Long-term Exercise Found to Improve Physical, Mental Health of PH Patients

A six-month exercise training program can significantly improve physical and psychological well-being in patients with pulmonary hypertension (PH), according to results of a new trial.

The study, “Long-Term Effect of an Exercise Training Program on Physical Functioning and Quality of Life in Pulmonary Hypertension: A Randomized Controlled Trial,” was published in BioMed Research International.

Supervised exercise training was suggested as a therapeutic strategy for PH patients by the 2015 ESC/ERS Joint Task Force for the Diagnosis and Treatment of PH. However, the effects of long-lasting exercise training in this patient population have not been thoroughly evaluated.

Now, a team led by researchers at Aristotle University of Thessaloniki in Greece investigated the effects of a six-month combined aerobic exercise and strengthening training program on physical functioning, anxiety, depression, and health-related quality of life (HRQoL) status in patients with precapillary PH. Of note, precapillary means patients have increased pulmonary vascular resistance, with a pulmonary capillary wedge pressure of 15mm Hg or lower.

“This is the only study to date examining the safety and efficacy of a 6-month mixed-type exercise training program in outpatients with precapillary PH,” the team wrote.

Only medically stable patients were included in the study. In total, 22 PH patients completed the study — 12 in the intervention group (mean average age of 54.7 years) and 10 in the control group (mean age of 53.1 years).

Patients in the intervention/exercise group had three training sessions per week, designed by cardiologists and a physical education teacher experienced in cardiac rehabilitation. The sessions lasted 45–60 minutes and consisted of a 10-minute warm-up, 20-minute cycling on a bicycle ergometer or walking on a treadmill, diverse exercises with a weight machine, and 5–10 minutes of stretching exercises. Patients in this group also increased their daily activity level on non-training days. After the six-month training, participants were instructed to stop exercising.

A physical and psychological evaluation was carried out at the start of the study and at the end of the exercise program. Patients were also physically assessed at three months post-training.

Participants in the control group followed their usual daily routine throughout the study period.

After six months, patients in the exercise program group showed higher functional capacity, as determined by the six-minute walk distance (6MWD) test — a mean increase in the 6MWD by 8.7% vs. 1.6% in the control group. Long-term exercise also improved the results in other functional capacity tests, such as the timed up and go test, and assessments in weightlifting/strength and lower limb strength.

Cardiorespiratory efficiency also revealed significant improvement after the exercise program.

“After training, [the intervention group] showed significant improvements in the exercise time achieved in the cardiopulmonary exercise testing by 51.3% compared to [the control group], who achieved an increase of 6.06%,” the researchers wrote.

Regarding psychological changes, the levels of depression (assessed using the Beck’s Depression Inventory) and anxiety (assessed through the State-Trait Anxiety Inventory) were significantly reduced after six months of exercise training in PH patients. Accordingly, researchers also observed an increase in HRQoL.

Importantly, the benefits of exercise were long-lasting and present at the three-month post-training follow-up assessment, the team noted.

“Patients who exercised adopted in the long term to a more active way of life, maintaining the favorable effects of the exercise training program on their functional capacity,” the researchers wrote.

No exercise-related complications were reported during the study, indicating the safety of the training program.

Overall, “the results of the present study demonstrate that an outpatient, long-term, combined aerobic and strength exercise training program is feasible and effective in improving physical functioning, overall psychological status, and HRQoL in patients with precapillary PH,” the team concluded.