Patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (PH) cite lack of energy, lack of self-discipline, and lack of interest as the primary barriers to increasing their levels of physical activity and exercise, according to study results published in Pulmonary Circulation. Investigators suggested additional research to determine causality and personalized regimens to address these barriers.

This cross-sectional study of patients with PAH and chronic thromboembolic PH was designed to identify patient-perceived barriers to physical activity. Study participants (N=40) were adults ≥18 years recruited between June 2016 and November 2016 from the University of Michigan Medical Center PH clinic as part of a more extended prospective study on the long-term associations between physical activity and quality of life.

In a cross-sectional survey, participants were asked to use a 5-point Likert scale to rate how frequently a list of 15 barriers get in the way of being physically active. The primary study outcome measure was physical activity quantified by participant use of the Fitbit Zip activity tracker for 2 weeks, and the primary independent study variables were the 15 rated barriers and a summary score of the total average barriers. The association between the barriers and the summary score and physical activity were assessed by performing multivariable linear regressions adjusting for sex, age, and PAH etiology.

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Of the 40 participants, 85% (n=34) had valid step counts and were included in analysis. Among the 34 included participants (91% [n=31] with PAH and 85% [n=29] female), the median number of steps per day was 3913 (interquartile range, 2309-6313). The most strongly endorsed barriers to physical activity were lack of energy, lack of self-discipline, and lack of interest. Multivariable analysis showed that each 1-unit increase in rating for the barriers lack of interest, lack of enjoyment, and lack of skills was associated with a significant decrease in daily step count: -1414 steps (95% CI, -2580 to -248), -1458 steps (95% CI, -2404 to -511), and -1533 steps (95% CI, -2910 to -156), respectively. Total average barriers and external barriers such as lack of equipment, environmental factors, lack of time, and poor weather did not correlate with reduced daily step counts.

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Study investigators concluded, “[F]uture work aimed at optimizing physical activity in patients with [PH] should include multidimensional interventions that consider the potential impact of intrinsic barriers,” and they recommended additional research to determine causality for more targeted counseling and interventions.  

Disclosures: One author reported affiliations with multiple pharmaceutical companies. Please see the reference for complete disclosure information.


Cascino T, McLaughlin VV, Richardson C, et al. EXPRESS: Barriers to physical activity in patients with pulmonary hypertension [published online April 15, 2019]. Pulm Circ. doi: 10.1177/2045894019847895