Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension

Richter, Manuel J.; Grimminger, Jan; Krüger, Britta; Ghofrani, Hossein Ardeschir; Mooren, Frank C.; Gall, Henning; Pilat, Christian; Krüger, Karsten

doi:10.1086/690553

Cited by 30 publications

(19 citation statements)

References 122 publications

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“…In randomized controlled trials, exercise therapy improves exercise tolerance, functional capacity, and quality of life, with a positive impact on social, emotional, and psychological aspects [3,30]. Therefore, supervised exercise rehabilitation programs are recommended [3].…”

Section: Non-pharmacological Therapiesmentioning

confidence: 99%

Impact of Nutrition on Pulmonary Arterial Hypertension

et al. 2020

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Pulmonary arterial hypertension (PAH) is characterized by sustained vasoconstriction, vascular remodeling, inflammation, and in situ thrombosis. Although there have been important advances in the knowledge of the pathophysiology of PAH, it remains a debilitating, limiting, and rapidly progressive disease. Vitamin D and iron deficiency are worldwide health problems of pandemic proportions. Notably, these nutritional alterations are largely more prevalent in PAH patients than in the general population and there are several pieces of evidence suggesting that they may trigger or aggravate disease progression. There are also several case reports associating scurvy, due to severe vitamin C deficiency, with PAH. Flavonoids such as quercetin, isoflavonoids such as genistein, and other dietary polyphenols including resveratrol slow the progression of the disease in animal models of PAH. Finally, the role of the gut microbiota and its interplay with the diet, host immune system, and energy metabolism is emerging in multiple cardiovascular diseases. The alteration of the gut microbiota has also been reported in animal models of PAH. It is thus possible that in the near future interventions targeting the nutritional status and the gut dysbiosis will improve the outcome of these patients.

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Section: Non-pharmacological Therapiesmentioning

confidence: 99%

Impact of Nutrition on Pulmonary Arterial Hypertension

et al. 2020

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“…▶ Tab. 2 Empfehlungen für Trainingskonzepte bei PH-Patienten [35]. [17,19,20], Krafttraining an Geräten [18], Atemmuskeltraining [18] oder Yoga [17,19,20] [17 -20].…”

Section: Diskussionunclassified

Körperliches Training bei pulmonaler Hypertonie – ein systematisches Review mit Metaanalyse

et al. 2019

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Zusammenfassung Hintergrund Pulmonale Hypertonie (PH) ist definiert als ein Anstieg des mittleren pulmonal-arteriellen Drucks auf > 20 mmHg in Ruhe, der auf Dauer zu einer Rechtsherzinsuffizienz führen kann. Bis vor einigen Jahren wurde PH-Patienten wegen der Befürchtung einer möglichen Symptomverschlechterung und dem Auftreten unerwünschter, belastungsassoziierter klinischer Ereignisse von körperlichem Training abgeraten. Methoden Drei elektronische Datenbanken wurden mit folgenden Suchbegriffen nach randomisiert, kontrollierten Studien durchsucht, in denen eine Trainingsintervention bei PH-Patienten untersucht wurde: „pulmonary hypertension ODER „pulmonary arterial hypertension“ UND „exercise“ ODER „pulmonary rehabilitation“ UND „randomized“. Ergebnisse In dieser Metaanalyse konnten Daten von 5 Studien mit insgesamt 187 PH-Patienten eingeschlossen werden, welche 3- bis 12-wöchige Trainingsprogramme (z. B. 10 – 45 Minuten Ergometertraining; 60 – 80 % der maximalen Herzfrequenz) absolvierten. Patienten in den Trainingsgruppen wiesen im Vergleich zur Kontrollgruppe signifikante (p < 0,001) Verbesserungen ihrer körperlichen Belastbarkeit auf: 6-Minuten-Gehtest: + 45 m [95 % KI: 26 m – 64 m] oder maximale Sauerstoffaufnahme VO 2 peak + 2,3 ml/kg/min [95 % KI: 1,8 ml/kg/min – 2,9 ml/kg/min]. Auch Komponenten der körperlichen und psychischen Lebensqualität verbesserten sich signifikant. Ernsthafte, unerwünschte Ereignisse im Rahmen der Trainingsinterventionen wurden nicht beobachtet. Schlussfolgerung Ein individuell angepasstes Trainingsprogramm bei stabilen PH-Patienten kann nach zuvor optimierter medikamentöser Therapie die körperliche Belastbarkeit und Lebensqualität ohne nachweisbare klinische Gefährdung verbessern. Diese Einschätzungen basieren bisher nur auf kleinen Fallzahlen und größere, randomisierte Studien mit unterschiedlichen PH-Schweregraden sind dringend notwendig.

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“…In primary PH, vascular remodeling contributes to the sustained elevation of the PVR with parallel increases in PASP . Elevated PVR is due to the smooth muscle cell proliferation, medial hypertrophy, and endothelial cell proliferation resulting in lumen obliteration.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

“…A normal mean PA/CO ratio is 0.5-3.0 mmHg/L/min during exercise in healthy individuals. 2 With the rise in PVR and PA systolic pressure, that is, worsening MS, that ratio will gradually increase.…”

Section: Hemodynamics During Exercisementioning

confidence: 99%

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Evaluation of the severity of mitral stenosis in patient with pulmonary hypertension: Role of exercise hemodynamics

Kern

Kim

et al. 2019

Cathet Cardio Intervent

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Dyspnea due to mitral stenosis (MS) and/or pulmonary hypertension (PHT) in patients who may have both conditions presents a challenging diagnostic dilemma. The hemodynamic response to exercise is probably the most helpful method to arrive at the correct diagnosis and treatment algorithm. In this hemodynamic rounds discussion, we evaluated a patient with MS and PHT prior to the decision for mitral valvuloplasty. Key Points Symptoms in patients with mitral stenosis and pulmonary hypertension cannot always be attributed to one pathology. Catheter‐based hemodynamics are often needed to differentiate valve from lung disease. Exercise hemodynamics can clarify the predominant pathology in complex clinical scenarios.

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Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension

Cited by 30 publications

References 122 publications

Impact of Nutrition on Pulmonary Arterial Hypertension

Impact of Nutrition on Pulmonary Arterial Hypertension

Körperliches Training bei pulmonaler Hypertonie – ein systematisches Review mit Metaanalyse

Evaluation of the severity of mitral stenosis in patient with pulmonary hypertension: Role of exercise hemodynamics

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