The Combination of Exercise and Respiratory Training Improves Respiratory Muscle Function in Pulmonary Hypertension

Kabitz, Hans‐Joachim; Bremer, Hinrich; Schwoerer, Anja; Sonntag, Florian; Walterspacher, Stephan; Walker, David; Ehlken, Nicola; Staehler, G.; Windisch, Wolfram; Grünig, Ekkehard

doi:10.1007/s00408-013-9542-9

Cited by 56 publications

(83 citation statements)

References 34 publications

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“…On median follow-up of 29.5 months (range, 21-36 months), the proportion of participants alive was 91% (12 deaths), and the proportion of participants with transplant-free survival was 89%. 18 Grünig et al 2012 19 Grünig et al 2012 20 Nagel et al 2012 27 Becker-Grünig et al 2013 21 Kabitz et al 2014 24 • 3 wk supervised training followed by 12 wk training at home • 1.5-h exercise training per day (in intervals distributed over the day) consisting of interval bicycle ergometer training at low workloads (10-60 W) 7 days a week • Dumbbell training of single muscle groups using low weights (500-1000g) …”

Section: Safety Of Exercise Trainingmentioning

confidence: 99%

“…Several small studies have evaluated exercise training as an adjunctive therapeutic strategy in patients with chronic pulmonary hypertension. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Although most of these studies were small and not designed to address clinical end points, such as mortality or hospitalizations, related to pulmonary hypertension, they have demonstrated a variable degree of improvement in exercise tolerance and quality of life in response to training.Therefore, because of the uncertainty about the benefit of structured exercise training programs in patients with pulmonary hypertension, we performed this systematic review and meta-analysis to assess the efficacy and safety of structured exercise training regimens in patients with pulmonary hypertension. …”

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confidence: 99%

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Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

106

110

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P ulmonary hypertension is a chronic cardiopulmonary disorder characterized by progressive increasing pulmonary vascular resistance, leading to right ventricular heart failure. 1 Prevalence of pulmonary hypertension is estimated to be 10 to 15 cases per million with a mortality rate of 15% per year. 2 Over the past 2 decades, targeted pharmacological therapies have been effective in reducing disease progression and improving the survival rate among patients with pulmonary hypertension.3,4 However, most patients remain symptomatic with significant exercise intolerance and reduced quality of life despite being on optimal medical therapy. 5,6 Thus, there is an unmet need for adjunctive therapeutic strategies to improve exercise tolerance and quality of life among these patients. Clinical Perspective on p 1043Exercise intolerance in patients with pulmonary hypertension is associated with a reduced maximal oxygen uptake and early onset of anaerobic threshold, similar to patients with severe heart failure. 7 The decrease in pulmonary vasculature distensibility associated with pulmonary hypertension leads to marked increases in pulmonary arterial mean pressure during exercise. This results in reduced pulmonary blood flow and low cardiac output insufficient to meet the metabolic demands of exercise. [7][8][9] Furthermore, pulmonary hypertension patients have significant skeletal muscle abnormalities leading to impaired peripheral oxygen utilization. These central and peripheral abnormalities contribute significantly to the exercise intolerance and functional limitation in patients with pulmonary hypertension. 10,11 Exercise training has been shown to improve cardiorespiratory fitness, functional status, and clinical outcomes in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease (COPD). 12,13 Considering the overlap in the pathophysiological derangements Original Article© 2015 American Heart Association, Inc.Circ Heart Fail is available at http://circheartfailure.ahajournals.org DOI: 10.1161/CIRCHEARTFAILURE.115.002130Background-Exercise training has been shown to improve cardiorespiratory fitness, physical capacity, and quality of life in patients with cardiopulmonary conditions, such as heart failure and chronic obstructive pulmonary disease. However, its role in management of pulmonary hypertension is not well defined. In this study, we aim to evaluate the efficacy and safety of exercise training in patients with pulmonary hypertension. Methods and Results-We included all prospective intervention studies that evaluated the efficacy and safety of exercise training in patients with pulmonary hypertension. Primary outcome of this meta-analysis was a change in 6-minute walk distance. We also assessed the effect of exercise on peak oxygen uptake, resting pulmonary arterial systolic pressure, peak exercise heart rate, and quality of life. A total of 469 exercise-training participants enrolled in 16 separate training studies were included. In the pooled ana...

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Section: Safety Of Exercise Trainingmentioning

confidence: 99%

mentioning

confidence: 99%

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Pandey

Garg

Khunger

et al. 2015

Circ: Heart Failure

106

110

View full text Add to dashboard Cite

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“…Respiratory muscle function has been shown to contribute to dyspnea, exercise limitation, [23][24][25][26] Furthermore, trials in interstitial lung disease and pulmonary hypertension showed improved exercise capacity, symptoms and quality of life following pulmonary rehabilitation with or without respiratory muscle training. [27][28][29] Marcisz et al 30 showed that FVC, forced expiratory volume in one second, VC, MVV, maximum midexpiratory flow rate 25-75%, and peak expiratory flow rate values were significantly decreased in SSc patients compared to controls.…”

Section: Resultsmentioning

confidence: 99%

The Effects of Respiratory Muscle Weakness and Pulmonary Involvement on Functional Status, Fatigue and Health Related Quality of Life in Patients With Systemic Sclerosis

et al. 2015

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“…Large improvements in 6-min walk test (6MWT) distance were reported in several studies after only 3 weeks of ExT [67][68][69][70][71]. However, most of these programmes included walking training, which may directly act upon 6MWT distance.…”

Section: Improving Endurance Capacity Exercise Trainingmentioning

confidence: 99%

The striated muscles in pulmonary arterial hypertension: adaptations beyond the right ventricle

et al. 2015

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Pulmonary arterial hypertension (PAH) is a fatal lung disease characterised by progressive remodelling of the small pulmonary vessels. The daily-life activities of patients with PAH are severely limited by exertional fatigue and dyspnoea. Typically, these symptoms have been explained by right heart failure. However, an increasing number of studies reveal that the impact of the PAH reaches further than the pulmonary circulation. Striated muscles other than the right ventricle are affected in PAH, such as the left ventricle, the diaphragm and peripheral skeletal muscles. Alterations in these striated muscles are associated with exercise intolerance and reduced quality of life. In this Back to Basics article on striated muscle function in PAH, we provide insight into the pathophysiological mechanisms causing muscle dysfunction in PAH and discuss potential new therapeutic strategies to restore muscle dysfunction. @ERSpublications RV, LV, diaphragm and peripheral muscle dysfunction contributes to reduced quality of life in PAH patients

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The Combination of Exercise and Respiratory Training Improves Respiratory Muscle Function in Pulmonary Hypertension

Abstract: Exercise and respiratory training as an adjunct to medical therapy may be effective in patients with PAH to improve respiratory muscle strength and exercise capacity. Future, randomized, controlled trials should be carried out to further investigate these findings.

Cited by 56 publications

References 34 publications

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension

The Effects of Respiratory Muscle Weakness and Pulmonary Involvement on Functional Status, Fatigue and Health Related Quality of Life in Patients With Systemic Sclerosis

The striated muscles in pulmonary arterial hypertension: adaptations beyond the right ventricle

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