Hipertensión arterial pulmonar: el entrenamiento físico como complemento de la terapia farmacológica

Abstract

Cardiopulmonary rehabilitation is a promising therapy for Pulmonary arterial hypertension (PAH) whose survival does not exceed 65% at five years. We performed a literature search about rehabilitation on PAH in MEDLINE, LILACS and COCHRANE databases, considering articles from 2005 to 2017. Fifteen articles were incorporated in the final analysis. We obtained information about safety parameters, type of exercises applied, duration and frequency of sessions. The interventions included aerobic, resistance and respiratory muscle training exercises. The results showed improvements in peak oxygen uptake, six minutes walking test, quality of life and inspiratory muscle strength, among others. We conclude that the evidence supports the recommendation of physical rehabilitation in selected patients with stable PAH as a complementary strategy to the available pharmacological therapy.

Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations

“…There is also insufficient data on what forms, frequencies, and intensities of exercise are required to obtain the most beneficial results [ 23 , 24 , 26 , 27 , 28 ]. The available literature shows that in addition to daily activity, regular endurance (or aerobic) training, strength training, and respiratory muscle training ought to be done [ 3 , 21 , 29 , 30 , 31 ].…”

“…Currently, it is believed that aerobic exercise, performed 2–3 times a week, sufficiently improves patients’ 6-minute walk distance (6MWD) and provides a slight increase in peak VO 2 value in cardiopulmonary exercise testing (CPET) [ 30 ]. However, it is likely that a higher frequency of aerobic exercise, performed 5 or more times a week, may increase physical fitness [ 28 , 30 , 33 , 34 , 35 ].…”

“…Initial sessions may consist of alternating same-duration exercises of moderate intensity followed by passive rest to avoid prolonged shortness of breath. As tolerance increases, the duration of intense exercise increases with it, eventually turning into a continuous phase of at least 30–45 min [ 30 ] with an intensity corresponding to approximately 60–80% of the HR (heart rate) achieved in an exercise test [ 25 , 28 , 35 ].…”

“…In addition to aerobic exercise, the inclusion of resistance exercise and inspiratory muscle training for 15 to 30 min as an element of a rehabilitation program has been associated with significant improvements in cardiopulmonary fitness and skeletal muscle profile [ 28 , 29 , 30 , 32 ].…”

“…or perceive exertion at >6 on the Borg scale. In case of desaturation, the use of oxygen supplementation is recommended (considered to improve exercise capacity), which increases the intensity of exercise, and thus the effects achieved due to training [ 18 , 19 , 28 , 35 ]. Patients dependent on home oxygen therapy should exercise with portable oxygen concentrators.…”