ERS Task Force Issues Statement on PH Exercise Training and Rehabilitation

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Exercise training can result in a substantial increase in cardiac index and significant decreases in mean pulmonary arterial pressure and pulmonary vascular resistance.
Exercise training can result in a substantial increase in cardiac index and significant decreases in mean pulmonary arterial pressure and pulmonary vascular resistance.

The European Respiratory Society (ERS) released a new statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension (PH), highlighting studies that have demonstrated the effectiveness of exercise and rehabilitation in these patients for improving muscular function, quality of life, and exercise capacity. The new statement was published in the European Respiratory Journal.1

A Task Force that included PH experts was convened by the ERS. The Task Force members used an evidence-based approach to create their statement, relying on evidence from 6 randomized controlled trials, 3 controlled trials, 10 prospective cohort studies, and 4 meta-analyses, totaling 784 patients with PH. For the purposes of their statement, the PH experts focused on providing an overview of the current literature rather than on performing a systematic literature review or meta-analysis of the currently available data on exercise training and rehabilitation in PH.

The Task Force members reported on 1 randomized controlled trial that showed a significant increase in mean peak oxygen consumption of nearly 25% in a training vs a control group (+3.1±2.7 mL/min/kg vs –0.2±2.3 mL/min/kg, respectively; P <.0001).2 In addition, the study showed that exercise training resulted in a substantial increase in the cardiac index (+9.3% vs –6.5%; P <.001) and significant decreases in mean pulmonary arterial pressure (–7.3% vs +16.1%; P =.007) and pulmonary vascular resistance (–19.3% vs +34.5%; P <.001) after 15 weeks.

In another study, researchers found significant improvement in quality of life after 15 weeks of exercise training in patients with severe chronic PH.3 Additional data demonstrated that rehabilitation appears to be the safest and most effective strategy in physically deconditioned moderate-risk patients with pulmonary arterial hypertension as well as in patients with inoperable chronic thromboembolic PH.4

The main limitation of the ERS statement was the lack of a pooled meta-analysis of the recent and available literature.

“In summary, the establishment of specialized rehabilitation programs for PH patients would further patient access to this treatment intervention,” the Task Force wrote. “As exercise training appears to be effective, cost-efficient and safe, but is scarcely reimbursed and supported by healthcare systems, an increased awareness among and support from healthcare institutions, commissioners of health care and research funding institutions are of high need.”

References

  1. Grünig E, Eichstaedt C, Barberà J-A, et al. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension [published online December 21, 2018]. Eur Respir J. doi:10.1183/13993003.00332-2018
  2. Ehlken N, Lichtblau M, Klose H, et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur Heart J. 2016;37:35-44.
  3. Grünig E, Ehlken N, Ghofrani A, et al. Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration. 2011;81:394-401.
  4. 4 Grünig E, Lichtblau M, Ehlken N, et al. Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J. 2012;40:84-92.

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