during the COVID-19 Pandemic

“…Given current research [ 25 ] and the present data, we suggest that patients should be encouraged to remain physically active even in pandemic times, although they should certainly do so in consideration of infection control. Vulnerable populations should also receive therapeutic support to improve their sleep quality and stress management as well as psychological resilience factors.…”

“…Here, it has been demonstrated for a large group of participants that lockdown restrictions did not lead to a decrease in sports activity levels in previously low active subjects [ 16 ]. From a therapeutic point of view, this seems to be problematic for PH patients, because a daily activity is an important prognostic factor for the symptomatology and progression of the disease [ 25 ].…”

“…These associations once again underline the close connection between different lifestyle factors. However, it has to be stated that the participation in sports activities is generally low in PH patients, even if there is sufficient evidence available that regular exercise training has an overall positive effect on the physiological and psychological components of PH [ 25 ]. The positive relationship between sports activity and mental wellbeing and life satisfaction holds for the PH and the control group as revealed by the missing interaction in the multiple regression analysis which is not surprising given the tremendous evidence for physical activity and sports to promote wellbeing and buffer stress [ 30 ].…”

High Right Ventricular Afterload during Exercise in Patients with Pulmonary Arterial Hypertension

“…Recently, an increasing number of studies have shown the efficacy of exercise training on molecular, functional, physiological, and psychological factors [ 10 , 11 , 12 ]. The first randomized clinical trial for rehabilitation in patients with PAH was reported by Mereles et al in 2006 [ 50 ].…”

“…Exercise training is provided based on an appropriate exercise prescription, which is different from maximal exercise, and it is recognized as an adjunctive therapy for physically deconditioned patients with PAH recently. An increasing number of reports have indicated the efficacy of exercise training in the last decade [ 10 , 11 , 12 ]. Although adverse events could occur during training, only a few serious adverse events have been reported when low-intensity training was closely monitored at a specialized center [ 10 ].…”