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Meta-analysis: Exercise training benefits patients with pulmonary hypertension
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Exercise training is safe and effective for patients with pulmonary hypertension, according to a meta-analysis published in Circulation: Heart Failure.
According to the study background, pulmonary hypertension can lead to right ventricular HF, and those who have it often have exercise intolerance and reduced quality of life despite medical therapy.
Therefore, Ambarish Pandey, MD, and colleagues wrote, additional therapeutic strategies are necessary. One possibility is exercise training, which has been shown to benefit patients with HF or chronic obstructive pulmonary disease.
Pandey, from the division of cardiology in the department of internal medicine at University of Texas Southwestern Medical Center, Dallas, and colleagues analyzed prospective intervention studies that assessed whether exercise training is safe and effective for patients with pulmonary hypertension.
The analysis included 16 studies of a total of 434 participants (71% women) who received exercise training. The primary outcome was change in 6-minute walk distance. Other outcomes of interest included peak oxygen uptake (peak VO2) as affected by exercise, resting pulmonary arterial systolic pressure, peak exercise heart rate and quality of life. The median follow-up of the studies analyzed was 15 weeks (range, 3-40).
Results from a pooled analysis indicated that exercise training participants showed improvement in 6-minute walk distance (weighted mean difference, 57.7 m; 95% CI, 42.5-72.8). When the analysis was limited to studies with parallel control and intervention arms, the observed improvement to 6-minute walk distance persisted (weighted mean difference, 67.8 m; 95% CI, 39.3-96.3).
An analysis of eight studies that measured peak relative VO2 indicated a significant benefit from exercise training (weighted mean difference, 1.7 kg/ml/min; 95% CI, 1.3-2), according to the researchers.
Seven studies reported resting pulmonary arterial systolic pressure as an outcome, eight reported peak exercise heart rate and four reported quality of life, according to the researchers. Across these studies, exercise training was associated with improvements in resting pulmonary arterial systolic pressure (weighted mean difference, –3.6 mm Hg, 95% CI, –5.8 to –1.4), peak exercise heart rate (weighted mean difference, 10.4 beats/min; 95% CI, 5.5-15.3) and quality of life as measured by the Short Form-36 categories physical functioning, role-physical, general health perception, vitality, social functioning, role-emotional and mental health.
The analysis also revealed a low participant dropout rate (5%) and no major adverse events associated with exercise training.
“Taken together, these findings suggest that exercise training could be used as a safe and effective adjunctive treatment strategy among stable and well-compensated patients with chronic pulmonary hypertension,” Pandey and colleagues wrote. – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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