Routine Rehabilitation as a Treatment Component for Patients With Pulmonary Arterial or Chronic Thromboembolic Pulmonary Hypertensions.
Journal
Journal of cardiopulmonary rehabilitation and prevention
ISSN: 1932-751X
Titre abrégé: J Cardiopulm Rehabil Prev
Pays: United States
ID NLM: 101291247
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
medline:
25
8
2023
pubmed:
21
3
2023
entrez:
20
3
2023
Statut:
ppublish
Résumé
Patients with pulmonary hypertension (PH) have long been advised to avoid exercise in fear of deterioration in right-sided heart function. Since the 2009 European Society of Cardiology guidelines, rehabilitation in expert centers is considered to have a specific role in care of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). We report routine rehabilitation effects in patients with PH as a component of real-life multimodal treatment. Patients with PAH or CTEPH were recommended for either in- or outpatient rehabilitation in addition to their usual care, unless there were practical problems or the patient declined. Assessment was conducted according to New York Heart Association classes, adverse events, 6 min-walk test, hemodynamics, and risk stratification after rehabilitation. Forty-one patients, 61% female, age 60 ±18 yr were included between March 2010 and May 2019. No major adverse events or deaths related to progression of right-sided heart failure were reported. Nevertheless, 22% of participants suffered adverse events in most cases not linked with physical activity. Rehabilitation as add-on to medical therapy and/or arterial deobstruction improved New York Heart Association class: mean difference, -0.39 (95% CI, -0.68 to -0.10), 6-min walk test: mean difference, 80 m (95% CI, 46-114), and was associated with improved right-sided heart hemodynamics. The risk assessment grade improved by -0.25 points (95% CI, -0.44 to -0.06) after rehabilitation. For patients with PAH or CTEPH, supervised rehabilitation as add-on to medical therapy and/or arterial deobstruction is safe and effective in improving patient and clinically related outcomes.
Identifiants
pubmed: 36939648
doi: 10.1097/HCR.0000000000000755
pii: 01273116-990000000-00082
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
354-360Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Gaine SP, Rubin LJ. Primary pulmonary hypertension. Lancet Lond Engl. 1998;352(9129):719–725.
Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30(20):2493–2537.
Mereles D, Ehlken N, Kreuscher S, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006;114(14):1482–1489.
Ganderton L, Jenkins S, Gain K, et al. Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial. BMC Pulm Med. 2011;11(1):25.
Chan L, Chin LMK, Kennedy M, et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest. 2013;143(2):333–343.
Ehlken N, Lichtblau M, Klose H, et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur Heart J. 2016;37(1):35–44.
Ley S, Fink C, Risse F, et al. Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension. Eur Radiol. 2013;23(2):324–331.
Morris NR, Kermeen FD, Holland AE. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev. 2017;1:CD011285. doi:10.1002/14651858.CD011285.pub2.
Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119.
Grünig E, Eichstaedt C, Barberà JA, et al. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J. 2019;53(2):1800332. doi:10.1183/13993003.00332-2018.
Grünig E, MacKenzie A, Peacock AJ, et al. Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial. Eur Heart J. 2021;42(23):2284–2295.
Ozemek C, Berry MJ, Arena R. A review of exercise interventions in pulmonary arterial hypertension and recommendations for rehabilitation programing. J Cardiopulm Rehabil Prev. 2019;39(3):138–145.
Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889. doi:10.1183/13993003.00889-2017.
Kylhammar D, Kjellström B, Hjalmarsson C, et al. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension. Eur Heart J. 2018;39(47):4175–4181.
Koudstaal T, Wapenaar M, van Ranst D, et al. The effects of a 10-wk outpatient pulmonary rehabilitation program on exercise performance, muscle strength, soluble biomarkers, and quality of life in patients with pulmonary hypertension. J Cardiopulm Rehabil Prev. 2019;39(6):397–402.
Delcroix M, Staehler G, Gall H, et al. Risk assessment in medically treated chronic thromboembolic pulmonary hypertension patients. Eur Respir J. 2018;52(5):1800248. doi:10.1183/13993003.00248-2018.
