Rehabilitation for Dyspnea Post Pulmonary Embolism Improves Exercise Capacity

Patients with persistent dyspnea after PE who received rehabilitation vs usual care performed better on the Incremental Shuttle Walk Test (mean difference 53.0 meters).

Patients with persistent dyspnea after pulmonary embolism (PE) who underwent rehabilitation had greater exercise capacity compared with those who received usual care, according to study findings published in Chest.

Investigators conducted a randomized controlled trial to evaluate an 8-week exercise-based rehabilitation program for patients with persistent dyspnea following pulmonary embolism. Outcomes of interest included exercise capacity, dyspnea, and quality of life.

Participants were identified from the thrombosis registry (TROLL) at a hospital in Norway. To be eligible, the patients (aged 18 to 75 years) had to have: (1) PE greater than isolated subsegmental emboli on computed tomography pulmonary angiography 6 to 72 months before inclusion; and (2) persistent, self-reported dyspnea of at least grade 1 as measured by the modified Medical Research Council dyspnea scale, with onset or exacerbation at PE diagnosis. The participants were enrolled from January 1, 2018, to June 1, 2022.

A total of 211 patients were randomly assigned to an intervention group (n=108) or control arm (n=103). Their overall median age was 57 (49-67) years, 56% were male, and their median time from diagnosis to inclusion was 10.3 (7.2-21.0) months. The intervention group engaged in a supervised outpatient exercise program for 1 hour twice a week for 8 weeks. They also had a home-based exercise program once or twice weekly. Patients in the control arm received usual care based on guidelines. The primary endpoint was the difference in Incremental Shuttle Walk Test (ISWT) in the 2 groups at follow-up. The median walking distance at baseline for the ISWT was 695 (530-940) meters.

Rehabilitation should be considered in patients with persistent dyspnea following PE, though further research is needed to assess the optimal patient selection, timing, mode, and duration of rehabilitation.

Follow-up and primary outcome data were available for 89 participants from the rehabilitation group and 87 participants from the control group. The researchers found that participants in the rehabilitation group performed better on the ISWT compared with those in the control group, with a mean difference between groups of 53.0 meters (95% CI, 17.7-88.3; P = .0035). No adverse events occurred.

In comparing participants based on time since diagnosis, researchers found that the difference in ISWT between the rehabilitation and control group consistently favored the rehabilitation group; the difference for those who were 6 to 12 months post-diagnosis was 63.8 meters (95% CI, 12.4-115.2; P =.015) and 47.4 meters for those who were 12.1 to 27 months post diagnosis (95% CI, 2.0-92.9; P =.041).

No difference was found regarding the EuroQol-5 Dimension index score or Shortness of Breath Questionnaire sum score between the 2 groups. The rehabilitation group had a better Pulmonary Embolism Quality of Life questionnaire total score vs the control group (difference -0.04 [-4%]; 95% CI, -0.09 to 0.00; P =.041).

The researchers noted that the primary endpoint was subject to a considerable ceiling effect, which may have affected the findings. In addition, a number of different physiotherapists participated in the completion of the intervention owing to the COVID pandemic, which may have resulted in some heterogeneity in the rehabilitation. Furthermore, a majority of participants had mild symptoms, which may have limited the potential benefits of the program.

“Rehabilitation should be considered in patients with persistent dyspnea following PE, though further research is needed to assess the optimal patient selection, timing, mode, and duration of rehabilitation,” the investigators commented.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Jervan Ø, Haukeland-Parker S, Gleditsch J, et al. The effects of exercise training in patients with persistent dyspnoea after pulmonary embolism: a randomized controlled trial. Chest. Published online May 4, 2023. doi:10.1016/j.chest.2023.04.042