September 20, 2006

Appropriate amounts of exercise offer psychological and physical benefits for patients with severe pulmonary hypertension (PH), according to research reported in Circulation: Journal of the American Heart Association.

“It is commonly believed that exercise training may be dangerous for PH patients, because increasing pressure on the pulmonary arteries may worsen right-sided heart failure," said Ekkehard Grünig, MD, senior author of the study and associate professor at University Hospital Heidelberg in Heidelberg, Germany. Patients should exercise, but only in certain amounts, in addition to taking medicine. All training should be started with supervision in a hospital.”

According to researchers, although treatment of PH is advancing, adverse effects occur with the medications that treat it. Most patients continue to have symptoms, reduced physical abilities, and reduced quality of life despite excellent medical treatment. Reduced exercise ability in PH is associated with depression and anxiety disorders, Grunig said.

Grunig and colleagues evaluated the effects of exercise and respiratory training in 30 patients (21 female), average age 50, with severe chronic PH who were stable for at least 3 months. Patients were randomly assigned to either a control group or a primary training group and evaluated before the study, at week three and at week 15.

The control group received a common rehabilitation program, while the primary training group participated in an additional low-dose exercise program, supervised by physicians and physiotherapists, seven days a week. The daily training consisted of:
* 10-25 minutes of interval bicycle training
* 60 minutes of walking
* 30 minutes of dumbbell-training
* 30 minutes of respiratory training (stretching, breathing techniques and yoga)

Researchers conducted the study in the hospital for the first 3 weeks. For the last 12 weeks, researchers developed home-training programs for primary training group patients, supervised by phone every 2 weeks. After the first 15-week study period was completed, patients in the control group were invited to re-enter the study and participate in the same exercise training program as the primary training group.

All training group patients tolerated the exercise well and had no adverse events such as progression of symptoms of PH or right-sided heart failure.

“With low-dose exercise training, patients had better uptake of oxygen, which made the heart work less and allowed them to exercise more and feel better," Grunig said.