Benefits of exercise for people with pulmonary hypertension

Benefits of exercise for people with pulmonary hypertension

Vanessa Jordan
PEARLS No.
720
Clinical question

What are the benefits and harms of exercise-based rehabilitation for people with pulmonary hypertension compared with usual care or no exercise-based rehabilitation?

Bottom line

This review suggests that exercise-based rehabilitation is safe, does not increase mean pulmonary arterial pressure, and results in clinically meaningful changes in exercise capacity and quality of life.

Inpatient exercise training was typically performed daily, whereas outpatient and home-based exercise training was undertaken 3 to 5 times per week. Exercise training typically consisted of aerobic exercise of the lower limbs using either cycling or walking on a treadmill or over ground. Exercise intensity was regulated with heart rate or by rating perceived exertion. While there were no studies that only implemented a strength training protocol, most studies included both upper and lower-limb strength training within the exercise protocol.

Caveat

There were only 5 serious adverse events reported across 11 studies, and exercise-based rehabilitation was not associated with an increased risk of serious adverse events. However, it should be noted that studies did not apply a universal definition for adverse events. It is also worth noting that exercise is not entirely without risk in people with pulmonary hypertension. International guidelines currently suggest that exercise rehabilitation should be undertaken by centres experienced in both pulmonary hypertension care and rehabilitation of compromised patients.

Context

Individuals with pulmonary hypertension have reduced exercise capacity and quality of life. Despite initial concerns that exercise training may worsen symptoms in this group, several studies have reported improvements in functional capacity and wellbeing following exercise-based rehabilitation.

Cochrane Systematic Review

Morris NR, et al. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev 2023;3:CD011285. This review contains 14 trials with a total of 571 participants.