Kettlebell training improves muscle strength and life quality in PAH
8-week program tested weight tool's use by patients for easing symptoms
An eight-week exercise program using kettlebells — a weight tool consisting of a heavy cast-iron ball and handle — led to gains in physical performance, breathing efficiency, and muscle strength in people with pulmonary arterial hypertension (PAH), according to a new study from Turkey.
Kettlebell training also improved quality of life for those taking part in the program, the researchers noted.
Participants who trained with kettlebells walked farther, used oxygen more efficiently, and felt less shortness of breath and fatigue during many daily activities than those who received standard care, the data showed. The program also increased physical activity levels and reduced symptoms of anxiety and depression.
As one example, the researchers noted that kettlebell training “was associated with significant improvements in several large muscle groups and grip [strength].”
While further studies are needed to confirm these findings, these results suggest that kettlebell training may be “a safe and potentially effective method” to improve functional capacity and ease PAH symptoms among patients, the researchers wrote.
The study, “Effects of kettlebell exercise training on functional capacity and metabolic costs of activities of daily living in patients with pulmonary arterial hypertension: A randomized controlled trial,” was published in the journal Respiratory Medicine.
A type of pulmonary hypertension (PH), PAH occurs when the arteries that carry blood from the heart to the lungs become abnormally narrow, raising blood pressure and forcing the heart to work harder to pump blood. This leads to symptoms such as shortness of breath, known as dyspnea, as well as fatigue, muscle weakness, and heart palpitations. Such symptoms can make everyday activities tiring and limit participation in physical activity due to “impaired oxygen delivery” in the body, the researchers noted.
Kettlebell training combines aerobic exercise, full-body movement
Exercise among PH patients has been shown to improve endurance and muscle function, and ease oxygen use. In PAH, training programs often involve aerobic exercise, such as walking or cycling, resistance training with light weights or elastic bands, respiratory muscle exercises, or a combination of these approaches.
Kettlebell training brings together many of these elements in a single form of exercise, through functional, full-body movements that mimic everyday activities.
However, the researchers noted, “although kettlebells have been used in clinics in the last 10 years, no study conducted on PH groups could be found in the literature.”
To address this gap, a research team from institutions across Turkey conducted a small study (NCT05242380) to evaluate the potential benefits of kettlebell exercise.
The team recruited 35 participants — 32 women and three men — with a confirmed diagnosis of PAH for a study at the Institute of Cardiology at Istanbul University-Cerrahpasa. All participants were being followed between January 2022 and October 2023.
The patients were randomly divided into two groups. The intervention group, comprising 18 individuals, took part in a supervised kettlebell exercise program three times a week for eight weeks. The 17 participants in the control group received a single education session about PAH without any structured exercise program. They were followed up weekly with telephone calls.
Each training session involved 12 exercises targeting major muscle groups; these progressed from basic single-movement exercises to more advanced, full-body movements. All sessions were supervised by a physiotherapist.
Nearly half of those given training improved in 6-minute walk test
At the study’s start, both groups were similar in terms of age, disease severity, and clinical characteristics. One participant in the control group and two in the intervention group withdrew due to personal reasons or COVID-19 infection. The others completed the program with no side effects reported.
After eight weeks, people in the kettlebell training group showed clear improvements in their physical performance, breathing, and strength as compared with both the study’s start and with the control group.
In the six-minute walk test — a standardized aerobic task used to assess functional exercise capacity — patients who trained with kettlebells walked 32.2 meters (105.6 feet) farther, while no significant change was observed in the control group. Eight participants in the kettlebell group achieved a clinically meaningful improvement of more than 33 meters (108.3 feet), compared with two in the control group.
Participants in the kettlebell training program also walked more efficiently, needing less breathing effort and energy to cover the same distance. Their oxygen consumption dropped, they breathed less air in and out each minute, and they reported less dyspnea, both compared to the start of the program and to those who didn’t exercise.
When tested on everyday activities — such as climbing stairs, washing dishes, sweeping, and a series of taking off shoes and socks when sitting, putting them back on, standing up, and then putting on and taking off a jacket — participants in the kettlebell group used less oxygen and reported less dyspnea in nearly all tasks. Fatigue eased significantly during stair climbing and sweeping. These improvements were not seen in the control group, the researchers noted.
Gains in strength were seen in muscle groups involved in movements of the shoulders, hips, thighs, and hands after the kettlebell program. No meaningful changes were seen in the control group, and the improvements were significantly greater among those who trained with kettlebells.
The results of this study suggest that [kettlebell training] is a safe and potentially effective method for improving functional capacity and reducing dyspnea and fatigue in many activities of daily living in patients with PAH.
Beyond reporting less fatigue and dyspnea, even during daily activities, people who trained with kettlebells also reported feeling less anxious and depressed after the program. These individuals became more physically active overall. The improvements were greater than those seen in the control group.
“Exercise training programs have been found to increase … quality of life in PAH,” the researchers noted. “In the current study, the mean change in [the intervention group] was found to be 6.9, exceeding the recommended MCID [minimal clinically important difference] of 6.0.”
Overall, according to the team, “the results of this study suggest that [kettlebell training] is a safe and potentially effective method for improving functional capacity and reducing dyspnea and fatigue in many activities of daily living in patients with PAH.”
Still, the researchers noted that “future studies including sham or traditional exercise training control groups are needed to confirm these findings.”
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