Abstract

BackgroundRehabilitation plays an important role in the management of patients with pulmonary arterial hypertension (PAH) and current guidelines recommend implementation of a monitored individualized exercise training program as adjuvant therapy for stable PAH patients on optimal medical treatment. An optimal rehabilitation model for this group of patients has not yet been established. This randomized prospective study assessed the effectiveness and safety of a 6-month home-based caregiver-supervised rehabilitation program among patients with pulmonary arterial hypertension.MethodsA total of 39 patients with PAH were divided into two groups: intervention group (16 patients), subjected to a 6-month home-based physical training and respiratory rehabilitation program adapted to the clinical status of participants, and control group (23 patients) who did not perform physical training. The 6-min walk test (6MWT), measurement of respiratory muscle strength, quality of life assessment (SF-36, Fatigue Severity Scale – FSS) were performed before study commencement, and after 6 and 12 months. Adherence to exercise protocol and occurrence of adverse events were also assessed.ResultsPhysical training significantly improved 6MWT distance (by 71.38 ± 83.4 m after 6 months (p = 0.004), which remained increased after 12 months (p = 0.043), and respiratory muscle strength after 6 and 12 months (p < 0.01). Significant improvement in quality of life was observed after the training period with the use of the SF-36 questionnaire (Physical Functioning, p < 0.001; Role Physical, p = 0.015; Vitality, p = 0.022; Role Emotional, p = 0.029; Physical Component Summary, p = 0.005), but it did not persist after study completion. Adherence to exercise protocol was on average 91.88 ± 14.1%. No serious adverse events were noted.ConclusionAccording to study results, the home-based rehabilitation program dedicated to PAH patients is safe and effective. It improves functional parameters and quality of life. Strength of respiratory muscles and 6MWD remain increased 6 months after training cessation.Trial registrationClinicalTrials.gov, NCT03780803. Registered 12 December 2018

Highlights

  • Rehabilitation plays an important role in the management of patients with pulmonary arterial hypertension (PAH) and current guidelines recommend implementation of a monitored individualized exercise training program as adjuvant therapy for stable PAH patients on optimal medical treatment

  • The European Respiratory Society/European Cardiology Society (ERS/ESC) guidelines published in 2015 recommend the implementation of monitored individualized exercise training as adjuvant therapy for stable PAH patients on optimal medical treatment [8]

  • Presented data includes the etiology of PAH, WHO-FC of PAH, comorbidities, specific PAH therapy, the right-heart catheterization (RHC), transthoracic echocardiography (TTE), cardiopulmonary exercise testing (CPET) parameters and laboratory test results prior to intervention

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Summary

Introduction

Rehabilitation plays an important role in the management of patients with pulmonary arterial hypertension (PAH) and current guidelines recommend implementation of a monitored individualized exercise training program as adjuvant therapy for stable PAH patients on optimal medical treatment. An optimal rehabilitation model for this group of patients has not yet been established This randomized prospective study assessed the effectiveness and safety of a 6-month home-based caregiver-supervised rehabilitation program among patients with pulmonary arterial hypertension. Pulmonary arterial hypertension (PAH) is a rare chronic disease leading to decreased physical activity, right-sided heart failure and a reduced life expectancy. The European Respiratory Society/European Cardiology Society (ERS/ESC) guidelines published in 2015 recommend the implementation of monitored individualized exercise training as adjuvant therapy for stable PAH patients on optimal medical treatment [8]. A clinically useful definition of exercise for pulmonary hypertension is still not available [17], and diversity in training forms and models highlights the necessity for more precise analysis

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