Women with PAH Found to Be Largely Sedentary, Amplifying Feelings of Fatigue

Women with pulmonary arterial hypertension (PAH) are often sedentary, and the lack of daily activity results in physical and mental feelings of low energy, according to a study published in the journal Chest. The study, “Physical Activity and Symptoms in Pulmonary Arterial Hypertension,” suggested that interventions to improve fatigue and other symptoms may lead to increased physical activity in PAH patients.

PAH is a chronic disease primarily affecting middle-age women. Patients with PAH report multiple symptoms, including dyspnea, fatigue, and chest discomfort, along with exercise limitations. Fatigue is a multidimensional symptom defined as a debilitating and sustained sense of exhaustion that decreases the ability to carry out daily activities and work effectively. Evidence has shown that more than 90 percent of patients with PAH report fatigue at levels that interfere with their daily lives, and many report a diminished health-related quality of life.

“Fatigue is a common symptom in patients with pulmonary arterial hypertension (PAH); however, the impact of fatigue on daily physical activity in PAH is unknown,” Lea Ann Matura, PhD, of the University of Pennsylvania School of Nursing in Philadelphia, and colleagues wrote, according to a news release. “Accelerometry is a validated measure for assessing physical activity. We hypothesized that patients with PAH reporting higher levels of fatigue would have lower daily physical activity measured by accelerometry.”

To determine the reliability of measuring physical activity with an accelerometer, the possible association between self-reported fatigue and physical activity levels, and the association between physical activity levels and health-related quality of life, Dr. Matura and colleagues conducted a prospective cohort involving 15 women with PAH. Of these, 53 percent had heritable or idiopathic PAH.

The study began with subjects completing the Multidimensional Fatigue Inventory (MFI), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR), and a six-minute walk test. Participants wore the accelerometer on their dominant hip and completed an activity diary for seven days. On Day 15, subjects repeated the MFI and the US CAMPHOR, and then wore the accelerometer and completed an activity diary for an additional seven days. All multivariate analyses were adjusted for age, body mass index, and PAH type.

Results revealed that 85 percent of the time, women with PAH were sedentary, with low-level activity performed only in 10 percent of their waking hours. The low levels of recorded activity were associated with worse self-reported energy levels, and with issues like physical and mental fatigue. Activity bouts, however, were also associated with worse self-reported energy levels.

According to the researchers, studies on energy conservation or other interventions aimed to increase physical activity are needed to assess their efficacy in improving patient-reported outcomes such as symptoms of fatigue, dyspnea, and poor health-related quality of life.