THE EFFECT OF AN OUTPATIENT EXERCISE REHABILITATION PROGRAM ON HAEMODYNAMICS AND CARDIAC MRI PARAMETERS OF RV FUNCTION IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION

Abstract

TYPE: Abstract TOPIC: Pulmonary Rehabilitation PURPOSE: To assess the effect of outpatient exercise on haemodynamics and right ventricular function in patients with Pulmonary Arterial Hypertension (PAH), a subgroup of PH. METHODS: Sixteen patients were randomised to either 12 week outpatient multidisciplinary rehabilitation (MDR) or home walking (exercise training, ET). The MDR program consisted of twice weekly (1hr) supervised exercise, and three psychology telehealth consultations. The ET group were instructed to undertake daily walking, aiming for 30mins per day. Primary outcome measures were right ventricular ejection fraction (RVEF), stroke volume (SV) and SV Index (SVI). Secondary outcomes included: haemodynamic measurements on right heart catheterisation (RHC); six minute walk test (6MWT), vital capacity, dominant hand grip strength (DHGS) and health-related quality of life questionnaires (CAMPHOR and DASS-21). Mixed factorial repeated measures analyses of variance (RM-ANOVAs) were used to examine longitudinal outcome data over time. RESULTS: Significant improvements occurred from baseline to week 12 across the cohort as a whole. These include reduction in mean pulmonary artery wedge pressure (p=0.015), significant increase in SV (p=0.025) and SVI (p=0.016), vital capacity (p=-0.05) and DHGS (p=0.032). Symptoms (p=0.04), depression (p=0.011) and anxiety (p=0.043) improved with exercise. There were no significant differences between the groups in the outcomes tested. Patients reported a high level of satisfaction with both programs when interviewed following the intervention. CONCLUSIONS: Outpatient exercise training/multidisciplinary rehabilitation was feasible and safe for patients with PAH. Such a program may induce physiological and psychological benefits and further, larger studies are warranted. CLINICAL IMPLICATIONS: Exercise based rehabilitation has both both physiological and psychological benefits in patients with Pulmonary Hypertension. DISCLOSURE: The ExPAH study was supported by an unrestricted research grant by Janssen (formerly Actelion). All authors had complete research independence for study protocol design, methodology, analysis and reporting of results. KEYWORD: Pulmonary Hypertension