Mechanisms underlying the impact of exercise training in pulmonary arterial hypertension

Abstract

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by progressive increases in pulmonary vascular resistance that can ultimately lead to right ventricle failure and death. Common symptoms include shortness of breath, fatigue, dizziness and chest pain, which negatively impact the functional capacity and quality of life. Despite the improvements in disease-targeted therapies, PAH remains incurable and with a high mortality rate, requiring effective therapeutic strategies. Exercise training is an important adjunct non-pharmacological treatment for patients with left heart failure and chronic obstructive pulmonary disease. Although exercise training was discouraged in PAH because of safety concerns, recent studies support that supervised exercise training is safe and beneficial in patients with stable PAH. However, the molecular mechanisms underlying these improvements are still poorly understood. This review summarizes and integrates the emerging clinical and experimental studies describing the molecular alterations related with exercise training in PAH.

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

“…Besides the effects on the muscular system (see section on Muscle function), there is some evidence, that exercise training may also affect the pulmonary vasculature. In animal PH models, inconsistent results on the impact of exercise training on pulmonary vascular remodelling had been reported with unchanged, increased and reduced pulmonary arterial hypertrophy across different studies [89]. However, several animal models detected a beneficial effect of training on the right ventricle as an increase of right ventricular capillary density (+86%, p<0.05) up to near-normal values, a reduction of right ventricular end-diastolic pressure [74,90] and reduction of interstitial volume (−60%, p<0.05) [74].…”

Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review

“…Several studies (5,(7)(8)(9) demonstrated that exercise therapy for PAH patients contributed to improved exercise capacity, quality of life (QOL), muscle strength, and respiratory muscle strength. The exercise types typically included aerobic exercise, resistance training, and respiratory muscle strength exercise (10).…”

“…However, the majority of review articles (6,7,10,13) have focused their investigations on the effectiveness of exercise interventions with respect to exercise capacity, muscle strength, and QOL. The improvement of exercise tolerance may be different according to the applied exercise intensity.…”

Evolution in PH Care: 3 Decades of Milestones

“…At first considered by many as unsafe [personal communications from 19 PH physicians, 1999], experts eventually realized that moderate aerobic training was not only safe, but in fact salutary for patients able to exercise. 21 Adjunctive treatments such as rehabilitative exercise have in fact been included in PH treatment guidelines since 2009, 12 and since then, additional evidence 22 supports the use of exercise as an adjunctive treatment modality. 23 As a researcher and treater in PAH with an avid interest in exercise, these advances have crowned nearly 2 decades of efforts to further the integration of exercise in both the evaluation and treatment of PH.…”