Weinstein AA, Chin LMK, Keyser RE, et al. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med. 2013;107(5):778–784.
González-Saiz L, Fiuza-Luces C, Sanchis-Gomar F, et al. Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: the WHOLEi+12 trial. Int J Cardiol. 2017;231:277–283.
Martínez-Quintana E, Miranda-Calderín G, Ugarte-Lopetegui A, Rodríguez-González F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension. Congenit Heart Dis. 2010;5(1):44–50.
Fox BD, Kassirer M, Weiss I, et al. Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail. 2011;17(3):196–200.
Fukui S, Ogo T, Takaki H, et al. Efficacy of cardiac rehabilitation after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Heart Br Card Soc. 2016;102(17):1403–1409.
de Man FS, Handoko ML, Groepenhoff H, et al. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2009;34(3):669–675.
Grünig E, Ehlken N, Ghofrani A, et al. Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respir Int Rev Thorac Dis. 2011;81(5):394–401.
Grünig E, Lichtblau M, Ehlken N, et al. Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J. 2012;40(1):84–92.
Nagel C, Prange F, Guth S, et al. Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension. PLoS One. 2012;7(7):e41603. doi:10.1371/journal.pone.0041603.
Grünig E, Maier F, Ehlken N, et al. Exercise training in pulmonary arterial hypertension associated with connective tissue diseases. Arthritis Res Ther. 2012;14(3):R148. doi:10.1186/ar3883.
Becker-Grünig T, Klose H, Ehlken N, et al. Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. Int J Cardiol. 2013;168(1):375–381.
Kabitz HJ, Bremer HC, Schwoerer A, et al. The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung. 2014;192(2):321–328.
Ehlken N, Verduyn C, Tiede H, et al. Economic evaluation of exercise training in patients with pulmonary hypertension. Lung. 2014;192(3):359–366.
Inagaki T, Terada J, Tanabe N, et al. Home-based pulmonary rehabilitation in patients with inoperable or residual chronic thromboembolic pulmonary hypertension: a preliminary study. Respir Investig. 2014;52(6):357–364.
Ihle F, Weise S, Waelde A, et al. An integrated outpatient training program for patients with pulmonary hypertension—the Munich Pilot Project. Int J Phys Med Rehabil. 2014;2:3. doi:10.4172/2329-9096.1000204.
Shoemaker MJ, Wilt JL, Dasgupta R, Oudiz RJ. Exercise training in patients with pulmonary arterial hypertension: a case report. Cardiopulm Phys Ther J. 2009;20(4):12–18.
Mainguy V, Maltais F, Saey D, et al. Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2010;30(5):319–323.
Raskin J, Qua D, Marks T, Sulica R. A retrospective study on the effects of pulmonary rehabilitation in patients with pulmonary hypertension. Chron Respir Dis. 2014;11(3):153–162.
Talwar A, Sahni S, Verma S, Khan SZ, Dhar S, Kohn N. Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients. J Exerc Rehabil. 2017;13(2):214–217.
Bussotti M, Gremigni P, Pedretti RFE, et al. Effects of an outpatient service rehabilitation programme in patients affected by pulmonary arterial hypertension: an observational study. Cardiovasc Hematol Disord Drug Targets. 2017;17(1):3–10.
Yuan P, Yuan XT, Sun XY, Pudasaini B, Liu JM, Hu QH. Exercise training for pulmonary hypertension: a systematic review and meta-analysis. Int J Cardiol. 2015;178:142–146.
Buys R, Avila A, Cornelissen VA. Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials. BMC Pulm Med. 2015;15:40.
Pandey A, Garg S, Khunger M, et al. Efficacy and safety of exercise training in chronic pulmonary hypertension: systematic review and meta-analysis. Circ Heart Fail. 2015;8(6):1032–1043.
Dalla Vecchia LA, Bussotti M. Exercise training in pulmonary arterial hypertension. J Thorac Dis. 2018;10(1):508–521.
Woolstenhulme JG, Guccione AA, Herrick JE, et al. Left ventricular function before and after aerobic exercise training in women with pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2019;39(2):118–126.