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Exercise improves quality of life for patients with severe chronic pulmonary hypertension

American Heart Association rapid access journal report

Appropriate amounts of exercise offer psychological and physical benefits for patients with severe pulmonary hypertension (PH), according to research reported in Circulation: Journal of the American Heart Association.

"It is commonly believed that exercise training may be dangerous for PH patients, because increasing pressure on the pulmonary arteries may worsen right-sided heart failure," said Ekkehard Grünig, M.D., senior author of the study and associate professor at University Hospital Heidelberg in Heidelberg, Germany. "Patients should exercise, but only in certain amounts, in addition to taking medicine. All training should be started with supervision in a hospital."

Pulmonary hypertension is an abnormal "high blood pressure" in the blood vessels that supply the lungs. It is a life-threatening disease that restricts physical capacity, lowers quality of life and has a poor prognosis because the heart's upper right chamber loses its ability to pump blood to the lungs.

According to researchers, although treatment of PH is advancing, adverse effects occur with the medications that treat it. Most patients continue to have symptoms, reduced physical abilities and reduced quality of life despite excellent medical treatment. Reduced exercise ability in PH is associated with depression and anxiety disorders, Grünig said.

Researchers evaluated the effects of exercise and respiratory training in 30 patients (21 female), average age 50, with severe chronic PH who were stable for at least three months. Patients were randomly assigned to either a control group or a primary training group and evaluated before the study, at week three and at week 15.

The control group received a common rehabilitation program, while the primary training group participated in an additional low-dose exercise program, supervised by physicians and physiotherapists, seven days a week. The daily training consisted of:

- 10–25 minutes of interval bicycle training
- 60 minutes of walking
- 30 minutes of dumbbell-training
- 30 minutes of respiratory training (stretching, breathing techniques and yoga)

"Mental training helped patients realize in the early stages of exercise if they were exceeding their physical abilities. Patients often wanted to do more than they should," Grünig said.

Researchers conducted the study in the hospital for the first three weeks. For the last 12 weeks, researchers developed home-training programs for primary training group patients, supervised by phone every two weeks. After the first 15-week study period was completed, patients in the control group were invited to re-enter the study and participate in the same exercise training program as the primary training group.

All training group patients tolerated the exercise well and had no adverse events such as progression of symptoms of PH or right-sided heart failure.

"With low-dose exercise training, patients had better uptake of oxygen, which made the heart work less and allowed them to exercise more and feel better," Grünig said.

The average increase in walking-distance observed in this study was 96 meters (314.96 feet) after 15 weeks, similar to the effect of the medication specific for PH. Low-dose exercise and respiratory training significantly improved exercise capacity, quality of life, functional class and peak oxygen consumption, Grünig said.

Researchers found that the six-minute walking distance of the primary training group showed a significant increase compared to the control group after three weeks of treatment, and also after 15 weeks. Patients in the secondary training group also showed a significant increase in their six-minute walking distance after three weeks.

Grünig and colleagues said that the results show exercise training in patients with severe PH is beneficial psychologically and physically. "Low-dose respiratory and exercise training may add to an optimized medical therapy. Nevertheless, for safety reasons exercise training should be started in the hospital and closely monitored in an out-patient setting. Cooperation between specialized centers for PH, rehabilitation clinics and general practitioners is necessary," Grünig said.

Bridgette McNeill | EurekAlert!
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