Exercise training in pulmonary hypertension: improving performance but waiting for outcome.

Abstract

This editorial refers to ‘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’, by N. Ehlken et al ., doi:10.1093/eurheartj/ehv337. Pulmonary hypertension is a pathophysiological condition characterized by an increase of mean pulmonary arterial pressure ≥25 mmHg at rest.1 Pulmonary hypertension may complicate multiple clinical disorders and invariably it reduces exercise and functional capacity and represents a risk factor for morbidity and mortality.2 Although important progress in the pharmacotherapy of pulmonary arterial hypertension has been achieved in the past 15 years,3,4 limited functional capacity and reduced survival still characterize patient outcome. Further advances are needed in this area to improve the clinical results of a comprehensive treatment strategy. Ehlken and colleagues now present the data of a randomized controlled trial on the impact of exercise training on peak oxygen consumption and haemodynamics in 87 patients with pulmonary arterial hypertension or inoperable chronic thrombo-embolic pulmonary hypertension.5 The majority of subjects (91%) were on background approved pulmonary arterial hypertension therapies. The exercise training started with an in-hospital 3-week programme and was continued at home with at least 15 min/day for 5 days a week for the following 12 weeks. After 15 weeks, the peak oxygen uptake (primary endpoint) significantly improved in the training group by +24.3% and the 6-min walk distance improved by 41 m. Haemodynamics at rest and during exercise significantly improved in the training group compared with the control group. However, the haemodynamic data were collected only in 74 patients (85%). No significant changes in the N-terminal pro brain natriuretic peptide (NT-proBNP) plasma …