Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial

Abstract

Aims This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17–33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18–51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2 P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group. Conclusion This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

“…Randomized controlled studies and controlled cohort studies providing a close inhospital monitoring consistently showed a significant increase in exercise capacity as a result of individually adapted exercise training, a reduction in heart failure symptoms, and an increase in health-related quality of life [131][132][133][134][135][136][137][138][139][140]. Moreover, a reduction in pulmonary vascular resistance and significant increase in cardiac output has been shown [134].…”

“…On the basis of these data, individualized exercise training in PH-patients can be regarded as an integral part of rehabilitation programs in these patients, provided sufficient medical supervision and expertise is guaranteed. [140].…”

Health-Related Quality of Life (HRQoL) in Sarcoidosis: Diagnosis, Management, and Health Outcomes

“…Aerobic and muscle-strengthening exercise is recognized across healthy populations and health conditions to significantly improve HRQoL as well as cardiovascular, endothelial, metabolic/glandular, muscle structure and function, lung mechanics, mobility and systemic inflammation, fatigue and depressive symptoms, with overall beneficial effect on a wide spectrum of physiological and psychological attributes. Pulmonary rehabilitation is a feasible, safe, and effective [156,157] strategy for improving breathing, exercise tolerance, fatigue, and cough through education, regardless of underlying diagnosis (e.g., ILD, PH). Exercise safety and safety parameters in sarcoidosis-related cardiopulmonary involvement [157,158] and programmatic considerations, and enhancements in this population, are outlined in Tables 6 and 7 [159].…”

“…Pulmonary rehabilitation is a feasible, safe, and effective [156,157] strategy for improving breathing, exercise tolerance, fatigue, and cough through education, regardless of underlying diagnosis (e.g., ILD, PH). Exercise safety and safety parameters in sarcoidosis-related cardiopulmonary involvement [157,158] and programmatic considerations, and enhancements in this population, are outlined in Tables 6 and 7 [159]. Evidence for the role of physical training in sarcoidosis is limited, but promising, and includes improved exercise capacity [110,111,160], muscle strength [110], and HRQoL [160], and decreased fatigue after a 12-week outpatient physical training intervention.…”

The Experience, Prerequisites, and the Barriers in Organizing a Specialized Rehabilitation Program for Patients with Pulmonary Hypertension

“…Limited availability and underutilization of exercise training remains a drawback in many specialized PH centers. A recent first multicenter RCT on feasibility, safety, and efficacy of exercise training on PH showed clearly positive results: the primary endpoint -change of 6-min walking distance -significantly improved by 30.7 ± 57.9 m in the training group, while it slightly decreased in the control group (−3.4 ± 25.9 m; p < 0.0001) [17]. Moreover, within this study, a standardized specialized training program, initiated in-hospital, was launched successfully in 10 European countries (including our center in Vilnius).…”