Exercise as it relates to Disease/Exercise As a Means to Improve Health and Wellbeing In Patients with Advanced Pulmonary Hypertension

This is an analysis of the journal article "Exercise and Respiratory Training Improve Exercise Capacity and Quality of Life in Patients With Severe Chronic Pulmonary Hypertension by Mereles, et al., (2006)

Background
Pulmonary hypertension (PH) is an increase of blood pressure in the arteries of the lungs. . This means the arteries that lead to the lungs are hard and narrow. This leads to the heart having to work harder to pump blood through the body.

This reduced blood flow to the lungs means less oxygen available for the body to use. This can lead to shortness of breath, tiredness, chest pain, swelling of the legs and a fast heart beat. Due to these symptoms quality of life is reduced and exercise is more difficult.

PH onset is gradual. There is no cure. and the cause is often unknown. Treatment depends on the type of disease. Some measures can be used such as oxygen therapy, diuretics and medication to prevent clotting.

Where is the Research From?
The study was conducted in Germany. The informed consent for this study was approved by the Ethics Committee of the University of Heidelberg.

Study Design
The study was a 15-week randomized controlled trial. Patients were randomly assigned to either a primary training group or a sedentary control group using a permuted block randomization procedure. After the 15 weeks the sedentary control group became the secondary exercise group and performed the same exercise program as the primary exercise group.

What did the Research Involve?
Once Chosen
 * 30 Patients with severe chronic PH participated. Participants were required to be stable and compensated under optimized medical therapy (such as endothelin antagonists, iloprost, sildenafil, calcium channel blockers, anticoagulants, diuretics, and supplemental oxygen) for at least 3 months before entering the study.
 * Participants were required to be aged between 18 and 75 years (participants ranged from 19-72).
 * Most fit under World Health Organization (WHO) functional class II to IV.
 * Participants could have no recent syncope, and no skeletal or muscle abnormalities prohibiting participation in an exercise program.
 * Most fit under World Health Organization (WHO) functional class II to IV.
 * Participants could have no recent syncope, and no skeletal or muscle abnormalities prohibiting participation in an exercise program.
 * Participants could have no recent syncope, and no skeletal or muscle abnormalities prohibiting participation in an exercise program.


 * Patients in each group resided in the hospital for the initial 3 weeks of the study period and continued with a program at home for another 12 weeks. Medication remained the same.
 * Patients were evaluated at baseline, week 3, and week 15.
 * Primary end points were the changes from baseline to week 15 in the distance walked in 6 minutes and in scores of the Short Form Health Survey quality-of-life questionnaire. Changes in WHO functional class, Borg scale, and parameters of echocardiography and gas exchange also were assessed.
 * The control group followed a common rehabilitation program based on a healthy diet and physical therapy such as massage and muscular relaxation without the use of exercise.
 * The exercise group performed a low intensity (10 to 60 W) interval bicycle ergometer session 7 days a week. 60 minutes of walking was performed 5 days a week and 30 minutes of dumbbell training was performed with light weights (500-1000g) 5 days a week.
 * The control group followed a common rehabilitation program based on a healthy diet and physical therapy such as massage and muscular relaxation without the use of exercise.
 * The exercise group performed a low intensity (10 to 60 W) interval bicycle ergometer session 7 days a week. 60 minutes of walking was performed 5 days a week and 30 minutes of dumbbell training was performed with light weights (500-1000g) 5 days a week.
 * The exercise group performed a low intensity (10 to 60 W) interval bicycle ergometer session 7 days a week. 60 minutes of walking was performed 5 days a week and 30 minutes of dumbbell training was performed with light weights (500-1000g) 5 days a week.
 * The exercise group performed a low intensity (10 to 60 W) interval bicycle ergometer session 7 days a week. 60 minutes of walking was performed 5 days a week and 30 minutes of dumbbell training was performed with light weights (500-1000g) 5 days a week.

What were the Basic Results?
At week 15, patients in the primary and secondary training groups had an improved 6-minute walking distance; the mean difference between the control and the primary training group was 111 m (95% confidence interval, 65 to 139 m; P<0.001). Exercise training was well tolerated and improved scores of quality of life, WHO functional class, peak oxygen consumption, oxygen consumption at the anaerobic threshold, and achieved workload.

Systolic pulmonary artery pressure values at rest did not change significantly after 15 weeks of exercise and respiratory training (from 61±18 to 54±18 mm Hg) within the training group. This suggests exercise is not a cure for PH, rather it adds additional benefits to medication.



What Conclusions Can We Take From This Research?
It is commonly believed that physical activity or training may have a negative effect for patients with Advanced. Due to this fact often times doctors tend to shy away from or even advise against exercise for those with advanced PH due to the high risk. Little is known about the affect of life style changes such as exercise on patients with advanced PH. This is the first prospective, controlled, randomized study investigating an exercise program and shows low intensity exercise as a promising, powerful and safe adjunct therapy for patients with PH.

Practical Advice?
It is important to keep in mind risks and limitations that the illness may cause. In this study physiological markers were closely monitored to maintain levels in a perceived safe zone. It is important to seek expert advice and supervision undergoing an exercise program. As research continues a better understanding will be gained on what should, and should not, be done. It is clear that lifestyle changes can and will continue to be an effective method to improve health and well being, including for those with chronic illness and disease.

Further Resources
This study shows similar improvements for patients with Inoperable or Residual Chronic Thromboembolic Pulmonary Hypertension http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0041603.

This is a study on the Efficacy and Safety of Exercise Training for Patients with PH: https://www.ncbi.nlm.nih.gov/pubmed/26185169

For more information regarding the practical side of exercise and PH (Pulmonary Hypertension Association) visit: https://phassociation.org/patients/living-with-ph/exercise-and-ph/

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