Rehabilitation exercises help PAH transplant candidates: Study
Pulmonary rehab improved aerobic, muscle measures
Adults with severe pulmonary arterial hypertension (PAH) awaiting lung transplants can safely participate in pulmonary rehabilitation and maintain or improve exercise capacity, a study found.
Pulmonary rehabilitation led to modest improvements in measures of aerobic training and in muscle training volumes with no major adverse events.
However, participation in outpatient pulmonary rehabilitation was interrupted by hospital admissions in 40% of lung transplant candidates with PAH.
“This is the first study to assess [pulmonary rehabilitation] safety and characterize the exercise capacity response of patients with severe PAH listed for [lung transplant],” researchers wrote in the study, “Pulmonary rehabilitation in lung transplant candidates with pulmonary arterial hypertension,” published in Respiratory Medicine.
PAH, a type of pulmonary hypertension, is characterized by the narrowing of small blood vessels known as pulmonary arteries, which transport blood from the heart to the lungs. The narrowing restricts blood flow in the lungs, causing high blood pressure, or hypertension. Hypertension in the lungs makes the heart work harder to pump blood, ultimately weakening heart muscles. People with PAH have symptoms including shortness of breath and fatigue, limiting their ability to exercise.
Rehabilitation exercises and transplant candidates
Pulmonary rehabilitation is a program of exercise training coupled with patient education and psychosocial support, aiming to improve exercise capacity and quality of life. Guidelines recommend that clinically stable patients with mild to moderate PAH participate in supervised pulmonary rehabilitation programs, but less is known about the benefits of pulmonary rehabilitation in lung transplant candidates whose symptoms restrict their exercise capacity.
The study looked at 40 PAH patients, 73% of them women, who were listed for lung transplants.
At the start of the study, half of the participants needed supplemental oxygen with exertion. Most were on dual or triple vasodilator therapy, PAH treatments that dilate the arteries.
The median duration of listing was 91 days. During this time, participants completed a median of 31 pulmonary rehabilitation sessions. The sessions consisted of an exercise regimen that included aerobic exercise on a cycle ergometer or treadmill, as well as resistance training, which aims to increase muscle strength by making the muscles work against a weight or force.
At the start of the study, patients’ exercise capacity was assessed with the six-minute walking distance test (6MWD), with a mean walking distance of 330 meters, or almost 1,083 feet.
For the 25 participants who had more than one 6MWT, results showed a mean increase in walking distance of 18 meters, or 59 feet, with pulmonary rehabilitation.
The program led to improvements in multiple measures of aerobic and muscle training volume.
Participants walked on the treadmill at significantly higher speeds and had improved peak oxygen uptake while walking on the treadmill. There was a trend towards a longer duration on the treadmill as well.
Muscle training volumes for the biceps and the quadriceps both improved with pulmonary rehabilitation.
“The small gains observed while listed for transplantation supports the ability of patients with severe PAH to maintain their exercise tolerance despite the progressive nature of their underlying condition,” the researchers wrote.
Sixteen patients had at least one hospital admission while listed for transplant. The most common PAH-related cause for that was decompensated heart failure. In all cases, hospital admission prevented participation in outpatient pulmonary rehabilitation, as patients remained in the hospital until transplant.
“Given the frequent hospital admissions in patients with PAH listed for [lung transplant], consideration should be given to optimizing physiotherapy practices during hospital admissions to align with the goals of ongoing [pulmonary rehabilitation] and addressing reintegration into outpatient [pulmonary rehabilitation] post-discharge,” the researchers wrote.
Research, they said, “should focus on prospective studies to assess if there is an association between exercise capacity, aerobic and resistance training volumes, and post-transplant outcomes in PAH [lung transplantation] recipients.”
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